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Brief ReportBrief Report

Families’ Perspectives on Social Services Navigation After Pediatric Urgent Care

Alison Aronstam, Denisse Velazquez, Holly Wing, Danielle Hessler, Victoria F. Keeton, Karen Sokal-Gutierrez and Laura M. Gottlieb
The Journal of the American Board of Family Medicine May 2024, 37 (3) 479-486; DOI: https://doi.org/10.3122/jabfm.2023.230232R2
Alison Aronstam
From the Department of Medicine, University of California, San Francisco (AA), Department of Neurology, University of California, Los Angeles (DEV), Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (HW), Department of Family and Community Medicine, University of California, San Francisco (DH), Betty Irene Moore School of Nursing, University of California, Davis (VFK), School of Public Health, University of California, Berkeley (KSG); University of California, Berkeley–University of California, San Francisco, Joint Medical Program (KSG), Department of Family and Community Medicine and Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (LMG).
MD, MS
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Denisse Velazquez
From the Department of Medicine, University of California, San Francisco (AA), Department of Neurology, University of California, Los Angeles (DEV), Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (HW), Department of Family and Community Medicine, University of California, San Francisco (DH), Betty Irene Moore School of Nursing, University of California, Davis (VFK), School of Public Health, University of California, Berkeley (KSG); University of California, Berkeley–University of California, San Francisco, Joint Medical Program (KSG), Department of Family and Community Medicine and Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (LMG).
BA
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Holly Wing
From the Department of Medicine, University of California, San Francisco (AA), Department of Neurology, University of California, Los Angeles (DEV), Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (HW), Department of Family and Community Medicine, University of California, San Francisco (DH), Betty Irene Moore School of Nursing, University of California, Davis (VFK), School of Public Health, University of California, Berkeley (KSG); University of California, Berkeley–University of California, San Francisco, Joint Medical Program (KSG), Department of Family and Community Medicine and Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (LMG).
MA
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Danielle Hessler
From the Department of Medicine, University of California, San Francisco (AA), Department of Neurology, University of California, Los Angeles (DEV), Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (HW), Department of Family and Community Medicine, University of California, San Francisco (DH), Betty Irene Moore School of Nursing, University of California, Davis (VFK), School of Public Health, University of California, Berkeley (KSG); University of California, Berkeley–University of California, San Francisco, Joint Medical Program (KSG), Department of Family and Community Medicine and Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (LMG).
PhD
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Victoria F. Keeton
From the Department of Medicine, University of California, San Francisco (AA), Department of Neurology, University of California, Los Angeles (DEV), Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (HW), Department of Family and Community Medicine, University of California, San Francisco (DH), Betty Irene Moore School of Nursing, University of California, Davis (VFK), School of Public Health, University of California, Berkeley (KSG); University of California, Berkeley–University of California, San Francisco, Joint Medical Program (KSG), Department of Family and Community Medicine and Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (LMG).
PhD, RN, CPNP
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Karen Sokal-Gutierrez
From the Department of Medicine, University of California, San Francisco (AA), Department of Neurology, University of California, Los Angeles (DEV), Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (HW), Department of Family and Community Medicine, University of California, San Francisco (DH), Betty Irene Moore School of Nursing, University of California, Davis (VFK), School of Public Health, University of California, Berkeley (KSG); University of California, Berkeley–University of California, San Francisco, Joint Medical Program (KSG), Department of Family and Community Medicine and Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (LMG).
MD, MPH
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Laura M. Gottlieb
From the Department of Medicine, University of California, San Francisco (AA), Department of Neurology, University of California, Los Angeles (DEV), Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (HW), Department of Family and Community Medicine, University of California, San Francisco (DH), Betty Irene Moore School of Nursing, University of California, Davis (VFK), School of Public Health, University of California, Berkeley (KSG); University of California, Berkeley–University of California, San Francisco, Joint Medical Program (KSG), Department of Family and Community Medicine and Social Interventions Research and Evaluation Network, Center for Health and Community, University of California, San Francisco (LMG).
MD, MPH
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Article Figures & Data

Figures

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  • Figure 1.
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    Figure 1.

    Pathways to Health Impacts: Participants described 3 pathways through which the Health Advocates program positively affected caregiver and/or family members’ physical and mental health.

Tables

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    Table 1.

    Study Participants’ Characteristics

    Caregivers of pediatric patients (n = 27) n (%) or mean (range)
    Caregiver relationship to child
     Mother26 (96%)
     Grandmother1 (4%)
    Caregiver age
     18 to 242 (7%)
     25 to 348 (30%)
     35 to 4414 (52%)
     45 and older3 (11%)
    Household size4.2 (2 to 8)
    No. people in household younger than 172.2 (1 to 6)
    Household income (n = 22)
     0-$10,0007 (32%)
     $10,001-$20,0003 (14%)
     $20,001-$30,0006 (27%)
     $30,001-$40,0003 (14%)
     >$40,0003 (14%)
    Caregiver education
     Less than high school10 (37%)
     High school graduate or GED9 (33%)
     Some college or college graduate8 (30%)
    Caregiver primary language
     English13 (48%)
     Spanish14 (52%)
    Caregiver race/ethnicity
     Non-Hispanic White1 (4%)
     Hispanic20 (74%)
     Non-Hispanic Black5 (19%)
     Non-Hispanic Pacific Islander/Hawaiian1 (4%)
    Child has usual source of primary care24 (89%)
    • View popup
    Table 2.

    Social Risks Reported by Study Participants at Baseline

    Social Risk Domainn (%)
    Food insecurity10 (37%)
    Unstable housing6 (22%)
    Problems paying bills7 (26%)
    Housing problems like mold, insects, rats or mice8 (30%)
    Difficulty finding a job4 (15%)
    Disability interfering with the ability to work3 (11%)
    Having no primary care provider for your child or other household member4 (15%)
    Problems with current or former job3 (11%)
    Difficulty obtaining unemployment insurance2 (7%)
    Getting cut off from or denied from programs that provide income support5 (19%)
    Having no health insurance5 (19%)
    Receiving medial or pharmacy bills you cannot afford3 (11%)
    Difficulty finding afterschool activities or opportunities for recreation/education for you or your child11 (41%)
    Difficulty finding childcare6 (22%)
    Bullying3 (11%)
    Concerns about your or another adult's mental or behavioral health in your household2 (7%)
    Difficulty affording transportation6 (22%)
    Other legal issues11 (41%)
    • View popup
    Table 3.

    The Health Advocates Program’s Impact on Social Risks

    Individual-Level Barriers to Resource AccessHealth Advocates’ Role in Helping Caregivers Overcome Barriers to Resource Access
    Feeling uncomfortable asking for help and/or sharing information about social risks
    • Navigators establish trust with caregivers and assure the security of information gathered

    • Health Advocates is integrated into routine care so that all families are screened for risks and offered support

    Challenges accessing and lack of information about what resources are available, including information on eligibility requirements and the location of services
    • Providing detailed resource information

    • Providing support for non-English speaking caregivers

    • Supporting individuals with low literacy by providing information orally (not only in writing)

    Not knowing how and/or not having the time and energy to apply for resources
    • Helping caregivers research resources and contact service providers

    • Providing regular reminders about resource applications

    Not knowing how to troubleshoot when resource access stalls and further support is needed
    • Offering guidance and support throughout the process of accessing resources

    Having limited social capital in applying for services
    • Contacting service organizations or businesses on caregivers’ behalf and directly advocating for caregivers

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The Journal of the American Board of Family   Medicine: 37 (3)
The Journal of the American Board of Family Medicine
Vol. 37, Issue 3
May-June 2024
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Families’ Perspectives on Social Services Navigation After Pediatric Urgent Care
Alison Aronstam, Denisse Velazquez, Holly Wing, Danielle Hessler, Victoria F. Keeton, Karen Sokal-Gutierrez, Laura M. Gottlieb
The Journal of the American Board of Family Medicine May 2024, 37 (3) 479-486; DOI: 10.3122/jabfm.2023.230232R2

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Families’ Perspectives on Social Services Navigation After Pediatric Urgent Care
Alison Aronstam, Denisse Velazquez, Holly Wing, Danielle Hessler, Victoria F. Keeton, Karen Sokal-Gutierrez, Laura M. Gottlieb
The Journal of the American Board of Family Medicine May 2024, 37 (3) 479-486; DOI: 10.3122/jabfm.2023.230232R2
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Keywords

  • Caregivers
  • Delivery of Health Care
  • Family Health
  • Health Disparities
  • Patient Navigators
  • Pediatrics
  • Public Health
  • Qualitative Research
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