A lot has happened for the SDH screener project in the weeks since I last wrote. First off, Jennifer has joined our team! She has been integral in so many ways- translating our resources to Spanish, doing quantitative data analysis, conducting surveys and more. Over the weeks, we have been continuously editing our manuscript and have arrived at a draft that we feel confident about (of course, there will be many more edits to come). I have also been busy conducting the one-month follow calls as a part of the pilot study (explained above).
This involves contacting families to hear about their experiences with the referral process. I ask them about the usefulness of the information they received from Pediatrics Associates and their experience at the community based organization itself. If a family did not visit any of the organizations to which they were referred, then I ask the family about any barriers which precluded them from going.
More recently, we have been working on creating a program so that we can train college students as volunteers to screen patients. We are hoping to recruit two Barnard students to join our team this semester and screen patients. As such, we have been working on putting together training materials while standardizing our screening and referral process so that it will be understandable to new volunteers. We are very excited to have volunteers join our team soon!
We have also been working on a modification to submit to the IRB. We have learned a lot over the course of the summer and now we hope to integrate our edits into the serener and pilot study in order to make the newest versions the best they can be. Something that I have loved about working on the screener is its changing nature. It is a work in progress and intended to be amended over and over again until we reach an efficient, effective product.
The summer in Pediatrics Associates has been amazing! I learned so many new things and worked with amazing people. I am thrilled that I will be continuing in the clinic come September!
Half the summer has gone by and our work on the “Social Determinants of Health Screening Project” in Pediatrics Associates continues! Over the weeks since I last wrote, Rebecca and I have continued to screen patients regularly. Last week we even reached our goal of screening 200 patients. Once we reached this number, we were able to analyze the data gathered from this first cohort.
This next step was new to me, as I had never before used excel to analyze data. It came time to learn! We had to figure out how to turn our data from “yes” and “no” answers into data that was numerical, conclusive and easy to communicate. Rebecca came up with a code in which 0 meant “no” and 1 meant “yes”. Using the summation feature on excel we could then total our positive screens and negative screens and present each as a percentage. Some of the less straightforward series of questions from the survey required more thought, but in the end, we were able to analyze all the data!
We also spent the last few weeks enrolling families in a pilot study. Using the general screener, we identified families that screened positive for food insecurity. Then we offered these families different resources and the option of being enrolled in Dr. Mogilner and Dr. Zajac’s pilot study called “The Food Insecurity Toolbox: Developing a Model for Addressing the Social Determinants of Health”. The study aims to assess the effectiveness of the resources being provided to patients. Families with food insecurity are referred to local community organizations and are contacted after one month to determine whether they have visited the organization and received services. To date, we have enrolled 45 families in the study.
As we screen and learn more about the issues at hand, we have also been updating our resources. We have reviewed our them with doctors as well as the social workers to ensure that we are providing patients with accurate resources. Sometimes patients can be referred directly to a community-based organization to address their needs. In other instances, patients need a referral form to be completed by a physician or social worker. In such a case, the screener needs to be able to connect the patient with the correct person. The endpoint of our referral can vary for different social determinants and different patients. We found this inconsistency to be a challenge when trying to identifying the appropriate resource to give a family. As such, we decided to create a clinic flow diagram to depict the process and end point of each screener question.
Creating the clinic flow diagram encouraged us to critically consider the efficiency and directness of the questions in our screener. Subsequently, we decided that our follow up asthma questions needed to be tweaked. These questions were open-ended and added unnecessary time to the survey duration. Dr. Mogilner then contacted an asthma specialist, who guided us in rewording these questions. In the next version of the screener, these questions will be updated.
We have also been busy writing up a manuscript for a paper which describes the process of implementing a screener into a pediatrics clinic. In order to begin writing, we did a major literature review of all related articles. We looked at articles about social determinants in general, as well as articles about the eight specific social determinants addressed in our screener. We also read articles about the implementation of screeners into clinics, the benefits, and challenges. We then researched different journals to which we could submit our paper. We needed to find a paper that accepted the kind of article we wanted to write and had guidelines which we thought we could follow. With Dr. Mogilner’s guidance, we were able to identify the journal where we hope to submit our manuscript.
With this decision made, we were able to get started actually writing the paper and sharing everything we have learned from our time working on the screener! The summer is flying by and it's time to get back to writing!
I joined Dr. Mogilner and Dr. Zajac’s research project this summer. I am working with a medical school student, Rebecca Rinehart, on their “Social Determinants of Health Screening Project,” conducted in the General Pediatrics Practice of Mount Sinai Hospital. Through this project, patients are screened for a number of social determinants of health. Such social and environmental factors have proven to greatly affect a person’s physical and mental health. This study uses a child’s visit to the pediatrician as an opportunity to screen families for different social determinants of health. After being screened, patients can be referred to community based resources related to the challenge that the family faces.
In my first weeks at Mount Sinai Hospital, I have been primarily working on two parts of this study. I have been trained to screen patients using the SDH screener as well as researched the resources to which we refer patients.
The SDH screener we are using covers issues such as food insecurity, environmental challenges, learning issues, insurance, and unstable housing. The above topics are personal and sensitive, and I needed to learn how to speak openly about them with patients. Of course, patients do not need to answer any questions they feel uncomfortable answering. The comfort level surrounding these topics varies from individual to individual. Recognizing this, I learned to approach these topics in the most respectful way possible. Tone is of course important. I also found myself changing the introduction I gave to patients. By now, I think I have figured out the best one. It is a little long, but this way I give patients a little sense of the personal topics that will be addressed before jumping right into the questions. Rebecca and I have also decided to change the order of the questions in the SDH screener. Initially, the first question stated: “within the past 12 months were you worried that your food would run out before you had money to buy more?” We now conduct the study beginning with one of two later questions from the screener about the home environment, or education- these seem to be less abrasive starting points.
The screening process has been a very meaningful and eye-opening experience for me. I interact with many patients every day. As the screeners, Rebecca and I (aka team Rebecca) need to figure out where we fit into the flow of the clinic. We sometimes find ourselves in the way of the doctors, and of course, the primary purpose of the patients’ visit is to see the doctor. We generally screen patients after they have been directed to an exam room by a nurse but are waiting for the doctor to examine them. If the doctor arrives while we are still asking the SDH screener questions, then we pop out and hope to catch the patient later. Sometimes we manage to catch the patient before they leave but sometimes we do not. We record this data because it is very important feedback. The hope is that one day screening for social determinants of health will be a part of every primary care visit. Therefore, while we are screening we are constantly thinking about what would be the best way to integrate such a screener without interrupting the routine flow of the clinic and without lengthening the patients’ visit to the clinic.
If a patient screens positive for any of the categories covered by the SDH screener, and wishes to receive resources to combat these issues, then I bring them a sheet of paper listing the available related resources. In addition to screening, I have spent a lot of time familiarizing myself with the resources we provide to patients. In order to be able to explain them to patients, I need to understand them myself. This means researching who qualifies to receive aid from different organizations, or during what hours an organization provides services, and answering other logistical questions. I was stunned to learn about the extensive resources available to help people in New York City. As we’ve combed through these resources, Rebecca and I have worked on shortening and formatting resource sheets so that referrals can be clear and readable for patients in the future. One resource to which we refer patients is the New York Common Pantry food pantry, where individuals get to select for themselves what food they would like to bring home. Hopefully, Rebecca and I will get the opportunity to visit the food pantry next week. I’ve also learned that the NY City Health Department can send a variety of health-related information via text message (try texting “SOGOOD” to 877-877 and see what happens)!
Working as a part of this team has been amazing! I am grateful to have Rebecca to work with during the day. She is efficient, knows a lot and is super helpful. Dr. Mogilner and Dr. Zajac have been incredible! They constantly check in with us to find out how the project is going on our end. They also let us join any meetings they have about the study. So, we’ve had the opportunity to hear about the focus groups they ran prior to starting the study. We also got a taste of what it means to analyze qualitative data. We work with two social workers as well who have been extremely helpful in introducing us to the study, resources and the software- Qualtrics and Redcap- that is essential for keeping track of our data. Dr. Mogilner also tells us about other cool things happening around the hospital, so last week I got to sit on pediatrics grand rounds! It was amazing to hear about other research projects currently underway at Mount Sinai.
The first weeks here have been great! In the coming weeks, I am very excited to continue screening patients and to start analyzing the data we have collected!