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!