Although the link between social determinants and health outcomes is well established, the social history remains poorly integrated into clinical care processes. This study’s purpose was to determine social risk documentation rates among newborns using a new electronic template. A retrospective review of 639 well-infant visits was performed. The authors determined documentation rates for a standardized social history embedded in the clinic electronic health record. Social history completion rates and prevalence of risks were identified. More than 80% of clinicians documented asking at least 1 of 7 questions (mean = 4.5, SD = 2.9). The most commonly asked question was about “making ends meet,” and the least common was about personal safety (79% vs 57%, P < .01). Nearly 30% of caregivers reported at least 1 risk, 11% at least 2 risks. An electronic health record–embedded social history led to documented screening in more than 80% of visits, identifying 30% as having at least 1 social risk.
GargAButzAMDworkinPHLewisRASerwintJR. Screening for basic social needs at a medical home for low-income children. Clin Pediatr (Phila). 2009;48: 32-36.
2.
FleeglerEWLieuTAWisePHMuret-WagstaffS. Families’ health-related social problems and missed referral opportunities. Pediatrics. 2007;119:e1332-e1341.
3.
ZuckermanBSandelMSmithLLawtonE. Why pediatricians need lawyers to keep children healthy. Pediatrics. 2004;114:224-228.
4.
MalatJOhHJHamiltonMA. Poverty experience, race, and child health. Public Health Rep. 2005;120:442-447.
5.
WoodD. Effect of child and family poverty on child health in the United States. Pediatrics. 2003;112(3, pt 2):707-711.
6.
ZuckermanBSandelMLawtonEMortonS. Medical-legal partnerships: transforming health care. Lancet. 2008;372:1615-1617.
7.
SilversteinMConroyKSandelM. Screening for social determinants of health in pediatric primary care. Pediatr Ann. 2008;37:740-746.
8.
CookJTFrankDA. Food security, poverty, and human development in the United States. Ann N Y Acad Sci. 2008;1136:193-209.
9.
LarsonKRussSACrallJJHalfonN. Influence of multiple social risks on children’s health. Pediatrics. 2008;121:337-344.
10.
PhongsavanPCheyTBaumanABrooksRSiloveD.Social capital, socio-economic status and psychological distress among Australian adults. Soc Sci Med. 2006;63:2546-2561.
11.
FrankDACaseyPHBlackMM. Cumulative hardship and wellness of low-income, young children: multisite surveillance study. Pediatrics. 2010;125:e1115-e1123.
12.
SpencerN. Social, economic, and political determinants of child health. Pediatrics. 2003;112(3 pt 2):704-706.
13.
KenyonCSandelMSilversteinMShakirAZuckermanB. Revisiting the social history for child health. Pediatrics. 2007;120:e734-e738.
14.
SatcherDKaczorowskiJTopaD. The expanding role of the pediatrician in improving child health in the 21st century. Pediatrics. 2005;115(4 suppl):1124-1128.
15.
ZuckermanBLawtonEMortonS. From principle to practice: moving from human rights to legal rights to ensure child health. Arch Dis Child. 2007;92:100-101.
16.
WilliamsDRCostaMVOdunlamiAOMohammedSA. Moving upstream: how interventions that address the social determinants of health can improve health and reduce disparities. J Public Health Manag Pract. 2008;14(suppl):S8-S17.
17.
FiscellaKEpsteinRM. So much to do, so little time: care for the socially disadvantaged and the 15-minute visit. Arch Intern Med. 2008;168:1843-1852.
18.
GargAButzAMDworkinPHLewisRAThompsonRESerwintJR. Improving the management of family psychosocial problems at low-income children’s well-child care visits: the WE CARE Project. Pediatrics. 2007;120:547-558.
19.
SandelMHansenMKahnR. Medical-legal partnerships: transforming primary care by addressing the legal needs of vulnerable populations. Health Aff (Millwood). 2010;29:1697-1705.
20.
BergmanDABeckARahmAK. The use of internet-based technology to tailor well-child care encounters. Pediatrics. 2009;124:e37-e43.
21.
CoJPJohnsonSAPoonEG. Electronic health record decision support and quality of care for children with ADHD. Pediatrics. 2010;126:239-246.
22.
SamaanZMKleinMDMansourMEDeWittTG. The impact of the electronic health record on an academic pediatric primary care center. J Ambul Care Manage. 2009;32:180-187.
23.
DanzigerSCorcoranMDanzigerSHeflinCM. Work, income, and material hardship after welfare reform. J Consumer Aff. 2000;34:6-30.
24.
MayerSEJencksC. Poverty and the distribution of material hardship. J Hum Resour. 1989;24:88-114.
25.
OuelletteTBursteinNLongDBeecroftE. Measures of Material Hardship: Final Report. Washington, DC: US Department of Health and Human Services; 2004.
26.
FeldhausKMKoziol-McLainJAmsburyHLNortonIMLowensteinSRAbbottJT. Accuracy of 3 brief screening questions for detecting partner violence in the emergency department. JAMA. 1997;277:1357-1361.
27.
SpitzerRLWilliamsJBKroenkeK. Utility of a new procedure for diagnosing mental disorders in primary care: the PRIME-MD 1000 study. JAMA. Dec141994;272:1749-1756.
28.
WhooleyMAAvinsALMirandaJBrownerWS. Case-finding instruments for depression: two questions are as good as many. J Gen Intern Med. 1997;12: 439-445.
29.
SuggNKInuiT. Primary care physicians’ response to domestic violence. Opening Pandora’s box. JAMA. 1992; 267:3157-3160.
30.
HingEHsiaoCJ. Electronic medical record use by office-based physicians and their practices: United States, 2007. Natl Health Stat Report. 2010;(23):1-11.
31.
CarrollAEBiondichPGAnandV. Targeted screening for pediatric conditions with the CHICA system. J Am Med Inform Assoc. 2011;18:485-490.
32.
BourgeoisFCMandlKDShawDFlemmingDNigrinDJ. My children’s: integration of a personally controlled health record with a tethered patient portal for a pediatric and adolescent population. AMIA Annu Symp Proc. 2009;2009:65-69.
