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Clinical Stakeholder Perspectives on Pediatric Inpatient Screening for Social Needs
Jana C Leary1, Leena Rijhwani2, Natalie M Bettez3
1Department of Pediatrics (JC Leary), Tufts Children's Hospital, Tufts University School of Medicine, Boston, Mass.
Insights
Clinical stakeholders identified barriers and facilitators for screening social needs in hospitalized children. This research informs strategies for effective implementation of social needs screening in pediatric care.
Area of Science:
- Healthcare delivery research
- Implementation science
- Pediatric health services research
Background:
- Social determinants of health significantly impact patient outcomes and quality of life.
- Integrating social needs screening into primary care is established, but hospital workflow integration remains a challenge.
- Effective screening requires understanding clinical stakeholder perspectives for successful implementation.
Purpose of the Study:
- To gather insights from pediatric clinical stakeholders on screening for social needs during hospitalizations.
- To identify potential barriers, facilitators, and process preferences for inpatient social needs screening.
- To inform the development of feasible and sustainable implementation strategies for pediatric social needs screening.
Main Methods:
- Conducted 23 semistructured interviews with physicians, nurses, social workers, and case managers.
- Interviews focused on current practices, perceived benefits, challenges, and optimal screening/referral processes.
- Thematic analysis was used to analyze transcribed interview data.
Main Results:
- Key themes included benefits (identifying vulnerable patients, understanding social context), barriers (prioritizing medical needs, lack of education), and facilitators (multidisciplinary teams, time with families).
- Stakeholders preferred verbal screening integrated into existing systems.
- Preferred referral processes involved empowering families with resources and seamless outpatient transitions.
Conclusions:
- Clinical stakeholders provided valuable perspectives on pediatric inpatient social needs screening.
- Understanding these perspectives is crucial for developing effective implementation strategies.
- This study highlights the need for tailored approaches to integrate social needs screening into hospital workflows.
Objectives:
Social determinants of health are major drivers of health outcomes and quality of life. While several social needs screening tools have been created for use in primary care settings, the best procedures to incorporate these tools into hospital workflow remain unclear. This study aimed to elicit clinical stakeholder perspectives on proposed screening for social needs during pediatric hospitalizations, with particular focus on informing implementation strategies.
Methods:
We conducted 23 semistructured interviews with pediatric clinical stakeholders (physicians, nurses, social workers, and case managers) at 1 tertiary and 2 community hospitals between July 2020 and January 2021, on topics including social needs screening practices, benefits and challenges to inpatient screening, and optimal screening and referral processes within hospital workflow. Interviews were recorded, professionally transcribed, and analyzed thematically.
Results:
Participants ranged in age from 25 to 62 years, with nearly half working in community hospitals. Regarding inpatient social needs screening, themes emerged about benefits, including enabling clinicians to identify vulnerable patients/moments, and providing clinicians with comprehensive understanding of social context; barriers, including prioritization of medical needs, lack of clinician education surrounding screening, and lack of pre-established relationships; facilitators, including duration of time spent with families, and multidisciplinary clinicians; screening process preferences, including verbal screening, and integration into pre-existing systems; and referral process preferences, including resource provision with family empowerment, and care transition to outpatient clinicians.
Conclusions:
Clinical stakeholders identified multiple barriers, facilitators, and process preferences for pediatric inpatient social needs screening, which may inform the future development of feasible and sustainable implementation strategies.
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