209 - Addressing Diaper Need and Secondary Impacts with Integration in a Medical Home

Publication Number: 209.3847

Winter Berry, State University of New York Upstate Medical University, Syracuse, NY, United States

Background: Diaper need is a lack of sufficient diapers to change a child as often as necessary. This need is not met by other safety net programs, affects 1 in 2 families, and has secondary impacts of caregiver stress, diaper dermatitis, missed caregiver work, and exacerbation of basic needs insecurities.

Objective: Our primary care clinic serves families in census tracts with some of the highest national rates of child poverty. Here, we present our experience over time including the COVID pandemic with a co-located diaper bank and resultant diaper need trends, including regional secondary benefits of diaper receipt.

Design/Methods: We partner with a local diaper bank that arranges logistics of diaper purchase and processing. Diapers are stored on site in our clinic. Nursing screens families at well visits under age 4 for diaper need. Families with need receive 50 diapers and are given a voluntary QR based survey. Our EMR was queried for number of well visits under age 4 from 2017 – 2023. Universal diaper need screening has been continuous over that time. Diaper distribution records were compared to total well visits to calculate the percentage of visits with diaper need.

Results: 31,313 well visits under age 4 were completed from 2017-2023. Volume of well visits per year decreased in 2020-2021 with some rebound in 2022-2023. 656,870 diapers were distributed over the 7 years. Percent of visits with need increased every year in the timeframe, peaking at 62% in 2023; a greater than 2.5 times increase from 2017. Regional survey data showed that 70% had reduced stress, 80% felt like a better parent, 69% could buy nonfood essentials, 70% could buy more food, 79% felt their babies are healthier, 76% could pay a bill.

Conclusion(s): Diaper need is an increasing issue for parents of young children. Our experience of universal screening shows consistently increasing diaper need year over year. Current rates of diaper need in our population are greater than nationally reported. Despite decreased clinical volume during the pandemic, the proportion of need continued to rise. Increased diaper need from 2020-2022 was likely due to the financial impacts of the early pandemic. Increases in 2023 were unexpected but may have been due to discontinuation of COVID era cash, WIC benefits, and pauses on utility shut offs and evictions. Survey data shows evidence of emotional and financial benefits to families and their communities. With co-location of a diaper bank, our program remains unique amongst pediatric medical homes and demonstrates a replicable means to address social determinants without undue stigma or barriers.

Incidence of Diaper Need vs. Well Child Volume 2017-2023