075 - Optimising Screening for Social Determinants of Health – When, Where and Who: A Comparison of Results in the NICU vs. Labor and Delivery

Publication Number: 75.5914

Bianca Olivieri, Baystate Children's Hospital, Holyoke, MA, United States; Elisabeth Romero, Floating Hospital for Children at Tufts Medical Center, Melrose, MA, United States; Katherine M. Murphy, Baystate Children's Hospital, Hatfield, MA, United States; Robert W. Rothstein, UMass Chan Medical School-Baystate, Longmeadow, MA, United States; joanna beachy, Baystate Children's Hospital, longmeadow, MA, United States; Jemimah Jurado, Baystate Children's Hospital, West Suffield, CT, United States; Emily Lajeunesse, Baystate Children's Hospital, Springfield, MA, United States

Background: Social determinants of health (SDoH) are non-medical factors that greatly affect health and quality-of -life. Despite AAP and CMS recommendations to screen for SDoH in all clinical settings, this has rarely been accomplished. We have previously shown the feasibility of implementing screening in a level III neonatal intensive care unit (NICU) during a year-long piloting project. Screening was expanded to all hospital divisions including labor and delivery (L&D) per state mandate in February 2024, creating the opportunity to compare screening results in different settings.

Objective: To evaluate the results of SDoH screening performed in the NICU compared to L&D.

Design/Methods: Design/Method: Baystate Medical Center, a safety net hospital in Springfield, MA was selected as one of 5 hospitals to pilot systemic SDoH screening in the NICU. Beginning in March 2023, screening was performed by a NICU social worker, typically 2 or more days after birth. Eligible patients were born after Jan 1 2023 with > 7 day length of stay. The screening tool included questions on access to housing, food, utilities, transportation, education, employment and childcare. In February 2024, the same screening tool was implemented in L&D, completed by a nurse at the time of maternal admission, typically prior to birth. The primary outcome is percent of families screening positive for at least one SDoH. Secondary outcomes include percent of families screening negative but requesting SDoH resource information and parents requesting mental health support.

Results: From Jan 2023 to Jan 2024, 299 eligible families were screened in the NICU with 22% screening positive. From Feb 2024 to June 2024, 141eligible families were screened by L&D staff,with 8% screening positive. There was a significant decrease in the number of families who requested SDoH resource information though screened negative (average 3 per month in the NICU vs 1 in L&D). There was also a decrease in parents requesting mental health support (average 1.5 in the NICU vs 0 in L&D).

Conclusion(s): Positive SDoH screening responses decreased from 22% to 8% when screening was changed from the NICU to L&D. Requests for resources also decreased as did requests for mental health support. Given the longer duration of stay and prevalence of at-risk families, the NICU is an ideal setting for SDoH screening. Our results suggest that SDoH screening is significantly impacted by timing and setting.

Positive Social Determinants of Health Screens from February 2023 to June 2024
Positive SDoH screens decreased significants from 22% to 8% when screening occurred in the NICU compared to being performed in L&D.

Requests for Social Determinants of Health Resources and Mental Health Support.
There was an average of 3 families per month screening positive on SDoH screens, when screening took place in the NICU (from February 2023 to January 2024). This decreased to an average of 1 family screening positive per month when screening was competed in L&D. There was also a decrease in mothers requesting mental health support when screening occurred in the NICU (average of 1 positive screen per month) compared to in L&D (average of no positive screen per month).