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Research ArticleOriginal Research

Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric Patients

Elena Byhoff, Arvin Garg, Michelle Pellicer, Yareliz Diaz, Grace H. Yoon, Martin P. Charns and Mari-Lynn Drainoni
The Journal of the American Board of Family Medicine May 2019, 32 (3) 297-306; DOI: https://doi.org/10.3122/jabfm.2019.03.180276
Elena Byhoff
the Department of Medicine, Tufts Medical Center; Institute for Clinical Research and Health Policy Studies, Tufts CTSI, Boston, MA (EB); Department of Medicine, Tufts University School of Medicine, Boston (EB); Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston (AG, MP); Department of Health Law Policy & Management, Boston University School of Public Health, Boston (YD, GHY, MPC, M-LD); VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, MA (MPC); Section of Infectious Diseases, Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston (M-LD).
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Arvin Garg
the Department of Medicine, Tufts Medical Center; Institute for Clinical Research and Health Policy Studies, Tufts CTSI, Boston, MA (EB); Department of Medicine, Tufts University School of Medicine, Boston (EB); Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston (AG, MP); Department of Health Law Policy & Management, Boston University School of Public Health, Boston (YD, GHY, MPC, M-LD); VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, MA (MPC); Section of Infectious Diseases, Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston (M-LD).
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Michelle Pellicer
the Department of Medicine, Tufts Medical Center; Institute for Clinical Research and Health Policy Studies, Tufts CTSI, Boston, MA (EB); Department of Medicine, Tufts University School of Medicine, Boston (EB); Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston (AG, MP); Department of Health Law Policy & Management, Boston University School of Public Health, Boston (YD, GHY, MPC, M-LD); VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, MA (MPC); Section of Infectious Diseases, Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston (M-LD).
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Yareliz Diaz
the Department of Medicine, Tufts Medical Center; Institute for Clinical Research and Health Policy Studies, Tufts CTSI, Boston, MA (EB); Department of Medicine, Tufts University School of Medicine, Boston (EB); Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston (AG, MP); Department of Health Law Policy & Management, Boston University School of Public Health, Boston (YD, GHY, MPC, M-LD); VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, MA (MPC); Section of Infectious Diseases, Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston (M-LD).
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Grace H. Yoon
the Department of Medicine, Tufts Medical Center; Institute for Clinical Research and Health Policy Studies, Tufts CTSI, Boston, MA (EB); Department of Medicine, Tufts University School of Medicine, Boston (EB); Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston (AG, MP); Department of Health Law Policy & Management, Boston University School of Public Health, Boston (YD, GHY, MPC, M-LD); VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, MA (MPC); Section of Infectious Diseases, Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston (M-LD).
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Martin P. Charns
the Department of Medicine, Tufts Medical Center; Institute for Clinical Research and Health Policy Studies, Tufts CTSI, Boston, MA (EB); Department of Medicine, Tufts University School of Medicine, Boston (EB); Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston (AG, MP); Department of Health Law Policy & Management, Boston University School of Public Health, Boston (YD, GHY, MPC, M-LD); VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, MA (MPC); Section of Infectious Diseases, Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston (M-LD).
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Mari-Lynn Drainoni
the Department of Medicine, Tufts Medical Center; Institute for Clinical Research and Health Policy Studies, Tufts CTSI, Boston, MA (EB); Department of Medicine, Tufts University School of Medicine, Boston (EB); Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston (AG, MP); Department of Health Law Policy & Management, Boston University School of Public Health, Boston (YD, GHY, MPC, M-LD); VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, MA (MPC); Section of Infectious Diseases, Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston (M-LD).
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  • Article
  • Figures & Data
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Article Figures & Data

Figures

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    Figure 1.

    Number of domains screened for by each participating community health center (CHC) for pediatric visits compared with any visit.

  • Figure 2.
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    Figure 2.

    Number of community health centers (CHCs) screening for each social & behavioral domain by adult vs. pediatric visits.

Tables

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    Table 1.

    Demographics of Participant Community Health Centers

    All Participating Health Centers, Mean (Range)3 Implementation Sites, Mean (Range)
    Total annual patient visits23,271 (9,553–70,603)17,726 (12,410–21,518)
    % of patients <1825% (16–32)30% (27–32)
    Patients of racial and/or ethnic minority75% (21–98)91% (87–95)
    Patients at or below 200% of FPL85% (47–100)96% (93–100)
    Uninsured18% (6–31)13% (11–17)
    Medicaid/CHIP 249% (35–61)51% (42–56)
    Dually eligible (Medicare and Medicaid)3% (2–7)2% (2–3)
    Medical visits81% (51–98)83 (82–85)
    Dental visits26% (5–45)21 (17–25)
    Mental health visits7% (2–11)6 (2–10)
    • Data taken from publicly available Health Resources and Services Administration uniform data system or reported by individual health center for 11 of 13 participating health centers—2 health centers were hospital affiliated and did not release patient or visit level demographic data.

    • CHIP, Children's Health Insurance Program; FPL, Federal Poverty Level.

    • View popup
    Table 2.

    Empirically identified SDOH Domains from Health Center Screening Documents

    SDOH Domains*Dimensions
    CultureReligion/spiritual beliefs
    Family culture
    DemographicsGender/sexual orientation
    Place of birth
    Race/ethnicity
    Refugee status
    Justice involvement
    Economic indicatorsIncome
    Assets
    Assistance programs
    Indebtedness
    EducationEducational attainment
    Basic literacy
    Health literacy
    Numeracy
    EmploymentUnemployed
    Migrant/seasonal
    Day laborers
    Disability status
    Retirement status
    Student
    Job assistance
    FamilyMarital status
    Dependents
    Living arrangements
    Functional statusADLs
    IADLs
    Frailty
    Health behaviorsAlcohol
    Drug use
    Tobacco
    Secondhand smoking
    Physical activity
    Sexual activity
    Safety
    Diet
    Healthcare accessInsurance status
    Healthcare affordability
    Source of usual care
    HousingHomelessness
    Housing safety
    Housing quality
    Housing insecurity
    LanguagePrimary language
    English proficiency
    Interpreter/translator needed
    Other language proficiency
    Material hardshipFood insecurity
    Utilities
    Transportation
    Medication affordability
    Access to technology
    Child care
    Clothing
    Legal services
    Mental healthDepression
    Anxiety
    PTSD
    ADD/ADHD
    Suicide/Self-harm
    Stress
    Sleep
    Social supportCommunity activities
    Safe environment
    Public spaces
    Racism
    Discrimination
    Trust
    School culture
    Social isolation
    Trauma/violenceIPV
    Trauma
    Physical abuse
    Sexual abuse
    Mental abuse
    Veteran statusMilitary trauma history
    Combat veteran
    Active military
    • ADD/ADHD, Attention deficit disorder/hyperactivity disorder; ADL, activity of daily living; IADL, independent activities of daily living; IPV, interpersonal violence; PTSD, Post-traumatic stress disorder; SDOH, Social and Behavioral Determinants of Health.

    • ↵* All core domains had a “General” subdomain code if screening questions did not pertain to one of the listed subdomains on the right column.

    • Sixteen domains.

    • Seventy-eight dimensions.

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The Journal of the American Board of Family     Medicine: 32 (3)
The Journal of the American Board of Family Medicine
Vol. 32, Issue 3
May-June 2019
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Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric Patients
Elena Byhoff, Arvin Garg, Michelle Pellicer, Yareliz Diaz, Grace H. Yoon, Martin P. Charns, Mari-Lynn Drainoni
The Journal of the American Board of Family Medicine May 2019, 32 (3) 297-306; DOI: 10.3122/jabfm.2019.03.180276

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Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric Patients
Elena Byhoff, Arvin Garg, Michelle Pellicer, Yareliz Diaz, Grace H. Yoon, Martin P. Charns, Mari-Lynn Drainoni
The Journal of the American Board of Family Medicine May 2019, 32 (3) 297-306; DOI: 10.3122/jabfm.2019.03.180276
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  • Boston
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