Screening for Both Child Behavior and Social Determinants of Health in Pediatric Primary Care.
Evelyn Berger-Jenkins, Catherine Monk, Katherine DʼOnfro and 6 others
PMID 31318781WHAT IT FOUND
Screening in 349 families found 28% had behavior problems and 25% reported social stressors.
Of families referred for behavior problems, 80% completed doctor follow-up, but documentation goals were rarely met.
Key findings
01Screen administration reached the 50% goal in 8 of 18 months, but documentation reached the 75% goal in only 3 of 18 months.
02In the 349-family sample, 28% screened positive for behavior problems and 25% reported at least one social stressor; of families referred for behavior problems, 80% completed doctor follow-up.
03Parental concern about child behavior was independently associated with child behavior symptoms and with social stressors after adjustment.
STILL TO COME
How it was doneWhat they found
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What it does not show
The project was done at one pediatric clinic, so it may not apply to other settings. Referral and follow-up data came from a convenience sample of 349 families screened during the first 4 months, not all families screened over 18 months. There was no comparison group, so the study cannot show that screening caused the follow-up rates or improved child outcomes. Follow-up visits were recorded, but what happened at those visits and whether children improved was not measured. Incomplete screens were excluded from scoring, and the effect of missing items on risk assessment, referrals, or management was not assessed. Initial screening may have been biased because children with complex medical conditions were sometimes thought to be ineligible. Families who spoke languages other than English or Spanish were excluded, and infants younger than 6 months and adolescents aged 11 years or older were not screened in this project.
Declared interests
The article states that conflicts of interest are none. It does not report a funding source.
The easy way to misread this
Do not read this as evidence that universal psycho-social screening improves child behavior or social stressors. It was a single-clinic quality-improvement project with no comparison group, and it did not measure what happened after follow-up visits.