Children with difficult medical issues — those who have chronic physical or mental health problems with functional limitations and more healthcare needs than their peers — were more likely to experience social challenges at home than children without those challenges, according to findings published in JAMA Pediatrics.
The study, co-authored by Michelle Macy, MD, MS, associate professor of Pediatrics in the Division of Emergency Medicine, demonstrates the need for additional support for these children in clinical settings and highlights opportunities for pediatric providers to serve as a point of connection between families and social services within patient communities.
“If we are able to identify social challenges and put supports in place to address these challenges, we can expect the result to be healthier and happier children and families,” Macy said.
The current study was developed by a team of pediatric health services investigators, including Macy, who care for children with special healthcare needs in collaboration with a parent of a child with complex and chronic medical conditions.
The team utilized data from the 2017 National Survey of Children’s Health, which included data from surveying caregivers and data available about communities, to compare social challenges in children with more significant medical challenges, or higher medical complexity, to those who had no special healthcare needs and those with lower medical complexity who have either functional limitations or a need for more care, but not both.
From the survey data, the investigators identified three types of social determinants of health challenges: neighborhood factors, such as rundown housing or vandalism; parent or household factors, including having a single parent, parents with poor mental or physical health, or living in poverty; and adverse childhood experiences, including divorce, incarceration of a parent or child abuse and food insecurity.
Overall, social challenges were more prevalent in children with higher medial complexity, suggesting that implementation of not only individual-level but also community-level social solutions is needed, according to Macy.
“Our findings are a call for pediatric healthcare providers to identify these social challenges in their medically complex patients and to advocate for social services to support families in their clinics and communities,” Macy said.
According to Macy, potential next steps are to better understand how pediatric healthcare providers currently screen for and identify social stressors in patients, to determine ways in which providers can screen for social stressors earlier on, and to establish best practices for connecting families to social services for additional support.
This study was supported by grant UA6MC31101 from the Health Resources and Services Administration of the U.S. Department of Health and Human Services.
