Postdoctoral Fellow Dartmouth Hitchcock Medical Center Lebanon, New Hampshire, United States
Background: Families living in rural areas may be disproportionately affected by social determinants of health (SDOH), including financial instability, food and housing insecurity, and unreliable transportation and childcare. SDOHs often function as a proxy for a host of early adverse experiences (ACEs) that put children at risk for poor physical and mental health outcomes. Universal screening in pediatric primary care can inform providers and improve referrals and access to patient-desired resources to meet needs. Objective: 1) To implement an electronic medical record (EMR) based comprehensive screening tool for 0-5 year old well-child checks (WCCs) in a medium-sized, rural academic medical center; 2) to characterize demographics, SDOHs, ACEs, parental concerns, and child characteristics within the pediatric sample served; 3) to assess changes in referrals for family resource centers, early intervention, and social services over the early implementation period; and 4) to explore links between identified SDOHs/ACEs, parent mental health, parenting practices, and markers of children’s adjustment. Design/Methods: A recently developed Child Wellbeing Survey (CWBS) was implemented in June 2023 to improve clinical care for all WCCs for children ages 0-5 in a pediatric primary care clinic. The academic medical center’s IRB approved study design and procedures. The CWBS combines validated pediatric screening instruments at selected ages (including the Survey of Well-Being of Young Children, the Modified Checklist for Autism in Toddlers, and the Pediatric Symptom Checklist), caregiver mental health screening (the Edinburgh Postnatal Depression Scale and PHQ-2), and other social screening measures (SDOHs, ACEs, Outings and Activities). The survey was built in the EMR to facilitate completion at home or in clinic. Monthly data reviews have been conducted for quality improvement. To date, parents have completed screenings for some 80% of eligible visits (~300 screens/month). We will collate screening data through March 2024 to enable more robust and representative analyses for presentation.
