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Screening for Both Child Behavior and Social Determinants of Health in Pediatric Primary Care

Berger-Jenkins, Evelyn MD, MPH*; Monk, Catherine PhD; D'Onfro, Katherine MPH; Sultana, Majeda MS§; Brandt, Lisa MD; Ankam, Jyoti MBBS; Vazquez, Nadiuska LCSW**; Lane, Mariellen MD*; Meyer, Dodi MD*

Journal of Developmental & Behavioral Pediatrics: July/August 2019 - Volume 40 - Issue 6 - p 415–424
doi: 10.1097/DBP.0000000000000676
Original Article

Objective: To implement comprehensive screening for child behavior and social determinants of health in an urban pediatric practice and explore rates of referrals and follow-up for positive screens.

Method: Quality improvement methodology was used to implement routine screening using an adapted version of the Survey of Well Being of Young Children, a child behavior and social screen, for all children aged 6 months to 10 years. Rates of screen administration and documentation were assessed for 18 months. Medical records of a convenience sample (N = 349) were reviewed to track referrals and follow-up for positive screens. A secondary analysis explored associations between reported parental concern for their child's behavior and both child behavior symptoms and social stressors.

Results: Over 18 months, 2028 screens were administered. Screening rates reached 90% after introducing a tablet for screening. Provider documentation of screens averaged 62%. In the convenience sample, 28% scored positive for a behavioral problem, and 25% reported at least 1 social stressor. Of those with positive child behavior or social stressor screens, approximately 80% followed up with their primary medical doctor, and approximately 50% completed referrals to the clinic social worker. Further analysis indicated that referral and follow-up rates varied depending on whether the family identified child behavior or social issues. Logistic regression revealed that parental concern was independently associated with child behavior symptoms (p = 0.001) and social stressors (p = 0.002).

Conclusion: Implementing a comprehensive psychosocial screen is feasible in pediatric primary care and may help target referrals to address psychosocial health needs.

*Division of Child and Adolescent Health, Department of Pediatrics, Columbia University Medical Center, New York, NY;

Divisions of Behavioral Medicine and Developmental Neuroscience, Department of Psychiatry and Obstetrics and Gynecology, Columbia University Medical Center, New York, NY;

Heilbrunn Department of Population and Family Health, Columbia University Mailman School of Public Health, New York, NY;

§Department of Clinical Psychology, Columbia University Teacher's College, New York, NY;

Columbia University College of Physicians and Surgeons, New York, NY;

Department of Biostatistics, Columbia University Mailman School of Public Health, New York, NY;

**Division of Social Work, New York Presbyterian Hospital, Ambulatory Care Network, New York, NY.

Address for reprints: Evelyn Berger-Jenkins, MD, MPH, Division of Child and Adolescent Health, Columbia University Medical Center, 622 West 168th St, New York, NY 10032; e-mail:

Disclosure: The authors declare no conflict of interest.

Sources of Funding: Sackler Parent Infant Project.

See related commentary on page 470

Received April 17, 2018

Accepted March 08, 2019

Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.