Health Related Social Problems in Emergency Department Patients: Can the Highest Risk Patients by Identified and Social Navigation Provided?

Significant advances have been made in pediatrics in the United States in the last 60 years. Mortality from infectious disease and cancer, for instance, has declined significantly. The more stubborn issues in pediatrics include poor asthma control, obesity, suicide and adolescent homicide. To address these, our profession must begin to systematically address social determinants of health. Scourges such as poverty, unemployment, and domestic violence are known contributors to pediatric morbidity, adverse childhood experiences, and poor adult health and achievement. - The emergency department (ED) may be a strategic venue in which to identify patients at high risk for multiple social issues. We suspect that certain ED patient characteristics may be indicative of those families at highest risk and that comprehensive screening for social determinants of health may be the means by which they can be identified and targeted for intervention.

Social issues in EDs are often addressed individually instead of comprehensively, if done at all. There have been no studies of comprehensive screening for social determinants of health in large, urban, full service pediatric EDs. In addition, no study has attempted to identify those groups of ED patients at highest risk for a large number of social risk factors who might benefit most from rapid interventions. The immediate objective of this proposal is to identify groups of patients at high risk for a large number of social risk factors in a patient-centric manner in a busy pediatric ED, using a single computerized instrument to administer a comprehensive screen and to provide social navigation services to adolescent patients. We will sequentially approach caregivers of patients 0-17 years of age and patients 13-21 years of age to complete surveys regarding social risk factors. The outcomes of interest are 1) the total social risk score and 2) ED recidivism, total social risk score and community resource use in adolescent patients who receive social navigation services vs. enhanced usual care.

We hypothesize that patients with the following ED characteristics will have a higher social risk score than other ED patients: patients with any of nine "high risk" chief complaints (alleged physical abuse , alleged sexual abuse , peer assault , mammalian bites, adolescent reproductive and sexual health issues, intoxication/substance abuse , ingestion/poisoning , psychiatric/behavioral complaints , any complaint with the lowest estimated severity index ); a body mass index in the obese range; frequent non-urgent visits to the ED; or poor asthma control. Further, we hypothesize that adolescents who receive social navigation services will have lower ED recidivism, a lower total social risk score and increased community resource use at 12-month follow up than adolescents who receive enhanced usual care.

SPECIFIC AIM #1: To characterize the cumulative social risk score for patients and families in a large, urban pediatric ED Hypothesis #1: Caregivers of pediatric ED patients and adolescent ED patients will report an increased number of social risks than patients in primary care settings have reported in prior studies.

SPECIFIC AIM #2: To compare the cumulative social risk score in pediatric ED patients with a subset of 9 (nine) high-risk chief complaints, frequent non-urgent visits, obesity, or poor asthma control to the cumulative burden of social risk factors in the general pediatric ED population Hypothesis #2: Patients who present to the ED with any of a subset of nine high-risk chief complaints, frequent non-urgent visits, obesity or poor asthma control will have a higher social risk score than the general pediatric ED population.