P2.159: Menu versus Screening in Identifying Desire for Social Resources: SECURE RCT ED Subgroup Analysis

Background: The Emergency Department (ED) is a key setting for social care, with 40% of patients reporting at least one unmet social need. Although screening is generally the first step in social care, evidence suggests that interest in resources does not correlate with a positive screen, and screening may limit acceptance of resources due to fear of stigma or negative repercussions. This is particularly salient in the ED given lack of longitudinal relationships with patients. Alternatives to screening, such as a “resource menu” where caregivers can self-select resources without disclosing risk, may improve connection with resources. This subgroup analysis investigates ED caregivers’ acceptance of and engagement with social resource information following a resource menu versus standardized social risk screening.

Methods: In a 3-arm pragmatic RCT we recruited adult caregivers of pediatric patients, speaking one of 6 languages, in the ED and 2 primary care clinics associated with a children’s hospital. Caregivers were randomized to: 1) a social risk screener, 2) a resource menu, or 3) no assessment. All caregivers were then provided with an electronic resource map, individual resource navigation 5 days after enrollment, and could request a same-day social work consultation; automatic same-day consultation was triggered for “emergent” needs. Consenting caregivers received a survey 30 days after enrollment to assess reported use of the resource map. Between group differences were assessed with Chi-squared test and logistic regression.

Results: Of 1,996 ED caregivers randomized, 1,406 (70.4%) reported prior use of a social resource. A significantly higher proportion of participants in the resource menu arm reported desire for resources compared to the screening arm (39.6% vs 31.7%, P=0.003). Among the 441 follow-up survey participants, 45.8% reported using the resource map, and 36.7% reported sharing the resource map. Across randomization arms, the likelihood of engaging with resource navigation increased with the number of desired resource domains (OR=2.6, 95% CI=2.2-3.0, p< 0.001).

Conclusion: Our results demonstrate that ED caregivers’ desire for resources can best be identified using a resource menu rather than screening. Additionally, our results suggest a tiered structure of ED social care: electronic resources provided to all, tailored resource information and referrals for those requesting assistance, and individualized resource navigation for those who desire it. This approach enhances equity by centering caregiver autonomy to self-identify desired supports.