Paper on screening for social factors in clinical settings

HealthBegins members might be interested in our recent paper exploring methods of screening for social needs in clinical settings. 

A Randomized Trial on Screening for Social Determinants of Health: the iScreen Study.

Gottlieb LHessler DLong DAmaya AAdler NPediatrics. 2014 Nov 3. pii: peds.2014-1439. 



There is growing interest in clinical screening for pediatric social determinants of health, but little evidence on formats that maximize disclosure rates on a wide range of potentially sensitive topics. We designed a study to examine disclosure rates and hypothesized that there would be no difference in disclosure rates on face-to-face versus electronic screening formats for items other than highly sensitive items.


We conducted a randomized trial of electronic versus face-to-face social screening formats in a pediatric emergency department. Consenting English-speaking and Spanish-speaking adult caregivers familiar with the presenting child's household were randomized to social screening via tablet computer (with option for audio assist) versus a face-to-face interview conducted by a fully bilingual/bicultural researcher.


Almost all caregivers (96.8%) reported at least 1 social need, but rates of reporting on the more sensitive issues (household violence and substance abuse) were significantly higher in electronic format, and disclosure was marginally higher in electronic format for financial insecurity and neighborhood and school safety. There was a significant difference in the proportion of social needs items with higher endorsement in the computer-based group (70%) than the face-to-face group (30%).


Pediatric clinical sites interested in incorporating caregiver-reported socioeconomic, environmental, and behavioral needs screening should consider electronic screening when feasible, particularly when assessing sensitive topics such as child safety and household member substance use.

Copyright © 2014 by the American Academy of Pediatrics.


emergency medicine; psychosocial issues

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Comment by Rajiv Bhatia on December 16, 2014 at 3:14pm

Thanks Laura.  This is timely and useful knowledge for moving toward more standard and systematic social determinants screening.


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