436 - Differences in patient experience and preferences for social needs screening by guardian type in a primary care clinic

Poster Number: 436
Publication Number: 436.392

Background: Screening and intervening for social drivers of health has become the mainstay for many pediatric practices. Children in foster care have unique social needs but little is known about foster family experiences and preferences for social needs screening.

Objective: To determine if patient experience and preferences for social needs screening in a primary care clinic vary by guardian type

Design/Methods: We investigated the experience and preferences for social needs screening of families engaged in a medical home for social complexity via surveys and focus groups. Participants were recruited based on convenience sampling and outreach calls to a random sample of patients. Focus groups and surveys were anonymous and guardians were compensated with gift cards. We tested differences in preferences by using Pearson’s Chi-squared test. Thematic analysis was applied to the qualitative data to identify themes and patterns from the guardians’ responses.

Results: Of 101 families surveyed, 63 were biological parents, 34 were foster parents (21 kinship; 13 non-relative). Six focus groups of foster, biological, and Spanish-speaking parents were conducted to further explore preferences (24 parents; 12 biological and 12 foster). In their experience of social needs screening, biological and foster parents differed slightly but did not achieve statistical significance (Table 1). A sub-analysis of kinship vs non-relative guardian (Table 2) revealed that kinship parents were significantly more likely to agree that they wanted to be asked about stressors (50% vs 15%, p = 0.07) and desired help with stressors (62% vs 23%, p = 0.03). The most prevalent focus group themes (Table 3) were the importance of trust and relationship when discussing social needs. Parents feared judgement around screening and foster parents valued privacy due to fears about child welfare reporting. Both concerns were mitigated by trust and relationships with the screening clinician. Foster families described stress navigating the child welfare system.

Conclusion(s): Foster parents have similar preferences for social needs screening as biological parents. Kinship foster parents had a stronger preference for addressing social needs than non-relative foster parents. A trusting clinical relationship mitigated fears of judgement and hesitancy to discuss social needs among all parents. Social needs screening for foster families within a trusting therapeutic relationship may offset hardships faced by families engaged in the child welfare system.