109. Identifying Adolescents With Elevated Social Risk In The Pediatric Emergency Department

Abstract

Addressing social determinants of health (SDH) is a mandate of Healthy People 2020 and the American Academy of Pediatrics. The emergency department (ED), often serving as a safety net for vulnerable populations, may be a strategic venue for this activity as evidence supports the impact SDH can have on health outcomes. The objective of this analysis was to identify characteristics of adolescent ED patients who may benefit from proactive intervention during an ED visit to address and mitigate elevated social risk. We hypothesized that adolescents with one or more of the following characteristics would have a higher number of reported social risks than adolescents without them: 1) any of nine (9) chief complaints (animal bites, psychiatric complaints, intoxication, ingestion, reproductive or sexual health issues, peer assault, physical abuse, sexual assault/abuse or any complaint triaged at the least acute level), 2) a body mass index (BMI) > 95th percentile, 3) three or more non-urgent visits in the preceding 12 months, OR 4) poor asthma control. This is a secondary analysis of an ongoing randomized trial designed to measure the impact of an ED-based social navigation system on ED recidivism. Adolescents ( ≥13 years of age) seeking care in a large, urban pediatric ED completed a tablet-based survey comprised of questions regarding 13 social domains: literacy, housing, food security, education, access to primary care, mental health, substance abuse, sexual health and behaviors, intimate partner violence (IPV), immigration, human trafficking and legal issues. Items in each domain were derived from previously validated measures when available. The total number of reported social risks was calculated. The Mann Whitney U test was used to compare the median number of social risks between participants identified as high risk (as defined above) and those who did not. Statistical analysis was completed using SAS. In this ongoing study, 226 adolescents have been approached with 92 completed surveys. The mean age is 16.5 (SD 2.0) years and the majority identified as black (75.8%) and female (69.2%). 95.6% of adolescents reported at least one social risk factor; 46.1% reported at least 3 risk factors. The most frequently identified social risk factors were mental health issues (69.6%), safety issues (41.3%), sexual health issues (34.8%), and poor access to primary care (27.7%). The median number of social risk factors was 3 (95% CI 2-5) in patients with a high risk chief complaint, BMI > 95th percentile, more than 3 nonurgent visits in the preceding 12 months or poor asthma control versus 2 (95% CI 1-3) in patients without any of these characteristics (p=0.0014). Many adolescents seeking care in the pediatric ED report high rates of social risk. High risk adolescents had significantly greater numbers of social issues than non-high risk adolescents. Studies assessing optimal implementation of SDH screening and intervention in the pediatric ED are warranted.