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Danaher FS, Obando AM, Morris JE, Biskind H, Jasrasaria R, Bosson R, Gartland MG, Mohareb AM. Responding to the Health Needs of Newly Arrived Families Within Fractured Policy Environments. Pediatr Ann 2024; 53:e161-e166. [PMID: 38700920 DOI: 10.3928/19382359-20240306-07] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2024]
Abstract
The increase in forcibly displaced populations seeking refuge in the United States has been met with fragmented, chaotic, and highly politicized responses to the detriment of migrants and receiving communities alike. Migrants encounter compounding systemic barriers to accessing basic resettlement resources. Expanding on pandemic-era innovations can strengthen social safety net infrastructure as a whole. Pediatricians are a potential early touchpoint for newly arrived families, providing an opportunity to support their specific health needs, refer to critical safety net services, and advocate for improved systems and policies. [Pediatr Ann. 2024;53(5):e161-e166.].
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Rucker A, Watson A, Badolato G, Jarvis L, Patel SJ, Goyal MK. Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial. J Adolesc Health 2024; 74:292-300. [PMID: 37804303 DOI: 10.1016/j.jadohealth.2023.08.030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Revised: 08/18/2023] [Accepted: 08/21/2023] [Indexed: 10/09/2023]
Abstract
PURPOSE Adolescent emergency department (ED) patients have unmet social needs that contribute to ED use. This study aimed to evaluate the effect of social needs navigation for adolescents on subsequent ED visits and community resource use and to identify characteristics associated with elevated social risk. METHODS Between July 2017 and August 2019, we used a random date generator to establish intervention and control group enrollment dates. All adolescents completed a social needs survey. Adolescents enrolled on intervention dates received in-person, risk-tailored social needs navigation. Those enrolled on control dates received a preprinted resource guide. We used chart review and follow-up calls to assess 12-month ED revisits and community resource use. Logistic regression was used to compare these outcomes between groups. We measured the association between ≥3 reported unmet needs and characteristics hypothesized a priori to be associated with elevated social risk (nonurgent visits, obesity, or any of nine "socially sensitive" chief complaints) using logistic regression. RESULTS A total of 399 adolescents were randomized. There was no difference between groups in the number of ED revisits. There was increased community resource use in the intervention group (adjusted odds ratio [aOR]: 3.5 [95% confidence interval {CI}: 1.5, 8.2]). Adolescents with a socially sensitive chief complaint had increased odds of ≥3 unmet needs (aOR: 2.2 [95% CI: 1.3, 3.6]), as did those with food insecurity in a post hoc analysis (aOR: 9.9 [95% CI: 4.0, 24.6]). DISCUSSION Social needs navigation increased community resource use but not subsequent ED visits. Adolescents with socially sensitive chief complaints or food insecurity reported increased unmet needs.
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Affiliation(s)
- Alexandra Rucker
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C.
| | - Ar'Reon Watson
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C
| | - Gia Badolato
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C
| | - Lenore Jarvis
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Shilpa J Patel
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
| | - Monika K Goyal
- Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C
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Gabbay JM, Abrams EM, Nyenhuis SM, Wu AC. Housing Insecurity and Asthma Outcomes. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2024; 12:327-333. [PMID: 37871647 DOI: 10.1016/j.jaip.2023.10.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/03/2023] [Accepted: 10/14/2023] [Indexed: 10/25/2023]
Abstract
Asthma is a chronic respiratory disease with widespread prevalence that affects children, adolescents, and adults. Asthma morbidity and mortality can be exacerbated in the setting of housing insecurity. In this Grand Rounds Review article, we present a case and discuss the implications that housing insecurity has on asthma outcomes in the United States. We then highlight ways in which providers can advocate for patients with asthma and housing insecurity.
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Affiliation(s)
| | - Elissa M Abrams
- Department of Pediatrics, Section of Allergy and Clinical Immunology, University of Manitoba, Winnipeg, MB, Canada
| | - Sharmilee M Nyenhuis
- Department of Pediatrics, Section of Allergy and Immunology, University of Chicago, Chicago, Ill
| | - Ann Chen Wu
- Department of Medicine, Boston Children's Hospital, Boston, Mass; Division of Child Health Research and Policy, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Mass
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Kim G, Qua K, Clark M, Furman L. Childhood Homelessness and Housing Insecurity: A Curriculum for Pediatric Residents. Acad Pediatr 2024; 24:176-178. [PMID: 37743015 DOI: 10.1016/j.acap.2023.09.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Revised: 08/18/2023] [Accepted: 09/16/2023] [Indexed: 09/26/2023]
Affiliation(s)
- Grace Kim
- Division of Pediatric Hospital Medicine, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio; Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Kelli Qua
- Center for Medical Education, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Marie Clark
- Division of Developmental and Behavioral Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio; Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
| | - Lydia Furman
- Division of General Academic Pediatrics, UH Rainbow Babies and Children's Hospital, Cleveland, Ohio; Department of Pediatrics, Case Western Reserve University School of Medicine, Cleveland, Ohio.
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Msw RET, Warner L, Shy BD, Manikowski C, Roosevelt GE. A descriptive study of screening and navigation on health-related social needs in a safety-net hospital emergency department. Am J Emerg Med 2023; 74:65-72. [PMID: 37778164 DOI: 10.1016/j.ajem.2023.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2023] [Revised: 09/02/2023] [Accepted: 09/04/2023] [Indexed: 10/03/2023] Open
Abstract
BACKGROUND Health-related social needs (HRSN) have been associated with worse clinical outcomes, increased Emergency Department (ED) utilization and higher healthcare costs. The ED is uniquely positioned to bring HRSN screening to the bedside and develop effective interventions. We evaluated whether navigation services for high-risk patients led to the resolution of HRSN. METHODS Navigators screened a convenience sample of patients for HRSN with the Accountable Health Communities Screening Tool from October 2019 to January 2022. Patients with HRSN were considered high-risk if they had at least two ED visits in the previous 12 months. Patients who were high-risk were eligible for navigation including community referrals and one-on-one close follow-up. The HRSN status (resolved, in-progress, unable to resolve) was queried from the Centers for Medicare and Medicaid database. The state hospital association provided data on ED visits and inpatient hospitalizations within 6 months of the screening visit. RESULTS Of 185,470 ED visits, HRSN screening occurred in 4050 (2%). HRSN were self-reported in 48% (1944) of patient visits, with 71% of these (1379) considered high-risk. 15% of high-risk patients with HRSN opted out of navigation. Food insecurity was the most identified HRSN (35%) followed by housing instability (26%), transportation needs (24%) and utility assistance (15%). Food insecurity was the most resolved HRSN (39%, in-progress 32%) followed by utility assistance (37%, in-progress 26%), transportation needs (35%, in-progress 35%) and housing instability (28%, in-progress 36%). High-risk visits in which the patient or guardian accepted navigation were less likely to be associated with an ED visit within 6 months of the screening visit (51%) compared to high-risk patients in which the patient or guardian opted out of navigation (61%, p < 0.001), but there was no difference in inpatient hospitalizations (p = 0.427). CONCLUSIONS During the study period, one-third of HRSN were successfully resolved with another one-third in-progress. Navigation in high-risk patients was associated with fewer subsequent ED visits.
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Affiliation(s)
- Ruth Ellen Tubbs Msw
- Previous/Main: Denver Regional Council of Governments, 1001 17(th) Street, Suite 700, Denver, CO 80202, USA
| | - Leah Warner
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
| | - Bradley D Shy
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
| | - Christine Manikowski
- Previous/Main: Denver Regional Council of Governments, 1001 17(th) Street, Suite 700, Denver, CO 80202, USA
| | - Genie E Roosevelt
- Department of Emergency Medicine, Denver Health, University of Colorado School of Medicine, 601 Broadway, Denver, CO 80204, USA.
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Dario H, Spatz DL. An Integrative Review of Breastfeeding and Homelessness. Nurs Womens Health 2023; 27:416-426. [PMID: 37806318 DOI: 10.1016/j.nwh.2023.06.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2023] [Revised: 06/14/2023] [Accepted: 09/12/2023] [Indexed: 10/10/2023]
Abstract
OBJECTIVE To synthesize the current literature surrounding breastfeeding and homelessness, and to determine the impact of disparities in this population. DATA SOURCES An integrative search was conducted using Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and using the search terms "breastfeeding" and "homelessness" throughout electronic databases PubMed, CINAHL, and Scopus. STUDY SELECTION Inclusion criteria were articles published in English from January 2007 to September 2022. Exclusion criteria were studies published more than 15 years ago, studies published in a language other than English, opinion articles, and irrelevance to breastfeeding and homelessness. The initial search yielded 100 results. After removing duplicates and articles because of irrelevance, the final number of articles for this synthesis was seven. DATA EXTRACTION Data were extracted from each article, critically appraised using Joanna Briggs Institute criteria, and summarized in a table of evidence. DATA SYNTHESIS Three common themes were identified: Decreased Breastfeeding Initiation Rates and Duration in the Homeless Population, Impact of Community and Clinical Support, and Breastfeeding Practices Influenced by Individual Factors. CONCLUSION Providers and nurses should refer patients to the Special Supplemental Nutrition Program for Women, Infants, and Children; use techniques to instill a parent's intent to breastfeed; provide early breastfeeding education; promote breastfeeding initiation within 1 hour of birth; and encourage peer support groups. Although current researchers provide insight into potential barriers and interventions, more research is needed to gain additional data on how to overcome identified barriers to breastfeeding.
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Herbers JE, DeCandia CJ, Volk KT, Unick GJ. Profiles and Predictors of Neurodevelopmental Functioning among Young Children Experiencing Family Homelessness. EARLY CHILDHOOD RESEARCH QUARTERLY 2023; 65:407-416. [PMID: 37635734 PMCID: PMC10449385 DOI: 10.1016/j.ecresq.2023.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/29/2023]
Abstract
In the context of family homelessness, children experience acute adversities related to loss of housing and residential mobility compounded with more chronic, poverty-related adversities and stressors. Among children in families experiencing homelessness, variability in experiences and outcomes warrant person-centered approaches to better delineate patterns of risk and resilience. Using latent profile analysis as a person-centered approach, we identified five distinct profiles of neurodevelopmental functioning within a sample of 231 children (ages 3-5 years old) staying in emergency homeless shelters with their families. Latent profiles were informed by indicators from parent-reported items for ten different domains of neurodevelopmental functioning. We examined whether demographic and ecological factors including age, ethnicity, adverse childhood experiences, parent mental health, and overreactive parenting would predict profile membership. Overall, half of the children in the sample demonstrated a profile of resilient functioning across developmental domains. Profiles of maladaptive functioning differed in areas of strength and challenge, with a small percentage of children showing poor functioning across all domains. Children whose parents had more mental health problems or overreactive parenting were significantly more likely to show profiles of poor functioning than to show resilient functioning. Implications for future research, practice, and policy are discussed.
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Affiliation(s)
- Janette E Herbers
- Villanova University, Department of Psychological and Brain Sciences, Villanova, PA, USA
| | | | | | - George J Unick
- University of Maryland, School of Social Work, Baltimore, MD, USA
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Bohnhoff JC, Xue L, Hollander MAG, Burgette JM, Cole ES, Ray KN, Donohue J, Roberts ET. Healthcare Utilization Among Children Receiving Permanent Supportive Housing. Pediatrics 2023; 151:e2022059833. [PMID: 36974602 PMCID: PMC10071430 DOI: 10.1542/peds.2022-059833] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/11/2023] [Indexed: 03/29/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Permanent supportive housing (PSH) integrates long-term housing and supports for families and individuals experiencing homelessness. Although PSH is frequently provided to families with children, little is known about the impacts of PSH among children. We examined changes in health care visits among children receiving PSH compared with similar children who did not receive PSH. METHODS We analyzed Pennsylvania Medicaid administrative data for children entering PSH between 2011 and 2016, matching to a comparison cohort with similar demographic and clinical characteristics who received non-PSH housing services. We conducted propensity score-weighted difference-in-differences (DID) analyses to compare changes in health care visits 3 years before and after children entered PSH versus changes in the comparison cohort. RESULTS We matched 705 children receiving PSH to 3141 in the comparison cohort. Over 3 years following PSH entry, dental visits among children entering PSH increased differentially relative to the comparison cohort (DID: 12.70 visits per 1000 person-months, 95% confidence interval: 3.72 to 21.67). We did not find differential changes in preventive medicine visits, hospitalizations, or emergency department (ED) visits overall. When stratified by age, children ≤5 years old at PSH entry experienced a greater decrease in ED visits relative to the comparison cohort (DID: -13.16 visits per 1000 person-months, 95% confidence interval: -26.23 to -0.10). However, emergency visit trends before PSH entry differed between the cohorts. CONCLUSIONS Children in PSH had relatively greater increases in dental visits, and younger children entering PSH may have experienced relative reductions in ED visits. Policymakers should consider benefits to children when evaluating the overall value of PSH.
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Affiliation(s)
- James C. Bohnhoff
- Schools of Medicine
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Lingshu Xue
- Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | | | | | - Evan S. Cole
- Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kristin N. Ray
- Schools of Medicine
- UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Julie Donohue
- Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Eric T. Roberts
- Public Health, University of Pittsburgh, Pittsburgh, Pennsylvania
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Hare MM, Landis TD, Hernandez ML, Graziano PA. A Systematic Review of Infant Mental Health Prevention and Treatment Programs. EVIDENCE-BASED PRACTICE IN CHILD AND ADOLESCENT MENTAL HEALTH 2023; 9:138-161. [PMID: 38680216 PMCID: PMC11052540 DOI: 10.1080/23794925.2022.2140458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Although many prevention and treatment programs exist for children and families, there have been no reviews specifically examining their impact on infant mental health at the program level. Therefore, the purpose of the current review was to a) systematically examine prevention and treatment programs targeting infant mental health outcomes (i.e., internalizing problems, externalizing problems, social-emotional development, trauma) or the parent-infant relationship/ attachment in children from pregnancy to 2 years; b) classify each program by level of empirical support; and c) highlight strengths and identify gaps in the existing literature to inform future mental health intervention science. From over 121,341 publications initially identified, 60 prevention and treatment programs met inclusion criteria for this review. Each program was reviewed for level of scientific evidence. Of the 60 programs reviewed, 29 (48.33%) were classified as promising, while only six (10.0%) were classified as effective. Lastly, only two programs (3.33%; Attachment and Biobehavioral Catch-Up and Video-feedback Intervention Parenting Program) were classified as evidence-based specific to infant mental health and/or parent-infant relationship/attachment outcomes. Implications related to disseminating evidence-based prevention/treatment programs are discussed.
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Affiliation(s)
- Megan M Hare
- Center for Children and Families, Department of Psychology, Florida International University
| | - Taylor D Landis
- Center for Children and Families, Department of Psychology, Florida International University
| | - Melissa L Hernandez
- Center for Children and Families, Department of Psychology, Florida International University
| | - Paulo A Graziano
- Center for Children and Families, Department of Psychology, Florida International University
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Kanak MM, Fleegler EW, Chang L, Curt AM, Burdick KJ, Monuteaux MC, Deane M, Warrington P, Stewart AM. Mobile Social Screening and Referral Intervention in a Pediatric Emergency Department. Acad Pediatr 2023; 23:93-101. [PMID: 36075518 DOI: 10.1016/j.acap.2022.08.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Revised: 08/15/2022] [Accepted: 08/28/2022] [Indexed: 01/19/2023]
Abstract
OBJECTIVE Many families in pediatric emergency departments (PED) have unmet social needs, which may be detected and addressed with the use of a digital social needs intervention. Our objective was to characterize the feasibility and effectiveness of utilizing personal phones or a PED tablet for screening and referral to social services. METHODS We conducted a prospective single-arm intervention study using a convenience sample of caregivers and adult patients in an urban PED between May 2019 and October 2020. Participants chose either their personal phone or a PED-provided tablet to use an app, "HelpSteps." Participants self-selected need(s) then referrals to service agencies. Participants completed a 1-month follow-up. Clinicians were surveyed about screening and impact on visit. RESULTS Of 266 participants enrolled, 55% of participants elected to use their personal phone. Of all participants, 67% self-selected at least 1 health-related social need; 34% selected 3 or more. The top 3 "most important" needs were housing (14%), education (12%), and fitness (12%). At one month follow-up, 44% of participants reported their top need was "completely" or "somewhat" solved. For 95% of encounters, clinicians reported the intervention did not increase length of stay. CONCLUSIONS A mobile social needs intervention was feasible and effective at identifying and referring participants in the PED setting. While more than half of participants used their personal phones, several smartphone owners cited barriers and elected to use a tablet. Overall, participants found the app easy to use, appropriate for the PED, and the intervention had minimal impact on clinical flow.
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Affiliation(s)
- Mia M Kanak
- Children's Hospital Los Angeles (MM Kanak), Division of Emergency Medicine and Transport Medicine, Los Angeles, Calif.
| | - Eric W Fleegler
- Boston Children's Hospital (EW Fleegler, L Chang, MC Monuteaux, M Deane, and AM Stewart), Division of Emergency Medicine, Boston, Mass; Harvard Medical School (EW Fleegler, L Chang, AM Curt, MC Monuteaux, and A M Stewart), Boston, Mass
| | - Lawrence Chang
- Boston Children's Hospital (EW Fleegler, L Chang, MC Monuteaux, M Deane, and AM Stewart), Division of Emergency Medicine, Boston, Mass; Harvard Medical School (EW Fleegler, L Chang, AM Curt, MC Monuteaux, and A M Stewart), Boston, Mass
| | - Alexa M Curt
- Harvard Medical School (EW Fleegler, L Chang, AM Curt, MC Monuteaux, and A M Stewart), Boston, Mass
| | - Kendall J Burdick
- University of Massachusetts Medical School (KJ Burdick), Worcester, Mass
| | - Michael C Monuteaux
- Boston Children's Hospital (EW Fleegler, L Chang, MC Monuteaux, M Deane, and AM Stewart), Division of Emergency Medicine, Boston, Mass; Harvard Medical School (EW Fleegler, L Chang, AM Curt, MC Monuteaux, and A M Stewart), Boston, Mass
| | - Melissa Deane
- Boston Children's Hospital (EW Fleegler, L Chang, MC Monuteaux, M Deane, and AM Stewart), Division of Emergency Medicine, Boston, Mass
| | | | - Amanda M Stewart
- Boston Children's Hospital (EW Fleegler, L Chang, MC Monuteaux, M Deane, and AM Stewart), Division of Emergency Medicine, Boston, Mass; Harvard Medical School (EW Fleegler, L Chang, AM Curt, MC Monuteaux, and A M Stewart), Boston, Mass
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Staniczenko AP, Wen T, Gonzalez A, D'Alton ME, Logue TC, Friedman AM. Trends and outcomes of delivery hospitalizations with unstable housing, 2000-2018. J Matern Fetal Neonatal Med 2022; 35:10455-10457. [PMID: 36539262 DOI: 10.1080/14767058.2022.2128664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Purpose: Data on trends in and implications of unstable housing during pregnancy are limited. The purpose of this study was to address these knowledge gaps.Methods: This repeat cross-sectional study using the National Inpatient Sample analyzed unstable housing diagnoses among 2000-2018 delivery hospitalizations. Joinpoint regression was used to estimate trends in unstable housing by calculating the average annual percent change.Results: From 2000 to 2018, 27,984 delivery hospitalizations had associated diagnoses of unstable housing (0.03%). There was a significant increase in the unstable housing rates, from 0.72 per 10,000 deliveries in 2000 to 12.8 per 10,000 deliveries in 2018. Delivery hospitalizations with unstable housing were at significantly higher risk of antepartum hemorrhage, preterm delivery, hypertensive disorders of pregnancy, postpartum hemorrhage, and severe maternal morbidity than those without.Conclusions: This serial cross-sectional analysis of delivery hospitalizations found that the reported prevalence of unstable housing is low but increasing and associated with adverse outcomes.
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Affiliation(s)
- Anna P Staniczenko
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Timothy Wen
- Department of Obstetrics and Gynecology, University of California-San Francisco, San Francisco, CA, USA
| | - Amalia Gonzalez
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Mary E D'Alton
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
| | - Teresa C Logue
- Department of Obstetrics and Gynecology, Columbia University, New York, NY, USA
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O'Donnell M, McKinnon S. Advocating for Change to Meet the Developmental Needs of Young Children Experiencing Homelessness. Am J Occup Ther 2022; 76:23885. [PMID: 35984484 DOI: 10.5014/ajot.2022.050114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Young children experiencing homelessness are at considerable risk for developing physical and cognitive impairments, yet federal and state programs often overlook their needs. Although early intervention programs should serve as family-centered, health-promoting resources for families experiencing homelessness, many do not locate and comprehensively screen eligible children ages ≤3 yr in their communities. Occupational therapy practitioners have a role in advocating for improved access to high-quality, federally mandated programming for this population. They should be aware of the barriers faced by homeless families in accessing equitable early developmental services and of strategies to support individual families and communities experiencing homelessness.
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Affiliation(s)
- Mary O'Donnell
- Mary O'Donnell, OT, OTD, OTR, is Instructor, Entry-Level OTD Program, MGH Institute of Health Professions, Boston, MA;
| | - Sarah McKinnon
- Sarah McKinnon, OT, OTD, OTR, BCPR, MPA, is Program Director, Post-Professional OTD Program, MGH Institute of Health Professions, Boston, MA
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13
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Sakai-Bizmark R, Kumamaru H, Estevez D, Neman S, Bedel LEM, Mena LA, Marr EH, Ross MG. Reduced rate of postpartum readmissions among homeless compared with non-homeless women in New York: a population-based study using serial, cross-sectional data. BMJ Qual Saf 2022; 31:267-277. [DOI: 10.1136/bmjqs-2020-012898] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/27/2021] [Indexed: 01/04/2023]
Abstract
ObjectiveTo assess differences in rates of postpartum hospitalisations among homeless women compared with non-homeless women.DesignCross-sectional secondary analysis of readmissions and emergency department (ED) utilisation among postpartum women using hierarchical regression models adjusted for age, race/ethnicity, insurance type during delivery, delivery length of stay, maternal comorbidity index score, other pregnancy complications, neonatal complications, caesarean delivery, year fixed effect and a birth hospital random effect.SettingNew York statewide inpatient and emergency department databases (2009–2014).Participants82 820 and 1 026 965 postpartum homeless and non-homeless women, respectively.Main outcome measuresPostpartum readmissions (primary outcome) and postpartum ED visits (secondary outcome) within 6 weeks after discharge date from delivery hospitalisation.ResultsHomeless women had lower rates of both postpartum readmissions (risk-adjusted rates: 1.4% vs 1.6%; adjusted OR (aOR) 0.87, 95% CI 0.75 to 1.00, p=0.048) and ED visits than non-homeless women (risk-adjusted rates: 8.1% vs 9.5%; aOR 0.83, 95% CI 0.77 to 0.90, p<0.001). A sensitivity analysis stratifying the non-homeless population by income quartile revealed significantly lower hospitalisation rates of homeless women compared with housed women in the lowest income quartile. These results were surprising due to the trend of postpartum hospitalisation rates increasing as income levels decreased.ConclusionsTwo factors likely led to lower rates of hospital readmissions among homeless women. First, barriers including lack of transportation, payment or childcare could have impeded access to postpartum inpatient and emergency care. Second, given New York State’s extensive safety net, discharge planning such as respite and sober living housing may have provided access to outpatient care and quality of life, preventing adverse health events. Additional research using outpatient data and patient perspectives is needed to recognise how the factors affect postpartum health among homeless women. These findings could aid in lowering readmissions of the housed postpartum population.
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Holroyd TA, Oloko OK, Limaye RJ. Experiences with Medicaid Renewal and Reauthorization Policies in the Context of Child Health and Vaccine Coverage. SOCIAL WORK 2022; 67:105-113. [PMID: 35085388 DOI: 10.1093/sw/swac004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 07/16/2020] [Indexed: 06/14/2023]
Abstract
Difficulties complying with Medicaid recertification requirements may be responsible for a portion of Medicaid disenrollments and may impact access to preventive care. This study aimed to explore the barriers parents experienced renewing their child's Medicaid, how those barriers impact access to healthcare, and how changes in Medicaid policy can improve child health outcomes. To understand the barriers associated with Medicaid renewal, authors conducted in-depth interviews (N = 24) with racially and demographically diverse parents living in Baltimore. They found that administrative burden, lack of awareness regarding reauthorization, challenges with navigation assistance, and lack of access to the renewal system were crucial barriers to renewing Medicaid. Many participants identified negative impacts on child health outcomes resulting from lapses in coverage, including lack of healthcare access and missed immunizations. Drawing on these findings, the authors provide recommendations for streamlining and clarifying the Medicaid renewal process in Maryland, and the role of social work policy and practice in reducing barriers to renewal.
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Affiliation(s)
- Taylor A Holroyd
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Oladeji K Oloko
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Rupali J Limaye
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
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Stoklosa H, Alhajji L, Finch L, Williams S, Prakash J, Sfakianaki AK, Duthely LM, Potter JE. "Because the resources aren't there, then we fail. We fail as a society": A Qualitative Analysis of Human Trafficking Provider Perceptions of Child Welfare Involvement among Trafficked Mothers. Matern Child Health J 2022; 26:623-631. [PMID: 35015174 DOI: 10.1007/s10995-021-03342-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/27/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Little is understood about child welfare involvement (CWI) in cases where the birth mother has experienced human trafficking. OBJECTIVES The aim of this study was to explore provider perceptions of the impact of CWI for the trafficked mother. METHODS Participants were selected among providers caring for trafficked birth mothers. Semi-structured interviews were conducted with providers and qualitative content analysis was conducted. RESULTS Interviewees reported reasons for CWI, positive and negative impacts of CWI and provided recommendations for systems improvement. CONCLUSION FOR PRACTICE Recommendations from this exploratory study include mechanisms to support trafficked mothers, train hospital social workers, and systems change. During the prenatal period, strategies to support the trafficked mother may include addressing gaps in social determinants of health, ensuring appropriate medical and mental health care, early screening and referral to substance use treatment services, enhancing community support, and working to develop safety plans for survivors and their families. Enhanced engagement of social workers and all providers to improve understanding of the unique complexity of trafficked mothers is needed. Education should include an understanding that judgement of a caretaker's ability to parent should be current and holistic and not reflexive based on history in the electronic medical record. An exploration of the child welfare system itself should also be undertaken to identify and modify discriminatory laws and policies. Finally, efforts to address social determinants of health in the community and enhance the trauma-informed nature of child welfare referrals could improve the lives of trafficked mothers.
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Affiliation(s)
- Hanni Stoklosa
- Department of Emergency Medicine, Brigham and Women's Hospital, Harvard Medical School, 75 Francis St, Boston, MA, 02115, USA.
- HEAL Trafficking, Los Angeles, USA.
| | - Lujain Alhajji
- Department of Psychiatry & Behavioral Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, USA
| | - Lindsey Finch
- Jackson Health System, Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, USA
| | - Sacha Williams
- Johns Hopkins All Children's Hospital, St. Petersburg, USA
| | | | - Anna K Sfakianaki
- Section of Maternal-Fetal Medicine, Gynecology and Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, USA
| | - Lunthita M Duthely
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, USA
| | - JoNell E Potter
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, USA
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16
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Homelessness in pregnancy: perinatal outcomes. J Perinatol 2021; 41:2742-2748. [PMID: 34404925 PMCID: PMC9507167 DOI: 10.1038/s41372-021-01187-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 06/03/2021] [Accepted: 08/06/2021] [Indexed: 11/08/2022]
Abstract
OBJECTIVE Investigate the association between maternal homelessness at the time of delivery and perinatal outcomes, with a focus on neonatal health outcomes. STUDY DESIGN Population-based cohort using California's statewide database included 1,520,253 women with linked birth and maternal discharge data, 2008-2012. Multivariable analysis assessed homelessness at time of delivery on perinatal outcomes, preterm delivery, and neonatal intensive care unit admission. RESULT A total of 672 women (0.05%) were homeless at the time of delivery. Homelessness was associated with premature delivery at multiple gestational age cutoffs (34w0d-36w6d; 32w0d-33w6d; 28w0d-31w6d; <28w0d) (range of aORs:1.62-2.19), and neonatal intensive care unit admission (aOR = 1.66, 95% CI:1.31-2.09). Among term infants, homelessness remained associated with increased odds of neonatal intensive care unit admission (aOR = 1.84, 95% CI:1.34-2.53), low birthweight (aOR = 1.99, 95% CI:1.36-2.90), neonatal abstinence syndrome (aOR = 2.13, 95% CI:1.35-2.53), hypoxic-ischemic encephalopathy (aOR = 14.38, 95% CI:3.90-53.01), and necrotizing enterocolitis (aOR = 14.94, 95% CI:2.68-83.20). CONCLUSION Homelessness in pregnancy was associated with adverse perinatal outcomes including increased odds of preterm delivery across all gestational ages, and increased risk of neonatal intensive care unit admission and low birth weight independent of preterm delivery.
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17
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Fu LY, Torres R, Caleb S, Cheng YI, Gennaro E, Thoburn E, McLaughlin J, Alexander-Parrish R, Wang J. Vaccination coverage among young homeless children compared to US national immunization survey data. Vaccine 2021; 39:6637-6643. [PMID: 34629209 DOI: 10.1016/j.vaccine.2021.09.073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 09/21/2021] [Accepted: 09/28/2021] [Indexed: 10/20/2022]
Abstract
INTRODUCTION Comprehensive vaccination coverage among homeless children in the United States (US) is largely unknown although a few studies suggest low coverage with single vaccinations. This study compared vaccination coverage with a combined 7-vaccines series among homeless children in the District of Columbia (DC) to coverage among other US children. MATERIALS AND METHODS A cross-sectional survey of homeless children in DC was conducted from 2018 to 2019. Recruitment occurred at housing shelters, social services centers, and a diaper dispensary, and through limited chain referral. English-speaking parents of a child aged 19 to 35 months who spent the majority of the last 30 nights homeless were recruited. Participants consented for their child's healthcare providers to submit vaccination records. The vaccination coverage estimate of this sample was compared with estimates of three populations in the 2018 National Immunization Survey (NIS): children in DC (NIS DC), children in the US (NIS US), and children in the US below the federal poverty level (NIS poor). RESULTS Most of the 135 children had experienced at least two lifetime episodes (63.7%) and 12 months (57%) of homelessness. The estimated percent up to date was 52.6% (95% CI: 43.8%, 61.3%). This estimate was 20.4 (95% CI: 11.9, 28.8, p < .0001), 20 (95% CI: 11.5, 28.4, p < .0001), and 11.5 (95% CI: 3.1, 20, p < .01) percentage points lower than estimates for the NIS DC, NIS US and NIS poor populations, respectively. After adjusting for child's age and race/ethnicity, vaccination coverage of the NIS DC sample was below that of NIS US (p < .01) and NIS poor samples (p < .05). CONCLUSION Children experiencing homelessness may be at risk of under-vaccination, even when compared to a general population of children in poverty. Awareness of this heightened risk may allow for more precise targeting of vaccination delivery support specifically to children experiencing homelessness.
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Affiliation(s)
- Linda Y Fu
- Goldberg Center for Community Pediatric Health, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA; Center for Translational Science, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA.
| | - Rachel Torres
- Center for Translational Science, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA
| | - Susan Caleb
- Center for Translational Science, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA
| | - Yao I Cheng
- Center for Translational Science, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA
| | - Erica Gennaro
- Goldberg Center for Community Pediatric Health, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA
| | | | | | | | - Jichuan Wang
- Center for Translational Science, Children's National Hospital, 111 Michigan Ave., NW, Washington, DC 20010, USA
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18
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Fanning K. What about the babies? A critical review of infants' and toddlers' absence in homelessness scholarship. Infant Behav Dev 2021; 64:101625. [PMID: 34375860 DOI: 10.1016/j.infbeh.2021.101625] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 07/29/2021] [Accepted: 07/30/2021] [Indexed: 11/30/2022]
Abstract
Rates of family homelessness continue to reach unprecedented levels. As many as two million young children experience family homelessness each year, with an estimated one in 10 younger than one year old. Yet, despite their high prevalence, a dearth of studies have specifically investigated infants' and toddlers' experiences of homelessness. Overall, the available literature suggests homeless infants and toddlers experience increased risk to physical health, development, and well-being at an individual- and family-level. This presents a severely limited understanding of homeless infants' and toddlers' experiences, with substantial gaps remaining. This review documents the scant existing literature on infant and toddler development within the context of homelessness at both the individual and family-system levels, and proposes next steps for research, practice, and policy.
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Affiliation(s)
- Kerrie Fanning
- University of Wisconsin - Madison, Madison, WI, United States.
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19
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Rochin E, Reed K, Rosa A, Guida W, Roach J, Boyle S, Kohli N, Webb A. Perinatal Quality and Equity-Indicators That Address Disparities. J Perinat Neonatal Nurs 2021; 35:E20-E29. [PMID: 34330140 DOI: 10.1097/jpn.0000000000000582] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
There is tremendous attention in maternal and neonatal disparities, particularly disparities of race and ethnicity and subsequent outcomes that continue despite calls to action. The literature has offered potential opportunities for exploring data related to racial and ethnic disparities, including the utilization of a race and ethnicity reporting dashboard. This article reviews definitions of perinatal quality and disparity and provides insight into the development of a nationally targeted race and ethnicity dashboard. This quarterly dashboard provides hospitals with specific key metric outcomes through the lens of race and ethnicity, provides a national benchmark for comparison, and creates a data platform for team exploration and comprehensive review of findings. An overview of the development of the dashboard is provided, and the selection of key maternal and neonatal metrics is reviewed. In addition, recommendations for data science strategic planning and nursing's role in metric development, analysis, and utilization are offered and key steps in accelerating disparity data into everyday clinical care are discussed.
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20
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The development and implementation of an advanced practice registered nurse-led prenatal education program for housing insecure women. J Am Assoc Nurse Pract 2021; 33:1111-1115. [PMID: 33560755 DOI: 10.1097/jxx.0000000000000557] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 11/11/2020] [Indexed: 11/26/2022]
Abstract
ABSTRACT Housing insecurity has been shown to have an impact on the health care system due to negative maternal and neonatal outcomes. Housing insecurity is associated with the social determinants of health under the umbrella of economic stability and neighborhood/physical environments. Research shows that educational programs and support resources can help alleviate this strain for women who are pregnant. This article discusses the development and implementation of an advanced practice registered nurse (APRN)-led, prenatal education group for women facing housing insecurity who are pregnant and high risk. The curriculum was revised and based on a March of Dimes Becoming a Mom with alignment to Maslow's Hierarchy of Needs. The 10-week prenatal education program was created and implemented by a group of APRNs and registered nurses to aid pregnant women facing housing insecurity with coping strategies and education regarding their pregnancy.
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21
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Bovell-Ammon A, Yentel D, Koprowski M, Wilkinson C, Sandel M. Housing Is Health: A Renewed Call for Federal Housing Investments in Affordable Housing for Families With Children. Acad Pediatr 2021; 21:19-23. [PMID: 32619545 DOI: 10.1016/j.acap.2020.06.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 06/17/2020] [Accepted: 06/27/2020] [Indexed: 11/17/2022]
Affiliation(s)
| | - Diane Yentel
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Mike Koprowski
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Chantelle Wilkinson
- National Low Income Housing Coalition (D Yentel, M Koprowski, and C Wilkinson), Washington, DC
| | - Megan Sandel
- Boston Medical Center (A Bovell-Ammon and M Sandel), Boston, Mass
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22
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Samuels‐Kalow ME, Ciccolo GE, Lin MP, Schoenfeld EM, Camargo CA. The terminology of social emergency medicine: Measuring social determinants of health, social risk, and social need. J Am Coll Emerg Physicians Open 2020; 1:852-856. [PMID: 33145531 PMCID: PMC7593464 DOI: 10.1002/emp2.12191] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Revised: 06/18/2020] [Accepted: 06/22/2020] [Indexed: 01/12/2023] Open
Abstract
Emergency medicine has increasingly focused on addressing social determinants of health (SDoH) in emergency medicine. However, efforts to standardize and evaluate measurement tools and compare results across studies have been limited by the plethora of terms (eg, SDoH, health-related social needs, social risk) and a lack of consensus regarding definitions. Specifically, the social risks of an individual may not align with the social needs of an individual, and this has ramifications for policy, research, risk stratification, and payment and for the measurement of health care quality. With the rise of social emergency medicine (SEM) as a field, there is a need for a simplified and consistent set of definitions. These definitions are important for clinicians screening in the emergency department, for health systems to understand service needs, for epidemiological tracking, and for research data sharing and harmonization. In this article, we propose a conceptual model for considering SDoH measurement and provide clear, actionable, definitions of key terms to increase consistency among clinicians, researchers, and policy makers.
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Affiliation(s)
- Margaret E. Samuels‐Kalow
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
| | - Gia E. Ciccolo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
| | - Michelle P. Lin
- Department of Emergency MedicineIcahn School of Medicine at Mount SinaiNew YorkNew YorkUSA
| | - Elizabeth M. Schoenfeld
- Department of Emergency Medicine and Institute for Healthcare Delivery and Population ScienceUniversity of Massachusetts Medical School – BaystateSpringfieldMassachusettsUSA
| | - Carlos A. Camargo
- Department of Emergency MedicineMassachusetts General HospitalHarvard Medical SchoolMassachusettsUSA
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23
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Samuels-Kalow ME, Molina MF, Ciccolo GE, Curt A, Cleveland Manchanda EC, de Paz NC, Camargo CA. Patient and Community Organization Perspectives on Accessing Social Resources from the Emergency Department: A Qualitative Study. West J Emerg Med 2020; 21:964-973. [PMID: 32726271 PMCID: PMC7390556 DOI: 10.5811/westjem.2020.3.45932] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2019] [Accepted: 03/27/2020] [Indexed: 01/17/2023] Open
Abstract
INTRODUCTION Social risks adversely affect health and are associated with increased healthcare utilization and costs. Emergency department (ED) patients have high rates of social risk; however, little is known about best practices for ED-based screening or linkage to community resources. We examined the perspectives of patients and community organizations regarding social risk screening and linkage from the ED. METHODS Qualitative interviews were conducted with a purposive sample of ED patients and local community organization staff. Participants completed a brief demographic survey, health literacy assessment, and qualitative interview focused on barriers/facilitators to social risk screening in the ED, and ideas for screening and linkage interventions in the ED. Interviews were conducted in English or Spanish, recorded, transcribed, and coded. Themes were identified by consensus. RESULTS We conducted 22 interviews with 16 patients and six community organization staff. Three categories of themes emerged. The first related to the importance of social risk screening in the ED. The second category encompassed challenges regarding screening and linkage, including fear, mistrust, transmission of accurate information, and time/resource constraints. The third category included suggestions for improvement and program development. Patients had varied preferences for verbal vs electronic strategies for screening. Community organization staff emphasized resource scarcity and multimodal communication strategies. CONCLUSION The development of flexible, multimodal, social risk screening tools, and the creation and maintenance of an accurate database of local resources, are strategies that may facilitate improved identification of social risk and successful linkage to available community resources.
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Affiliation(s)
- Margaret E Samuels-Kalow
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Melanie F Molina
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Gia E Ciccolo
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Alexa Curt
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Emily C Cleveland Manchanda
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
| | - Nicole C de Paz
- Boston Children's Hospital, Harvard Medical School, Division of General Pediatrics, Boston, Massachusetts
| | - Carlos A Camargo
- Massachusetts General Hospital, Harvard Medical School, Department of Emergency Medicine, Boston, Massachusetts
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24
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Physical illnesses associated with childhood homelessness: a literature review. Ir J Med Sci 2020; 189:1331-1336. [PMID: 32385787 DOI: 10.1007/s11845-020-02233-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2020] [Accepted: 04/09/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Childhood homelessness is a growing concern in Ireland [1] creating a paediatric subpopulation at increased risk of physical illnesses, many with life-long consequences [2]. AIM Our aim was to identify and categorize the physical morbidities prevalent in homeless children. METHODS A review of the English-language literature on physical morbidities affecting homeless children (defined as ≤ 18 years of age) published from 1999 to 2019 was conducted. RESULTS Respiratory issues were the most commonly cited illnesses affecting homeless children, including asthma, upper respiratory tract infections, and chronic cough [3]. Homeless children were described as being at increased risk for contracting infectious diseases, with many studies placing emphasis on the risks of sexually transmitted infections (STIs) and HIV/AIDS transmission [4, 5]. Dermatologic concerns for this population comprised of scabies and head lice infestation, dermatitis, and abrasions [3, 6]. Malnutrition manifested as a range of physical morbidities, including childhood obesity [7], iron deficiency anemia [4], and stunted growth [8]. Studies demonstrated a higher prevalence of poor dental [7] and ocular health [9] in this population as well. Many articles also commented on the risk factors predisposing homeless children to these physical health concerns, which can broadly be categorized as limited access to health care, poor living conditions, and lack of education [3, 10]. CONCLUSION This literature review summarized the physical illnesses prevalent among homeless children and the contributing factors leading to them. Gaps in the literature were also identified and included a dearth of studies focusing on younger children compared with adolescents. Further research into prevention and intervention programs for this vulnerable population is urgently needed.
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25
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Bovell-Ammon A, Mansilla C, Poblacion A, Rateau L, Heeren T, Cook JT, Zhang T, de Cuba SE, Sandel MT. Housing Intervention For Medically Complex Families Associated With Improved Family Health: Pilot Randomized Trial. Health Aff (Millwood) 2020; 39:613-621. [DOI: 10.1377/hlthaff.2019.01569] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Affiliation(s)
- Allison Bovell-Ammon
- Allison Bovell-Ammon is director of policy strategy at Children’s HealthWatch in the Department of Pediatrics, Boston Medical Center, in Massachusetts
| | - Cristina Mansilla
- Cristina Mansilla is a senior research assistant at Children’s HealthWatch, Department of Pediatrics, Boston Medical Center
| | - Ana Poblacion
- Ana Poblacion is a research scientist at Children’s HealthWatch, Department of Pediatrics, Boston Medical Center
| | - Lindsey Rateau
- Lindsey Rateau is a statistical data analyst in the Biostatistics and Epidemiology Data Analytics Center, Boston University School of Public Health, in Massachusetts
| | - Timothy Heeren
- Timothy Heeren is a professor of biostatistics at the Boston University School of Public Health
| | - John T. Cook
- John T. Cook is an associate professor of pediatrics at the Boston University School of Medicine
| | - Tina Zhang
- Tina Zhang is a medical student at the Boston University School of Medicine
| | - Stephanie Ettinger de Cuba
- Stephanie Ettinger de Cuba is executive director of Children’s HealthWatch, Department of Pediatrics, Boston University School of Medicine
| | - Megan T. Sandel
- Megan T. Sandel is an associate professor of pediatrics at the Boston University School of Medicine and is co–lead principal investigator at Children’s HealthWatch and codirector of the Grow Clinic in the Department of Pediatrics, Boston Medical Center
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