As pediatric hospitalists, we often ask ourselves “What can I do to ensure a safe discharge plan for my patient?” A part of that includes challenging ourselves to think about the social factors that may impact a child’s health when they leave the hospital and attempt to mitigate any external factors. Many hospitals have integrated screening tools within their electronic health systems to address issues such as financial instability, housing, and food insecurity. Often, these screening tools do not capture all patients, nor provide personalized resources, and rarely do they help providers fully understand how patients and their families are impacted. In the article entitled “Caregivers’ View of a Pediatric Inpatient Intervention to Address Health-Related Social Risks (HRSRs),” Abramsohn et al. address food insecurity and other HRSRs in hospitalized patients using a universal, rather than “screening-based,” approach and share the perspectives of caregivers on this tool (10.1542/hpeds.2024-008025).
The authors aim to evaluate the psychosocial impact of CommunityRx-Hunger, a universal evidence-based technology-driven social care intervention, on caregivers and hospitalized patients with food insecurity. This year-long, double-blinded randomized control trial was conducted at an urban academic medical center. Food security status was assessed upon enrollment for sufficient randomization, and CommunityRx-Hunger was universally delivered to all participants in the intervention group, including those with and without food insecurity. Caregivers in the intervention group received education on HRSRs, personalized resources, and ongoing support/resource information via text messages over 3 months following hospital discharge. Qualitative interviews were later conducted with caregivers if they were (1) English-speaking, (2) randomized to the intervention arm, and (3) experiencing marginal food security or food insecurity in the past 12 months. Most caregivers interviewed identified as the child’s mother and many identified as African American or Black.
There were 3 major themes noted during the interviews conducted: (1) Caregivers reported overall positives experiences with the intervention, (2) Caregivers highlighted barriers to integration of social care with medical care, and (3) Caregivers provided recommendations on how providers could optimize social care delivery. Overall, caregivers expressed satisfaction with the resources provided and many felt empowered to also be a resource to others. However, caregivers shared a fear of judgement by medical providers and the potential for negative outcomes associated with disclosing a need for resources (i.e., Child Protective Services [CPS] involvement) as a major barrier. Caregivers shared that use of compassionate language by providers, universal delivery of information/resources, and longitudinal support were all beneficial.
Not only does this article inform pediatric hospitalists on how we can provide resources for our patients, but it also educates us on how we can navigate these conversations. Using compassionate and normalizing language and providing reassurance to families can reduce the stigma associated with having to disclose these health-related social risks. In addition, providing families with education on HRSRs, personalized resources, and ongoing follow-up can lead to overall positive experiences. By taking these steps, we can truly create an environment where families feel comfortable, and where we can capture more hospitalized patients with HRSRs prior to discharge.
