Variations in screening tools for social determinants of health

1. In this systematic review, researchers found that multiple different tools were used to screen for social determinants of health (SDOH) in children, though all were unified in that they screened for features of the family context, such as violence in the home and abuse or neglect.

2. Despite the unifying feature of screening for family context, screening tools were quite variable in their follow up procedures, with some practices offering community resources or referrals based on the screening tool results, while others had no formal follow up procedures in place.

Evidence Rating Level: 2 (Good)  

Study Rundown: Despite overwhelming evidence that SDOH have a significant impact on long term health outcomes, little research has been done regarding how to best screen patients for various SDOH in a standardized and effective fashion. In this systematic review, researchers reviewed various publications on screening tools for SDOH and compared their methodology, content, and follow up procedures. Researchers noted that despite a variety of different areas surveyed in the various screening tools analyzed in the study, all were unified by somehow assessing for the home context, such as screening for child neglect or violence in the home. In contrast, there was quite a range of follow up procedures after the screening tool was completed, with some practices offering community resources or referrals in response to survey data, while others had no formal follow up plan in place. The authors themselves note their study is limited by the small sample size of only 11 unique screening tools assessed in their review. Additionally, authors of the accompanying commentary note that the study results highlight the need to move beyond the simple implementation of screening tools, due to pressure from legislation or policy changes, without thinking about their impact or the resources necessary to address resulting concerns. Overall, these findings demonstrate that much work is still required to create a standardized, validated screening tool for SDOH that effectively addresses the needs of those being screened.

Click here to read the original article, published today in Pediatrics

Click here to read the accompanying commentary in Pediatrics

Relevant Reading: Poverty Grown Up: How Childhood Socioeconomic Status Impacts Adult Health

In-Depth [systematic review]: In this systematic review, authors initially searched a number of databases—including PubMed, Cumulative Index to Nursing and Allied Health Literature via EBSCO, Embase via Elsevier, Cochrane Central Register of Controlled Trials, and Web of Science Core Collection— and screened for articles from the inception of each database through November 2018. Researchers used the Healthy People 2020 definition of SDOH to guide their literature search. After their initial search, 6274 articles related to SDOH were found, though the majority were deemed irrelevant based on their definition of SDOH as noted above. Ultimately, 17 references were retained for review. The screening tools all had some component of assessing for the child’s home context, such as by asking about violence in the home or child neglect. Much variability was seen in the follow up procedures for each screen, with 4 studies reporting no structured follow up, 6 studies reporting follow up was offered or scheduled but never actually delivered, 3 studies scheduling or offering follow up referrals without discussing screening results with caregivers, and only 3 studies establishing follow up or scheduling referrals as well as discussing screening tool results with caregivers.

Image: PD

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