Abstract
Background: Social conditions influence children’s morbidity, well-being and health equity from pre-conception throughout their life course. Hospital in- and outpatient admissions offer an excellent non-stigmatizing opportunity for the detection of social needs, the initiation of counselling and referrals to social services, if needed. However, it is not yet routine practice to measure social conditions systematically in child health care. Thus, the aim of our study is to develop an instrument to measure social conditions and screen for health-related social needs in children within in- and outpatient hospital care for children in Germany.
Methods: Based on items of an existing Canadian screening tool and additional items identified through a recent systematic review we will define a pool of possible items for the new instrument. A Delphi panel will select appropriate items based on an adapted UCLA/RAND method. Where needed, items will subsequently be culturally adapted. The Delphi panel will consist of interdisciplinary experts from medicine, psychology, social work, nursing and public health as well as parent and patient representatives. Throughout the project, we collaborate with social workers and practitioners at the department of general paediatrics in Düsseldorf to ensure feasibility and integration of the newly developed instrument into routine health and social care pathways.
Results: The result of our study will be the first German-language questionnaire completed by parents, capturing social conditions and health-related social needs of children and families in a broad age range (0 to 18 years). We will present preliminary findings of the Delphi process, including the item pool compiled for evaluation as well as items considered appropriate to measure social conditions and identify needs and the level of agreement between the experts. In addition, we will report reasons for adaptation of items to fit the German context. Specifically, we will discuss how contextual factors (e.g. health insurance and national welfare systems) influence changes in the wording of the items.
Lesson learned and next steps: Insights from this study will contribute to advancing the measurement of social conditions and identification of health-related social needs of children in the German health care system. The study contributes to the existing evidence, which mainly originates from studies in North America, and increases the understanding of how different contexts of social and health care systems affect the content, process and form of screening for social needs. The development of the parent-reported social condition and health-related social needs instrument will be followed by pilot testing and validation at the paediatric wards and clinics in Düsseldorf. Over a period of three months, all parents of children admitted to the outpatient clinics (neuropediatric, endocrinology, gastroenterology, pulmonology, social paediatric centre) and respective inpatient wards will be asked to fill out the parent instrument. During this phase, we offer easily accessible support by hospital social services for all families participating in the study. After feasibility testing and validation, we plan to transfer the instrument to routine care, as the first element of a system to refer families to social supports if and as needed.