77 - Families’ Perspectives on Social Services Navigation in Pediatric Urgent Care

Poster Number: 77
Publication Number: 77.210

Alison Aronstam, University of California, San Francisco, School of Medicine, Palo Alto, CA, United States; Denisse Velazquez, University of California, Los Angeles David Geffen School of Medicine, Hawthorne, CA, United States; Holly Wing, University of California, San Francisco, School of Medicine, San Franciso, CA, United States; Danielle Hessler, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Victoria F. Keeton, University of California, San Francisco, School of Medicine, San Francisco, CA, United States; Karen Sokal-Gutierrez, University of California Berkeley, School of Public Health, Berkeley, CA, United States; Laura M. Gottlieb, UCSF, SF, CA, United States

Background: Interest is growing in clinic-based programs that screen for and intervene on patients’ social risk factors, including housing, food, and transportation. Though several studies suggest these programs can positively impact health, few examine the mechanisms underlying these effects.

Objective: This study explores pathways through which identifying and intervening on social risks can impact families’ health.

Design/Methods: This qualitative study was embedded in a randomized clinical trial based in the pediatric urgent care unit of a San Francisco county hospital. The primary study examined the health impacts of participation in the Health Advocates program, in which families visiting urgent care were offered navigation services intended to facilitate connections with social services programs. We conducted semi-structured interviews with 27 English or Spanish-speaking caregivers of pediatric patients who had participated in the Health Advocates program. Interviews were analyzed using thematic analysis.

Results: Of 175 invited participants, 54 caregivers of pediatric patients expressed interest in completing interviews, of whom 27 caregivers were interviewed. Demographics of caregivers who completed interviews are summarized in Table 1. Nearly all participants (25/27) endorsed at least one social risk and most (19/27) endorsed multiple social risks (average number of social risks endorsed 3.7, range 0-9). 
Caregivers described three pathways through which the Health Advocates program affected overall child and/or caregiver health (Figure 1): 1) increasing families’ knowledge of and access to social services; 2) helping families connect with health care services; and 3) providing emotional support that reduces caregiver isolation and anxiety. Participants suggested that navigation programs can influence health even when they do not directly impact resource access.Conclusion(s): Social care programs may impact health through multiple potential pathways. Program impacts appear to be mediated by both the extent to which programs increase patients’ knowledge of and access to social and health care services and on the supportive relationships between patients and program personnel.
Table 1: Study Participants’ Characteristics
Figure 1: Pathways to Health ImpactParticipants described three pathways through which the Health Advocates program positively impacted caregiver and/or family members’ physical and mental health.