Statewide Variation in Social Needs Screening and Referral Practices Across Pediatric Primary Care Practices in...

There has been an increased focus on addressing health-related social needs (HRSN), with recent regulatory bodies requiring screening in adult populations. Though not yet included in the new requirements, pediatric primary care has been at the forefront. Assessing statewide practices is important to understand if HRSN screening and resource provision occur equitably for patients and families.

To characterize HRSN screening and referral processes amongst a representative sample of pediatric primary care practices in Maryland.

In this cross-sectional study (June-August 2023), Maryland pediatric primary care practices were sampled proportionally by county pediatric population density and surveyed regarding practice characteristics, HRSN screening, and referral mechanisms. Results were summarized descriptively.

Surveys were completed by 54 practices from 22 of the 24 Maryland counties approximately proportional to pediatric population density in each county. Of the 85% of practices reporting screening for at least one HRSN, all screen during well child visits. Screening processes varied across clinics, with most occurring in the exam room (52%), verbally (57%), and by a physician or nurse practitioner (54%). Most practices document HRSN in the electronic medical record (84%). Clinics have various cascading interventions including referrals to community resources, social workers, and community health workers.

In a geographically representative sample of pediatric primary care practices in Maryland, most screen for at least one HRSN though variability exists in the method and timing of screening and subsequent referral processes. Our findings underscore the need for practice-level support to ensure HRSN are optimally and equitably addressed.