Home and Community Care Digest

Home and Community Care Digest 7(1) March 2008

Brief Psychosocial Screening Links Targeted Families to Community Resources

Abstract

This study demonstrated that a brief psychosocial screening program was viable during routine pediatric health care visits. Specifically, psychosocial screening helped to identify families that would benefit most from this link to social services. Parents in the intervention group were more likely to have contacted a community service. Pediatric residents reported that use of the tool did not significantly lengthen visit times. This screening tool may supplement but not replace discussions between targeted families and community social workers.
Background: Psychosocial problems, such as food insecurity, housing instability, inadequate parental education, and parental substance use, have been associated with higher rates of behavioral, developmental and learning problems among children. Few pediatricians routinely address these family psychosocial problems at regular visits, claiming barriers such as lack of time, professional training, and knowledge of community resources. This study describes the feasibility and impact of an intervention on the management of family psychosocial topics during visits with pediatric residents.

Methods: Low-income parents of children aged 2 months to 10 years were recruited for the study. Families and pediatric residents (providers) were randomly assigned to either intervention or control groups. The intervention group received a family psychosocial screening tool prior to their scheduled visit. The self-report screening instrument focused on 10 psychosocial topics (lack of high school education, smoking, substance abuse, depression, intimate-partner violence, etc.), which were then used to encourage discussion with the providers. Providers in the intervention group received training and access to a book containing one-page tear-out sheets listing information on 2-4 community resources for each of the 10 psychosocial problems.

Findings: Parents in the intervention group discussed significantly more family psychosocial topics and had fewer unmet desires to discuss other issues compared to those in the control group. Fifty-one percent of parents in the intervention group received at least one referral during the visit, compared to 12% of parents in the control group. Most referrals were for high school equivalent diploma programs, job training, food resources, and smoking-cessation classes. Parents in the intervention group were more likely to have contacted a community resource one month after the visit. Of the provider outcomes, 77% of the residents reported that the intervention did not significantly lengthen the visit time.

Conclusions: This study demonstrated that a brief family psychosocial screening program is viable during routine pediatric healthcare visits. Self-reported screening by parents and associated provider training may lead to greater discussion of psychosocial topics and subsequent contact of community family support resources by parents. This intervention model was effective in identifying those families who would benefit most from existing services and in providing a necessary link between these targeted families and the services. The low reporting of highly sensitive psychosocial topics such as depression and intimate-partner violence may be due to social desirability and parental unwillingness to acknowledge sensitive psychosocial problems. As such, this intervention tool complements, rather than substitutes, for discussions with community social workers.

Reference: Garg A, Butz AM, Dworkin, PH, Lewis RA, Thompson RE, Serwint JR. Improving the Management of Family Psychosocial Problems at Low-Income Children's Well-Child Care Visits: The WE CARE Project. Pediatrics. 2007; 120:3: 547-58.

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