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Thoughts on Screening for the Social Determinants of Health :

August 22, 2018

Let me say it right now: Given the struggle that I have to complete everything that Bright Futures has laid out for us to do in the typical 15-minute visit, the announcement that our practice would be adding yet another screening test, this time for social determinants of health, was not particularly welcome news to me.

Let me say it right now: Given the struggle that I have to complete everything that Bright Futures has laid out for us to do in the typical 15-minute visit, the announcement that our practice would be adding yet another screening test, this time for social determinants of health, was not particularly welcome news to me.

So many public health problems have become part of the agenda of a primary care visit that, at times, the practice of general pediatrics seems akin to trying to achieve peace during a war by counseling the soldiers individually. Too much to do in too little time, and I often feel far downstream from the causes of what I am dealing with or trying to prevent. This felt no different.

Beyond this, being measurably effective at mitigating the effects of childhood poverty on a population level with efforts that originate in our pediatric offices will be very difficult, and we should be concerned with effectiveness. I then thought, even if we could magically succeed at connecting every family in need to a community service organization that can offer help (housing, food, legal help, immigration, domestic violence), I doubt these organizations have enough collective wealth and resources to substantially fix the childhood poverty problem.

So, why am I excited to be screening for social determinants of health in our practice?

Part of my enthusiasm is that, for once it seems, I don’t have to do the work! In a completely refreshing change, we actually have the right person, a community health worker, handling this initiative. She connects families that have screened positive to community-based organizations that are local to them. Bright Futures advocates a team-based approach to address its ambitious agenda, and thanks to a New York state initiative, we actually have that in place.

More importantly, while I bet it will prove difficult to show this effort is effective on a population level, making the connection between families and community-based service organizations will undoubtedly help many individual patients. I just recently saw this happen with the family of a patient of mine who, with the assistance of pro bono legal service, was able to prevent illegal eviction attempts that, had they succeeded, would have made his family of 6 homeless.

Moreover, the stories that will emerge about our patients’ hardships will personalize the pernicious effects of poverty on children for pediatricians like me who have not systematically “gone there” in the past.

If screening for social determinants of health catches on broadly and begins to illuminate the scope and frequency of poverty related hardships for the children who we know, it undoubtedly will help fuel the visionary movement to make childhood poverty a priority for Pediatricians nationally.

Why? Because detailed stories of childhood social injustice are hard for pediatricians to ignore.

Interested in how to do this? Check outthe resource-rich and very grounded article about this topic in the May issue of PIR.

Suggested Reading

Racine AD. Child poverty and the health care system. Acad Pediatr. 2016;16(3 Suppl):S83-9

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