499 - Social Needs & Children with Special Health Care Needs: Investigating Outcomes to Drive Health System Improvements

Poster Number: 499
Publication Number: 499.344

Kevin J. McKenna, The Children's Hospital at Montefiore, New York, NY, United States; Kevin Fiori, Albert Einstein College of Medicine, Bronx, NY, United States; Earle C. Chambers, Albert Einstein College of Medicine, Bronx, NY, United States

Background: Children with Special Health Care Needs (CSHCN) are at increased risk for higher financial burden, social stressors, unmet health needs, and are more likely to utilize health services and experience poor care coordination. Though past studies report association between CSHCN and poor care, further data is needed to identify the associations between specific CSHCN diagnoses and unmet social needs that can optimize systems improvement.

Objective: To investigate the associations between CSHCN diagnoses and social needs.

Design/Methods: We conducted a cross-sectional study of 19,779 Pediatric patients screened for social needs at primary care practices in a large urban health system in the Bronx, NY, from April 2018-December 2019. Patients were screened for 10 unmet needs such as poor housing quality, housing insecurity, and food insecurity (full listing in table 1). Using the electronic medical record, we also used ICD-10 codes to identify children with 6 of the most common CSHCN diagnoses (listed in table 1). In bivariate and logistic analyses, we evaluated CSHCN diagnoses and social need. Our independent variables were the CSHCN diagnoses. Our dependent variable was presence of social need. In our second analysis, we developed a separate model for each of the 10 social needs: our independent variables were the CSHCN diagnoses; our dependent variable was presence of the social need. The reference group in our analyses were children with no CSHCN diagnoses. In our logistic models, we adjusted for sex, age, race/ethnicity, language, insurance, and poverty status.

Results: Of 19,779 children included in the study, 1,223 of 8,708 (14%) of families without CSHCN expressed social need; 2,247 of 11,071 (20%) families with CSHCN expressed need. In bivariate analysis, families with CSHCN diagnoses were more likely to have a social need than families without CSHCN diagnoses (Odds Ratio [OR]: 1.55; 95% Confidence Interval [CI]: 1.44 – 1.68) (Table 1); when adjusted, OR was 1.53 (95% CI: 1.41-1.65) (Table 2). Children with Autism/Developmental Delay were most likely to have a social need compared to children without CSHCN (Table 1-2). Autism/Developmental Delay, Anxiety/Depression, and Asthma were most likely to express specific social needs (Table 3).Conclusion(s): This study provides evidence of association between specific CSHCN diagnoses and unmet social needs, particularly Autism/Developmental Delay and Anxiety/Depression. Health systems should be screening for these needs to address them among CSHCN populations; attention to these families’ needs may reduce system costs and improve overall health outcomes.
CV KevinMcKenna 2021 UPDATED 12.21.pdf
Association between CSHCN Diagnosis and Any Social Need, Multivariate Analysis