O2095: Co-Creation of a Social Needs Screening and Response Process for the PICU

Background: Racial and socioeconomic disparities are well-described in critically ill children. Neighborhood poverty, minority race and ethnicity, and insurance status are associated with higher rates of PICU admission and longer length of stay.1,2 Latino children have higher rates of PICU-related mortality compared to white children.3 Critically ill children and their families have twice the prevalence of food insecurity compared to the general population.4 For children admitted to the PICU with sepsis, low socioeconomic status is associated with higher odds of mortality.5,6 In response to the growing body of evidence of racial and socioeconomic disparities, many professional organizations recommend screening for and addressing unmet social needs.7–9 Emerging evidence shows that addressing unmet social needs may improve child health, reduce hospitalization rates, and improve access to resources.10–12 Further, there is evidence that racial inequities can be minimized or eliminated with equity-focused interventions.3 Despite this, routine unmet social needs screening and support is not regularly performed in the PICU. Social needs care represents an unexplored area to improve child health and reduce inequities for critically ill children and their families. Our objective was to co-created a screening and response process addressing unmet social needs for children and families that is activated out of the PICU, connects to longitudinal support, and uses family-centered and strengths-based design.

Methods: We conducted a qualitative study to understand family and stakeholder-identified facilitators and barriers to successful social needs screening and response processes in the PICU. Parents and caregivers of children admitted to the PICU within the 12 months prior to study start date were recruited for this study. We also recruited community partners working in social services provision. We used modified grounded theory to create focus group and interview guides exploring perspectives on the current state of social needs screening, perceived facilitators and barriers to successful screening and response processes, and structures and personnel necessary to ensure successful interventions. Transcripts were coded to identify common themes through thematic content analysis. Using co-creation and human-centered design, we co-developed a plan for a social needs screening intervention outlining a collective vision for a social needs intervention, resource platform, sustainability plan, and structured process for improvement.

Results: Qualitative interviews and focus groups were conducted until we achieved saturation of themes regarding facilitators and barriers to social needs screening and provision. We identified unique themes in the family interviews compared to the community stakeholder cohort. Both perspectives provided valuable and unique incite, which was incorporated into the co-creation of the screening and response process through multi-disciplinary, stakeholder-informed collaboration.

Conclusion: Family and stakeholder perspectives should be leveraged in the design of strengths-based, family-centered interventions by elevating individual and community assets to create a more equitable and healing environment.