In the wake of widespread protests against police brutality and systemic racism, many find themselves asking what they could do to support the Black Lives Matter movement. For CPCE, one starting point among a range of needed activities is to conduct research to uncover racial and ethnic disparities in access to healthcare and health outcomes, and explore how best to address upstream social determinants of health, in which race is often linked with other household and neighborhood factors. Previous issues of CPCE E-News reported on disparities in premature births and in bystander CPR.

A recent invited commentary by Chén Kenyon, MD, MSHP, Katie McPeak, MD, and Alexander Fiks, MD, MSCE praised a social needs intervention clinical trial conducted by a San Francisco Bay Area team. The San Francisco study compared in-person navigation by trained volunteers to address social needs vs. written information on relevant community services. Results published in 2016 showed that at four months after enrollment, the intervention group reported fewer social needs and greater improvement in parent-reported child health, compared to the active control group. A secondary analysis published this month showed that children in the intervention group were less likely to be hospitalized within 12 months after enrollment. Based on these recent results, Dr. Kenyon et al. wrote, “health systems hoping to implement social needs interventions in pediatrics can claim with more certainty that social needs interventions can lead to meaningful improvements in a costly health care outcome, ie, hospitalization.” Many questions remain, however, and Dr. Kenyon and colleagues recommend future effectiveness and implementation research “to specify the pathways and conditions by which social needs identification can lead to improved health outcomes to inform whether and how best to deploy similar interventions.” They further advocate for inclusion of family stakeholders as health systems move to implement social needs screening.

Dr. Kenyon also contributed to a recent study conducted at CHOP that looked at pediatric residents’ social needs screening practices in both inpatient and outpatient settings. Overall, they found higher rates of social needs screening in outpatient settings, although screening rates varied by type of need. They further found that residents were more likely to screen if questions were embedded in the electronic health record (EHR) template. These results suggest opportunities for improvement in screening and workflow, particularly in the inpatient setting. The team included Aditi Vasan, MD, attending physician in general pediatrics and member of the National Clinician Scholars Program at Penn, and Deepak Palakshappa, MD, MSHP, a graduate of the CHOP Academic General Pediatrics fellowship and now Assistant Professor of Pediatrics and General Internal Medicine at Wake Forest.

Ariel Williamson, PhD is currently adapting and piloting evidence-based behavioral sleep strategies for implementation in urban primary care practices, where a large portion of patients and families are of racial/ethnic minority backgrounds and of low socioeconomic status. Children in these groups are at elevated risk of poor sleep, which can lead to long-term health consequences. Two recent studies highlight this work. In one, Dr. Williamson’s team conducted semi-structured interviews with urban primary care clinicians and caregivers of toddlers and preschoolers with insomnia or insufficient sleep about potential barriers and facilitators to implementing evidence-based behavioral sleep interventions. Participants from both groups identified family work schedules, household and neighborhood factors as barriers; and intervention flexibility, collaborative and empowering care, caregiver-to-caregiver support, and use of technology as facilitators. In another study, Dr. Williamson and her collaborators sought to identify modifiable factors linking parenting skills and child sleep in families of racial/ethnic minority backgrounds. Their results indicate that interventions to improve child sleep may be enhanced by targeting parenting skills and promoting positive routines at home.

In research on autism spectrum disorder (ASD), a set of recent studies looked at disparities in screening and referral for follow-up services. In a study published late last year, Whitney Guthrie, PhD, Kate Wallis, MD, MPH and colleagues found disparities in screening rates in primary care. Children of color, those from lower socioeconomic backgrounds, and those exposed to a language other than English were screened less frequently and were more likely to be screened only once. Further, when children were screened, there were racial and socioeconomic disparities in the accuracy of the screening tool itself, with higher rates of false positives in these groups of children. Another study looked at a cohort of children with an initial positive screen to determine rates of referrals to Early Intervention services or further evaluation, as recommended by the American Academy of Pediatrics. They found low rates of referrals, especially for girls, children exposed to languages other than English, and black or Asian children. PolicyLab produced a Research at a Glance report on this work.

CPCE recognizes that much work is needed across the arc of research to ultimately promote equity and racial justice. We will leverage the Center’s broad range of methodological expertise in support of this goal.