Topical review: family psychosocial risk screening and social determinants of health assessment

Abstract

Objective: Social-ecological factors are highly congruent with social determinants of health (SDOH): Economic Stability; Educational Access/Quality; Healthcare Access/Quality; Neighborhood/Built Environment; and Social/Community Context. In this topical review, the correspondence of social-ecological theory with SDOH and assessment approaches is reviewed. The Psychosocial Assessment Tool (PAT) is used to show how existing tools may facilitate SDOH screening.

Methods: SDOH are defined, and their link to pediatric health outcomes is presented, followed by a review of the social-ecological model. Feasible, valid, and actionable approaches to assessment of social ecology and SDOH are presented with a focus on the PAT, a brief caregiver report screener based on social-ecological theory, validated in English, Spanish, and in multiple conditions and adapted/translated internationally. Multidisciplinary healthcare providers (n = 25) completed an online survey, indicating whether each PAT item fit into SDOH categories.

Results: Despite different approaches to assessing SDOH, there are few feasible and evidence-based approaches. Most PAT items (78%) were consistent with one of the SDOH categories by the majority of raters. PAT items corresponded to all five SDOH categories. Some items about child behavior and family were not categorized as an SDOH, reflecting the broader context of screening with the PAT.

Conclusion: The assessment of SDOH is a priority, but approaches to assessment and linking outcomes to intervention remain underdeveloped. As an evidence-based screener in pediatric healthcare, based on social-ecological and public health models, the PAT may provide a means of identifying relevant SDOH in pediatric practice.

Keywords: Psychosocial Assessment Tool (PAT); Social Determinants of Health (SDOH); family psychosocial functioning; pediatrics; social ecology.