A Social Care Intervention in Pediatric Practices: A Stepped Wedge Cluster Trial.

Abstract

To assess the impact of a social care intervention on parents' discussion, receipt of referrals, and enrollment in resources for social needs. We conducted a Type 2 hybrid effectiveness-implementation stepped wedge cluster trial in 18 pediatric practices across 14 states that were part of the American Academy of Pediatrics' Pediatric Research in Office Settings and Academic Pediatric Association Continuity Research Network. Three clusters of 6 practices (8 urban, 6 suburban, 4 rural) participated in Usual Care, Core Training, Pilot, and WE CARE (Well-Child Care Evaluation, Community Resources, Advocacy, Referral, Education) phases. The WE CARE intervention included the following: (1) a screener for 6 social needs and (2) clinician access to practice-generated Family Resource Books with referral handouts. Parents of children 2 months to 10 years were enrolled either during Usual Care or WE CARE phases at their well-child visit and followed up 3 months later. Data were analyzed using generalized estimating equation models. In total, 1882 parents were enrolled (WE CARE n = 842, Usual Care n = 1040), and 64% completed follow-up. Overall, 60% of children were publicly insured. Compared with Usual Care parents, significantly more WE CARE parents reported discussing social needs with their child's clinician (91% vs 79%; AOR, 3.6; 95% CI, 2.6-4.8) and receiving 1 or more referral (20% vs 12%; AOR, 1.7; 95% CI, 1.3-2.2). At 3-month follow-up, there were no self-reported differences with enrollment in new community resources between WE CARE and Usual Care parents (23% vs 22%; P = .63). Systematically screening and referring for social needs was associated with higher rates of social needs assessments and referrals but not enrollment differences.