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Improving Child Health and Healthcare Use Outcomes: How Risk and Resilience Intersect in Pediatric Care

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Abstract

More nuanced and comprehensive approaches are needed in preventive healthcare to have a larger impact on the social determinants of health that influence health and well-being over the life course. Using data from a nine-site study of pediatric health care innovations focused on screening, referring, and linking families of infants to services for social needs, we examined the clustering of risk and resilience reported by 888 parents at infant age birth to 6 months using latent profile analysis (LPA). We then examined how risk and resilience profiles were associated with children’s health status and family unmet need for social supports 1 year later. The study was conducted in three states in 2018–2020 with recruitment in pediatric clinics serving low-income families. Results found four distinct family profiles of risk and resilience, and families in one profile (high household/relational risk and lower strengths) reported worse health outcomes compared to the low-risk, high strengths profile. Public benefits need—income assistance, health insurance, housing, and food assistance—at 1 year continued to be heightened among all groups compared with the low risk, high-strength group, highlighting the importance of screening for social needs early in life as risk and resilience profiles are predictive of future need. Study findings point to the need to include risk and resilience screening in the strategies used by pediatric healthcare to predict health outcomes and design preventive approaches.

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References

  • Abraído-Lanza, A. F., Echeverría, S. E., & Flórez, K. R. (2016). Latino immigrants, acculturation, and health: Promising new directions in research. Annual Review of Public Health, 37, 219–236.

    Article  PubMed  PubMed Central  Google Scholar 

  • Andermann, A. (2016). Taking action on the social determinants of health in clinical practice: A framework for health professionals. Canadian Medical Association Journal, 188(17–18).

  • Angel, S., Disslbacher, F., Humer, S., & Schnetzer, M. (2019). What did you really earn last year? Explaining measurement error in survey income data. Royal Statistical Society, 182, 1411–1437. https://doi.org/10.1111/rssa.12463

  • Artiga, S. & Hinton, E. (2018). Beyond health care: The role of social determinants in promoting health and health equity. Henry J Kaiser Family Foundation. Issue Brief. Available: https://files.kff.org/attachment/issue-brief-beyond-health-care

  • Beniflah, J. D., Little, W. K., Simon, H. K., & Sturm, J. (2013). Effects of immigration enforcement legislation on Latino pediatric patient visits to the pediatric emergency department. Clinical Pediatrics, 52, 1122–1126.

    Article  PubMed  Google Scholar 

  • Bernstein, H., Gonzalez, D., Karpman, M., & Zuckerman, S. (2020). Amid confusion over the public charge rule, immigrant families continued avoiding public benefits in 2019. Urban Institute.

    Google Scholar 

  • Berry, C., Paul, M., Massar, R., Kalyanaraman Marcello, R., & Krauskopf, M. (2020). Social needs screening and referral program at a large US public hospital system, 2017. American Journal of Public Health Practice, 110(52). https://doi.org/10.2105/AJPH.2020.305642

  • Blumberg, S. J., Foster, E. B., Frasier, A. M., Satorius, J., Skalland, B. J., Nysse-Carris, K. L., Morrison, H. M., Chowdhury, S. R., & O’Connor, K. S. (2012). Design and operation of the National Survey of Children’s Health, 2007. Vital and Health Statistics, 1, 1–149.

    Google Scholar 

  • Bronfenbrenner, U., & Evans, G. (2000). Developmental science in the 21st Century: Emerging questions, theoretical models, research designs and empirical findings. Social Development, 9, 115–125.

    Article  Google Scholar 

  • Castañeda, H., Holmes, S. M., Madrigal, D. S., Young, M. E. D., Beyeler, N., & Quesada, J. (2015). Immigration as a social determinant of health. Annual Review of Public Health, 36, 375–392.

    Article  PubMed  Google Scholar 

  • Center on the Study of Social Policy. (n.d.). Core meanings of the strengthening families protective factors. Retrieved from https://cssp.org/wp-content/uploads/2018/10/Core-Meanings-of-the-SF-Protective-Factors-2015.pdf

  • Coady, D., & Dizioli, A. (2018). Income inequality and education revisited: Persistence, endogeneity and heterogeneity. Applied Economics, 50, 2747–2761. https://doi.org/10.1080/00036846.2017.1406659

    Article  Google Scholar 

  • Connor, K. M., & Davidson, J. R. T. (2003). Development of a new resilience scale: The Connor-Davidson resilience scale (CD-RISC). Depression and Anxiety, 18, 76–82. https://doi.org/10.1002/da.10113

    Article  PubMed  Google Scholar 

  • Connor, K.M., & Davidson, J.R.T. (2015). Connor-Davidson Resilience Scale. Unpublished Manual.

  • Cort, D. A., Lin, K. H., & Stevenson, G. (2014). Residential hierarchy in Los Angeles: An examination of ethnic and documentation status differences. Social Science Research, 45, 170–183. https://doi.org/10.1016/j.ssresearch.2013.12.013

    Article  PubMed  Google Scholar 

  • Dubowitz, H., Feigelman, S., Lane, W., & Kim, J. (2009). Pediatric primary care to help prevent child maltreatment: The Safe Environment For Every Kid (SEEK) model. Pediatrics, 123, 858–864.

    Article  PubMed  Google Scholar 

  • Dubowitz, H., Feigelman, S., Lane, W., Prescott, L., Blackman, K., Grube, L., & Tracy, J. K. (2007). Screening for depression in an urban pediatric primary care clinic. Pediatrics, 119, 435–443. https://doi.org/10.1542/peds.2006-2010

    Article  PubMed  Google Scholar 

  • East, C. N. (2018). The effect of food stamps on children’s health: Evidence from immigrants’ changing eligibility. Journal of Human Resources, 55, 387–427. https://doi.org/10.3368/jhr.55.3.0916-8197R2

    Article  Google Scholar 

  • Fauth, R. C., Leventhal, T., & Brooks-Gunn, J. (2004). Short-term effects of moving from public housing in poor to middle-class neighborhoods on low-income, minority adults’ outcomes. Social Science & Medicine, 59, 2271–2284. https://doi.org/10.1016/j.socscimed.2004.03.020

    Article  Google Scholar 

  • Garg, A., Toy, S., Tripodis, Y., Silverstein, M., & Freeman, E. (2015). Addressing social determinants of health at well child care visits: A cluster RCT. Pediatrics, 135, 296–304.

    Article  Google Scholar 

  • Garza, A., Brown, M., & Finno-Velasquez, M. (2022). A case study in working with remote field interviewers. SAGE Research Methods Cases. https://dx.doi.org/10.4135/9781529604986

  • Hall, M., & Greenman, E. (2013). Housing and neighborhood quality among undocumented Mexican and Central American immigrants. Social Science Research, 42, 1712–1725. https://doi.org/10.1016/j.ssresearch.2013.07.011

    Article  PubMed  Google Scholar 

  • Harper Browne, C. (2016). The strengthening families approach and protective factors framework™: A pathway to healthy development and well-being (pp. 1–24). In C. Shapiro & C. Harper Brown (Eds.) Innovative Approaches to Supporting Families of Young Children. Springer. https://doi.org/10.1007/978-3-319-39059-8

  • Hill, H. A., Singleton, J. A., Yankey, D., Elam-Evans, L. D., Pingali, S. C., & Kang, Y. (2019). Vaccination coverage by age 24 months among children born in 2015 and 2016- National Immunization Survey-child, United States, 2016–2018. Morbidity and Mortality Weekly Report, 68, 913–918. https://doi.org/10.15585/mmwr.mm6841e2

    Article  PubMed  PubMed Central  Google Scholar 

  • Horton, C. (2011). Protective factors literature review: Early care and education programs and the prevention of child abuse and neglect. Center for the Study of Social Policy.

    Google Scholar 

  • Hoynes, H., Schanzenbach, D. W., & Almond, D. (2016). Long-run impacts of childhood access to the safety net. American Economic Review, 106, 903–934.

    Article  Google Scholar 

  • Krysik, J., & LeCroy, C. W. (2012). Development and initial validation of an outcome measure for home visitation: The Healthy Families Parenting Inventory. Infant Mental Health Journal, 33, 496–505. https://doi.org/10.1002/imhj.21343

    Article  PubMed  Google Scholar 

  • LeCroy C, Milligan Associates, Inc. (2004). Healthy Families Parenting Inventory. Unpublished Manual.

  • Moreno, A.J., Byers, K., Monahan, E., Robinson, J.L, & McCrae, J. (2021). Beyond overwhelmed: A new measure of the functional impact of toxic stress on parents of young children. Children and Youth Services Review, 131.

  • Nandi, A., Galea, S., Lopez, G., Nandi, V., Strongarone, S., & Ompad, D. C. (2008). Access to and use of health services among undocumented Mexican immigrants in a US urban area. American Journal of Public Health, 98, 2011–2020. https://doi.org/10.2105/AJPH.2006.096222

    Article  PubMed  PubMed Central  Google Scholar 

  • NORC at the University of Chicago. (2020). Final report: Evaluating community approaches to preventing or mitigating toxic stress. Chapin Hall at the University of Chicago. IL.

  • Parikh, R. B., Jain, S. H., & Navathe, A. S. (2019). The sociobehavioral phenotype: Applying a precision medicine framework to social determinants of health. The American Journal of Managed Care, 25, 421–423.

    PubMed  Google Scholar 

  • Pearlin, L. I., & Schooler, C. (1978). The structure of coping. Journal of Health and Social Behavior, 19, 2–21.

    Article  CAS  PubMed  Google Scholar 

  • Pearlin, L. I., Menaghan, E. G., Lieberman, M. A., & Mullen, J. T. (1981). The stress process. Journal of Health and Social Behavior, 22, 337–356.

    Article  CAS  PubMed  Google Scholar 

  • Perreira, K.M., & Pedroza, J. M. (2019). Policies of exlusion: Implications for the health of immigrants and their children. Annual Review of Public Health, 40(147–166). https://doi.org/10.1146/annurev-publhealth-040218-044115

  • Pudrovska, T., Schieman, S., Pearlin, L. I., & Nguyen, K. (2005). The sense of mastery as a mediator and moderator in the association between economic hardship and health in late life. Journal of Aging and Health, 17, 634–660.

    Article  PubMed  Google Scholar 

  • Rollins, C., Glass, N. E., Perrin, N. A., Billhardt, K. A., Cough, A., Barnes, J., & Bloom, T. L. (2012). Housing instability is a strong predictor of poor health outcomes as level of danger in an abusive relationship: Findings from the SHARE study. Journal of Interpersonal Violence, 27, 623–643. https://doi.org/10.1177/0886260511423241

    Article  PubMed  Google Scholar 

  • Rose-Jacobs, R., Black, M. M., Casey, P. H., Cook, J. T., Cutts, D. B., Chilton, M., Heeren, T., Levenson, S. M., Meyers, A. F., & Frank, D. A. (2008). Household food insecurity: Associations with at-risk infant and toddler development. Pediatrics, 121, 65–72.

    Article  PubMed  Google Scholar 

  • Sala-Hamrick, K.J., Isakson, B., Del Campo De Gonzalez, S., Cooper, A., & Buchan, J. (2021). Trauma-informed pediatric primary care: Facilitators and challenges to the implementation process. Journal of Behavioral Health Services & Research, 1–18.

  • Sarría-Santamera, A., Hijas-Gómez, A. I., Carmona, R., & Gimeno-Feliú, L. A. (2016). A systematic review of the use of health services by immigrants and native populations. Public Health Reviews, 37, 1–29.

    Article  Google Scholar 

  • Sege, R., Preer, G., Morton, S., Cabral, H., Morakinyo, O., Lee, V., Abreu, C., De Vos, E., & Kaplan-Sanoff, M. (2015). Medical-legal strategies to improve infant health care: A randomized trial. Pediatrics, 136, 97–106. https://doi.org/10.1542/peds.2014-2955

    Article  PubMed  Google Scholar 

  • Singh, G. K., Yu, S. M., & Kogan, M. D. (2013). Health, chronic conditions, and behavioral risk disparities among US immigrant children and adolescents. Public Health Reports, 128, 463–479.

    Article  PubMed  PubMed Central  Google Scholar 

  • Sokol, R., Austin, A., Chandler, C., Byrum, E., Bousquette, J., Lancaster, C., Doss, G., Dotson, A., Urbaeva, V., Singichetti, B., Brevard, K., Wright S.T., Lanier, P., Shanahan, M. (2019). Screening children for social determinants of health: A systematic review. Pediatrics 144(4), e20191622. https://doi.org/10.1542/peds.2019-1622. Epub 2019 Sep 23. PMID: 31548335; PMCID: PMC6996928.

  • Spain, A. K., Brown, A. R., & Sander, A. (2020). Healthcare and early childhood systems integration in practice. Chapin Hall at the University of Chicago.

    Google Scholar 

  • Stimpson, J. P., & Wilson, F. A. (2018). Medicaid expansion improved health insurance coverage for immigrants, but disparities persist. Health Affairs, 37, 1656–1662.

    Article  PubMed  Google Scholar 

  • Sroufe, L. A., Egeland, B., Carlson, E. A., & Collins, B. E. (2005). The development of the person: The Minnesota study of risk and adaptation from birth to adulthood. The Guilford Press.

    Google Scholar 

  • Turner, R. J., & Noh, S. (1988). Physical disability and depression: A longitudinal analysis. Journal of Health and Social Behavior, 29, 23–27. https://doi.org/10.2307/2137178

    Article  CAS  PubMed  Google Scholar 

  • Walsh, F. (2016). Strengthening family resilience (3). The Guilford Press.

    Google Scholar 

  • Weil, J. (2009). Finding housing: Discrimination and exploitation of Latinos in the post-Katrina rental market. Organization & Environment, 22, 491–502.

    Article  Google Scholar 

  • Werner, E. (2013). What can we learn about resilience from large-scale longitudinal studies? In Goldstein & Brooks (Eds), Handbook of Resilience in Children (pp. 87–102). New York: Springer.

  • Werner, W. W., & Smith, R. S. (2001). Journeys from childhood to midlife: Risk, resilience, and recovery. Cornell University Press.

    Google Scholar 

  • Yates, T. M., Egeland, B., & Sroufe, L. A. (2003). Rethinking resilience: A developmental process perspective. In S. S. Luthar (Ed.), Resilience and vulnerability: Adaptation in the context of childhood adversities (pp. 243–266). Cambridge University Press.

    Chapter  Google Scholar 

  • Zaslow, M., Bronte-Tinkew, J., Capps, R., Horowitz, A., Moore, K. A., & Weinstein, D. (2009). Food security during infancy: Implications for attachment and mental proficiency in toddlerhood. Journal of Maternal and Child Health, 13, 66–80.

    Article  Google Scholar 

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Funding

This project was conducted with support through a grant from The JPB Foundation.

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Authors and Affiliations

  1. School of Social Welfare, University of Kansas, Lawrence, KS, USA

    Kaela Byers

  2. Chapin Hall, University of Chicago, Chicago, IL, USA

    Emma Monahan & Julie S. McCrae

  3. University of Connecticut, Storrs, CT, USA

    JoAnn Robinson

  4. New Mexico State University, Las Cruces, NM, USA

    Megan Finno-Velasquez

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  1. Kaela Byers
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  2. Emma Monahan
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  4. JoAnn Robinson
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Correspondence to Kaela Byers.

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This study was approved by the Institutional Review Board of the School of Social Service Administration at the University of Chicago and was conducted in accordance with tenets of the Declaration of Helsinki.

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Byers, K., Monahan, E., McCrae, J.S. et al. Improving Child Health and Healthcare Use Outcomes: How Risk and Resilience Intersect in Pediatric Care. Prev Sci 23, 1143–1155 (2022). https://doi.org/10.1007/s11121-022-01389-x

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