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

Autor: Ming DY; Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA. david.ming@duke.edu.; Department of Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA. david.ming@duke.edu.; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA. david.ming@duke.edu., Jones KA; Department of Population Health Sciences, Duke University School of Medicine, 215 Morris St, Durham, NC, 27701, USA., Sainz E; Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA., Tkach H; Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA., Stewart A; Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA., Cram A; University of North Carolina School of Public Health, 135 Dauer Drive, Chapel Hill, NC, 27599, USA., Morreale MC; Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA.; Legal Aid of North Carolina, 224 S. Dawson St, Raleigh, NC, 27601, USA., Dizon S; Department of Pediatrics, DUMC, Duke University School of Medicine, Box 3352, Durham, NC, 27710, USA.; Department of Medicine, Duke University School of Medicine, 2301 Erwin Rd, Durham, NC, 27710, USA., deJong NA; Department of Pediatrics, University of North Carolina School of Medicine, 260 MacNider Building, CB#7220, Chapel Hill, NC, 27599, USA.
Jazyk: angličtina
Zdroj: Implementation science communications [Implement Sci Commun] 2021 Nov 21; Vol. 2 (1), pp. 130. Date of Electronic Publication: 2021 Nov 21.
DOI: 10.1186/s43058-021-00237-3
Abstrakt: 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.
(© 2021. The Author(s).)
Databáze: MEDLINE
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