More Social Needs Endorsed by Caregivers of Young Children Experiencing Everyday Discrimination

Background: Both discrimination and social needs are underlying risk factors for poor health outcomes; however, there are no studies looking at how feelings of discrimination impact reporting of social needs in the pediatric health care setting. Objective: To compare caregiver report of social needs and desire for help addressing social needs in the pediatric primary care setting based on respondents’ experiences with discrimination. Methods: We conducted a cross-sectional study of caregivers of children aged 2-5 in an urban primary care setting. Caregivers completed a tool to screen for 15 social needs and desire for help to address these needs, with in-person assistance available. The tool was adapted based on qualitative data with this same population and included items from the PHQ-2, 2-item food insecurity screener, and WE CARE survey. The short version of the “Everyday Discrimination Scale” was also completed, and caregivers were categorized as experiencing everyday discrimination if they responded “rarely”, “sometimes”, or “often” on any of 5 types of discrimination. If caregivers experienced everyday discrimination, they were also asked about perceived basis for discrimination. T-tests were conducted to compare the number of reported social needs and number of needs for which a caregiver desired help between groups based on experience of everyday discrimination and type of discrimination. Results: One hundred seventy-eight caregivers (94% mothers, mean age 32) of diverse racial and ethnic backgrounds (29% white, 61% black; 10% Hispanic) completed the screening tool. Sixty-seven percent had public insurance, and 35% were from households with an annual income below $20,000. Fifty-three percent of caregivers reported everyday discrimination, especially in regards to being treated with less respect and receiving poorer service in stores and restaurants (Figure 1) and most commonly on the basis of race (48%), gender (38%), and age (31%). Both caregivers who endorsed everyday discrimination in general, and those endorsing discrimination specifically by gender and age, reported a significantly higher number of social needs and number of social needs for which they wanted help (Table 1). Conclusions: In an urban population of mostly young Black mothers, the majority endorsed feeling some degree of everyday discrimination. Despite this, caregivers who endorsed feelings of discrimination, especially because of their gender and age, reported more social needs and a greater desire for help addressing these needs. This suggests that caregivers feel comfortable reporting sensitive social needs in the context of a child’s healthcare setting even though they may experience everyday discrimination. These findings may also suggest an association between experienced discrimination and social needs, with both potentially influenced by similar sociodemographic factors

Understanding Social Needs of Families with Young Overweight Children in an Urban Primary Care Setting: A Mixed-Methods Study

Unmet social needs, such as stable housing, reliable access to food and treatment of parental depression are associated with childhood overweight. Little information exists on parental perception of addressing these needs. We sought to understand the perspective of parents of young overweight children on how to best address social needs in the primary care setting. We conducted a mixed-methods study. The 11-item WE CARE survey, PHQ-2, and 2-item food insecurity screener were used to screen for social needs. Semi-structured interviews were conducted with English-speaking parents of overweight (BMI ≥ 85%) children 2-5 years of age with Medicaid. Interviews assessed parental perception about addressing social needs in the primary care setting. Twenty-two parents participated. Parents responded positively to having a social need 46 times on the WE CARE survey, with the majority being in the areas of smoking cessation and employment. However, parents reported that they did not want to address the majority of these needs at the visit. Only 2 of 11 parents who screened positive for depression on the PHQ-2 endorsed wanting help to address mood, and only 1 in 10 who screened positive for food insecurity endorsed wanting help accessing food. Two salient themes arose during the interviews that influence asking for support: 1) level of comfort disclosing needs and 2) family resourcefulness and resiliency. Discomfort was associated with parental fear of being considered neglectful and involvement of child protective services. Though a majority of parents found the screener to be useful, they suggested reframing to highlight support available, emphasizing how resources may benefit the child. Screening tools may benefit from adaptation for families are uncomfortable asking for support or who are resourceful at meeting their needs. Emphasizing the non-punitive nature and providing information on resources upfront may promote resource utilization among this patient population