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Use of a Video Scoring Anchor for Rapid Serial Assessment of Social Communication in Toddlers

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High-Resolution Area-Level Measures as Predictors of Pediatric Individual-Level Social Risks.

Logan Beyer¹, Jarvis T Chen², Yang Lu³

¹Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, 677 Huntington Avenue, Boston, Massachusetts 02115, USA; Harvard Medical School, 25 Shattuck Street Boston, Boston, Massachusetts 02115, USA.

Academic Pediatrics

|July 9, 2026

Summary

High-resolution area-level measures failed to reliably identify pediatric patients with social risks in a safety-net setting. Direct, universal screening remains essential for effective preventive care and referrals.

Keywords:

Area Deprivation Index Child Opportunity Index Social determinants of health neighborhood deprivation social risk screening

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Area of Science:

Public Health
Pediatric Healthcare
Social Determinants of Health

Background:

Efficient social risk screening is crucial for preventive care and referrals in pediatric settings.
Area-level measures are increasingly explored to streamline screening and reduce clinic burden.

Purpose of the Study:

To evaluate the effectiveness of high-resolution area-level measures in identifying pediatric patients with social risks.
To assess if these measures could reduce the burden of traditional clinic-based social risk screening.

Main Methods:

Analysis of electronic health records for 5,237 pediatric patients in a safety-net hospital system (2020-2022).
Evaluation of Area Deprivation Index, Child Opportunity Index, and Bayesian social risk aggregation as predictors.
Receiver operating characteristic curve analysis to determine optimal cutoffs for primary screening and prescreening.

Main Results:

Area-level measures demonstrated limited predictive value, with low positive predictive values (0.23-0.28) as primary screeners.
As prescreens, these measures did not significantly reduce the need for direct family screening (reduction <10%).
Predictive performance was notably poorer for Hispanic and Brazilian children, and for those receiving care in Spanish or Portuguese.

Conclusions:

High-resolution area-level measures were unreliable for identifying social risks in this pediatric safety-net population.
Direct, universal social risk screening remains indispensable in pediatric care despite the potential of area-level data in other contexts.
Area-level measures, while valuable for public health equity, do not replace individualized screening for clinical referrals.