Feasibility of implementing systematic social needs assessment for children with medical complexity

Abstract Background Children with medical complexity (CMC) have inter-related health and social needs; however, interventions to identify and respond to social needs have not been adapted for CMC. The objective of this study was to evaluate the feasibility of implementing social needs screening and...

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Autores principales:	David Y. Ming, Kelley A. Jones, Elizabeth Sainz, Heidie Tkach, Amy Stewart, Ashley Cram, Madlyn C. Morreale, Samantha Dizon, Neal A. deJong
Formato:	article
Lenguaje:	EN
Publicado:	BMC 2021
Materias:	Children with medical complexity Social determinants of health Implementation strategy Complex care Medicine (General) R5-920
Acceso en línea:	https://doaj.org/article/21784f72995c40579bc817c96e2377eb
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spelling	oai:doaj.org-article:21784f72995c40579bc817c96e2377eb2021-11-28T12:04:02ZFeasibility of implementing systematic social needs assessment for children with medical complexity10.1186/s43058-021-00237-32662-2211https://doaj.org/article/21784f72995c40579bc817c96e2377eb2021-11-01T00:00:00Zhttps://doi.org/10.1186/s43058-021-00237-3https://doaj.org/toc/2662-2211Abstract Background Children with medical complexity (CMC) have inter-related health and social needs; however, interventions to identify and respond to social needs have not been adapted for CMC. The objective of this study was to evaluate the feasibility of implementing social needs screening and assessment within pediatric complex care programs. Methods We implemented systematic social needs assessment for CMC (SSNAC) at two tertiary care centers in three phases: (1) pre-implementation, (2) implementation, and (3) implementation monitoring. We utilized a multifaceted implementation package consisting of discrete implementation strategies within each phase. In phase 1, we adapted questions from evidence-informed screening tools into a 21-item SSNAC questionnaire, and we used published frameworks to inform implementation readiness and process. In phases 2–3, clinical staff deployed the SSNAC questionnaire to parents of CMC in-person or by phone as part of usual care and adapted to local clinical workflows. Staff used shared decision-making with parents and addressed identified needs by providing information about available resources, offering direct assistance, and making referrals to community agencies. Implementation outcomes included fidelity, feasibility, acceptability, and appropriateness. Results Observations from clinical staff characterized fidelity to use of the SSNAC questionnaire, assessment template, and shared decision-making for follow-up on unmet social needs. Levels of agreement (5-point Likert scale; 1 = completely disagree; 5 = completely agree) rated by staff for key implementation outcomes were moderate to high for acceptability (mean = 4.7; range = 3–5), feasibility (mean = 4.2; range = 3–5), and appropriateness (mean = 4.6; range = 4-5). 49 SSNAC questionnaires were completed with a 91% response rate. Among participating parents, 37 (76%) reported ≥ 1 social need, including food/nutrition benefits (41%), housing (18%), and caregiver needs (29%). Staff responses included information provision (41%), direct assistance (30%), and agency referral (30%). Conclusions It was feasible for tertiary care center-based pediatric complex care programs to implement a standardized social needs assessment for CMC to identify and address parent-reported unmet social needs.David Y. MingKelley A. JonesElizabeth SainzHeidie TkachAmy StewartAshley CramMadlyn C. MorrealeSamantha DizonNeal A. deJongBMCarticleChildren with medical complexitySocial determinants of healthImplementation strategyComplex careMedicine (General)R5-920ENImplementation Science Communications, Vol 2, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Children with medical complexity Social determinants of health Implementation strategy Complex care Medicine (General) R5-920
spellingShingle	Children with medical complexity Social determinants of health Implementation strategy Complex care Medicine (General) R5-920 David Y. Ming Kelley A. Jones Elizabeth Sainz Heidie Tkach Amy Stewart Ashley Cram Madlyn C. Morreale Samantha Dizon Neal A. deJong Feasibility of implementing systematic social needs assessment for children with medical complexity
description	Abstract Background Children with medical complexity (CMC) have inter-related health and social needs; however, interventions to identify and respond to social needs have not been adapted for CMC. The objective of this study was to evaluate the feasibility of implementing social needs screening and assessment within pediatric complex care programs. Methods We implemented systematic social needs assessment for CMC (SSNAC) at two tertiary care centers in three phases: (1) pre-implementation, (2) implementation, and (3) implementation monitoring. We utilized a multifaceted implementation package consisting of discrete implementation strategies within each phase. In phase 1, we adapted questions from evidence-informed screening tools into a 21-item SSNAC questionnaire, and we used published frameworks to inform implementation readiness and process. In phases 2–3, clinical staff deployed the SSNAC questionnaire to parents of CMC in-person or by phone as part of usual care and adapted to local clinical workflows. Staff used shared decision-making with parents and addressed identified needs by providing information about available resources, offering direct assistance, and making referrals to community agencies. Implementation outcomes included fidelity, feasibility, acceptability, and appropriateness. Results Observations from clinical staff characterized fidelity to use of the SSNAC questionnaire, assessment template, and shared decision-making for follow-up on unmet social needs. Levels of agreement (5-point Likert scale; 1 = completely disagree; 5 = completely agree) rated by staff for key implementation outcomes were moderate to high for acceptability (mean = 4.7; range = 3–5), feasibility (mean = 4.2; range = 3–5), and appropriateness (mean = 4.6; range = 4-5). 49 SSNAC questionnaires were completed with a 91% response rate. Among participating parents, 37 (76%) reported ≥ 1 social need, including food/nutrition benefits (41%), housing (18%), and caregiver needs (29%). Staff responses included information provision (41%), direct assistance (30%), and agency referral (30%). Conclusions It was feasible for tertiary care center-based pediatric complex care programs to implement a standardized social needs assessment for CMC to identify and address parent-reported unmet social needs.
format	article
author	David Y. Ming Kelley A. Jones Elizabeth Sainz Heidie Tkach Amy Stewart Ashley Cram Madlyn C. Morreale Samantha Dizon Neal A. deJong
author_facet	David Y. Ming Kelley A. Jones Elizabeth Sainz Heidie Tkach Amy Stewart Ashley Cram Madlyn C. Morreale Samantha Dizon Neal A. deJong
author_sort	David Y. Ming
title	Feasibility of implementing systematic social needs assessment for children with medical complexity
title_short	Feasibility of implementing systematic social needs assessment for children with medical complexity
title_full	Feasibility of implementing systematic social needs assessment for children with medical complexity
title_fullStr	Feasibility of implementing systematic social needs assessment for children with medical complexity
title_full_unstemmed	Feasibility of implementing systematic social needs assessment for children with medical complexity
title_sort	feasibility of implementing systematic social needs assessment for children with medical complexity
publisher	BMC
publishDate	2021
url	https://doaj.org/article/21784f72995c40579bc817c96e2377eb
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Feasibility of implementing systematic social needs assessment for children with medical complexity

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