Video Curriculum on Screening for the Social Determinants of Health

Publication ID Published Volume
9575 October 9, 2013 9

Abstract

Social Determinants of Health (SDH) are emerging as a major barrier to the promotion of child health in the 21st century. The effects of poverty, including food insecurity, unsafe housing conditions, inadequate educational interventions, domestic violence, and limited access to medical care, have been linked to poor health and developmental outcomes in children. Many pediatric residents lack competence in identifying families that face social, economic or environmental difficulties and feel inadequately prepared to counsel and refer patients and families to appropriate community resources due to their limited training during medical school and early residency years. Additionally, the majority of pediatric residents were not raised in poverty, so they cannot build upon their past experiences. Effective child advocacy training is a critical aspect of pediatric residency education and is required by the Accreditation Council for Graduate Medical Education (ACGME). Thus, it is imperative to develop innovative educational strategies to train residents in screening for and identification of SDH.

This curriculum was developed following a needs assessment and positive feedback obtained after a brief one-time educational experience with videotaped social history vignettes. In response, a multidisciplinary team of primary care clinic faculty, medical educators, and legal partners with content expertise collaborated for the development of this curriculum.

Scripts for a series of video vignettes depicting typical scenarios of resident physicians screening for SDH in continuity clinic were developed with clinic parents and resident physicians acting in their respective roles. Videotaping was done by a professional videographer. For each vignette, two versions, inappropriate and appropriate, were created using the same actors. In the inappropriate versions, resident actors failed to adequately screen for SDH despite verbal and non-verbal cues by the parent actors. In the appropriate versions, resident actors encountered the same cues, and they subsequently engaged the parent in a family-centered conversation that focused on screening for SDH. Vignettes highlighted screening for food insecurity, public benefits, housing conditions, maternal depression, domestic violence and education.

In addition, a “day in the life” series was created to allow actual patients and families from the clinic tell their story of how screening, detection, and intervention impacted their family’s lives. The topics of the “day in the life” series were chosen to complement the benefits, housing, and education vignettes.

In consideration of Kirkpatrick’s evaluation hierarchy, we evaluated the effectiveness of our social history video curriculum at multiple levels.

1) Level 1 – Resident Reaction to training (24 residents participated in training):

  • The vast majority (>95%) of participating residents strongly agreed/agreed that this education addressed important topics and included a good combination of both didactic and interactive components. Additionally, >90% of residents strongly agreed/agreed that the screening and day in the life videos added to the learning experience.

2) Level 2 – Learning:

  • Resident self-rated competence in screening for housing, benefits, and educational concerns significantly improved (p<0.05 for each)
  • Resident assessment of their ability to screen for food insecurity trended towards significant (p=0.06).
  • Although not statistically significant, 12.5% of the residents receiving the education self-identified as skilled in knowledge of domestic violence resources compared to 0% those who did not receive the education.

3) Level 3 – Behavior Change:

  • Parents (N=141) reported that residents receiving education were significantly more likely to screen for both domestic violence and depression when compared to those not receiving education (OR 2.16 and 2.63, 95% CI 1.01-4.63 and 1.15-5.99, respectively).
  • Parents also recalled being screened more frequently for food insecurity (OR 1.95), public benefit issues (OR 1.33), housing (OR 3.22) and educational needs (OR 1.57), but these differences did not reach statistical significance

4) Level 4 – Results (Patient Level Outcomes):

  • Referral rates per well-child check to our on-site Medical Legal Partnership doubled after the educational intervention and trended toward statistical significance (p=0.059).
  • Intervention for families with infants facing food insecurity was measured by allocation of a can of infant formula. Distribution rates per well-child check nearly doubled post-education in the intervention group, while the control group declined over the same time period (p=0.017).

Editor’s Note
This publication includes large downloadable files. If you experience difficulty downloading these files, please contact mededportal@aamc.org to receive a free DVD version via mail.

Citation

Klein M, Beck A, Kahn R, et al. Video curriculum on screening for the social determinants of health. MedEdPORTAL Publications. 2013;9:9575. http://dx.doi.org/10.15766/mep_2374-8265.9575

Educational Objectives

  1. To recognize the barriers to health that patients and families from diverse socio-economic backgrounds face.
  2. To be able to evaluate a collection of simulated social screening videos.
  3. To discuss empathetic engagement of patients and families in an attempt to maximize residents’ effectiveness in screening for SDH.
  4. To formulate a plan to mitigate the effects of SDH through referrals to government agencies and/or community resources.

Keywords

  • Social Determinants of Health, Poverty, Primary Health Care, Resident Education, Medical Legal Partnership, Health Equity Research

References

  1. “Give me your tired, your poor, and your huddled masses:” Developing an innovative curriculum to teach residents to address the social determinants of health. Association of Pediatric Program Directors Meeting, Nashville, TN; April 2013.
  2. “Teaching Today’s Healthcare Providers:” Using an innovative video curriculum to impact screening for social determinants of health. The National Medical Legal Partnership Meeting, Washington DC; April 2013.
  3. Stimulated Social History Videos: Can They Affect Practice and Impact Family Perception of Care? The Pratt Research Lectures platform presentation, Cincinnati, OH; May 2013.

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ISSN 2374-8265