Can a screening for social determinants of health effectively inform children's health care?
October 7, 2019
A study by students and faculty at the UNC Gillings School of Global Public Health explored whether screening tools that examine social determinants of health in children can accurately identify early indicators of risk. Based on the researchers’ comprehensive review of existing literature, it remains unclear whether such screenings — which aim to consider risk factors outside traditional medical information — inform better care for children.
Dr. Meghan Shanahan
Dr. Anna Austin
Dr. Rebeccah Sokol
Rebeccah Sokol, PhD, and Anna Austin, PhD, who both received doctoral degrees from the Gillings School in 2019, are lead authors of “Screening Children for Social Determinants of Health: A Systematic Review,” which was published in the October 2019 issue of Pediatrics. The publication is a project of UNC’s Child Maltreatment Research and Practice Network, which was co-founded in 2017 by Sokol, Austin and Meghan Shanahan, PhD, assistant professor of maternal and child health at the Gillings School and faculty adviser for the group.
The World Health Organization defines social determinants of health as “the conditions in which people are born, grow, work, live and age, and the wider set of forces and systems shaping the conditions of daily life.” These determinants include hardships such as food and housing insecurity, adverse childhood experiences such as maltreatment and parental substance use, community-based factors such as access to childcare and education, and other factors that can impact child health and development.
“There is still a lot of debate as to whether children should be screened for social determinants of health, particularly adverse childhood experiences,” says Austin. “Much of this debate centers around concern as to whether screening will actually result in improved care and appropriate linkage to community resources to meet family needs and priorities. The hope is that, if conducted, a screening for social determinants of health will be one component of a larger system of comprehensive, integrated care.”
Out of a sample of 6,274 studies, the group analyzed 17 studies that included 11 screeners. Screenings primarily were conducted in clinical settings with a parent or caregiver as the primary informant. The most common domains of social determinants of health that were assessed included family context and economic stability.
The team found that the extent to which screenings accurately assess a child’s social determinants of health is largely unevaluated in the existing research literature. Sokol and Austin say the findings highlight the need to incorporate assessments that fully consider the family’s context and circumstances.
“There’s been limited attention given to assessment of the validity and reliability of screeners, limited emphasis on protective factors and family and community strengths in screeners, and little attention to examining how screening results inform referrals and intervention,” says Austin.
The Child Maltreatment Research and Practice Network, which is entirely student-led with faculty support from the Gillings School, the School of Social Work and UNC’s Injury Prevention Research Center, allows students and faculty to discuss current developments in child maltreatment research, practice and policy. Students engage in journal club discussions, attend research presentations and visit local agencies serving children and families to consider how to bridge the gap between research and practice.
“We noticed that there were an increasing number of students entering Gillings with interests relating to child maltreatment and other early childhood adversities, so the network serves as a way to bring together students and faculty from multiple disciplines to engaging in learning and discussion,” Austin says.
Other Gillings School co-authors on the paper are Shanahan; Caroline Chandler, MPH, a doctoral student of maternal and child health; Elizabeth Byrum, a master’s student dually enrolled in maternal and child health and the social work program at UNC; Jessica Bousquette, a master’s student of health behavior; Christiana Lancaster, a master’s student of maternal and child health; Ginna Doss, MPH, a doctoral student of epidemiology; Venera Urbaeva, MPH, a master’s student of maternal and child health; and Bhavna Singichetti, MPH, a doctoral student of epidemiology.
Students and faculty interested in learning more about the Child Maltreatment Research and Practice Network can contact Caroline Chandler (chandlec@live.unc.edu), the current student co-leader of the network.
Contact the Gillings School of Global Public Health communications team at sphcomm@unc.edu.
