Study: Health center patients have social problems, too

David Taber

Over 80 percent of families with small children visiting area health centers report at least one health-related social problem, but only 51 percent received referrals to social service agencies during their visits, according to a study released Monday.

Researchers came by the statistics conducting a preliminary usability survey of a new automated patient referral system, another version of which, the Enhanced Violence Intervention Advocacy Program (EVIAP) is slated to go on-line soon at Boston Medical Center (BMC).

The study, “Families’ Heath-Related Social Problems (HRSPs) and Missed Referral Opportunities,” was conducted in 2003. It surveyed 205 families, at Martha Eliot Health Center in Jackson Square and the Children’s Hospital Primary Care Center, then known as the Pediatric Health Administration, at the hospital.

While other studies have gauged the prevalence of individual HRSPs, this study was the first to survey the range of HRSPs low-income families face, according to lead researcher Dr. Eric Fleegler, a pediatrician at Children’s.

“Overall, what was quite striking was that most families did not have just one problem,” Fleegler said. Fifty-four percent of families reported more than one HRSP.

At 56 percent, respondents reported housing issues were the most prevalent HRSP. Seven percent reported they were homeless, others reported they were living two families to a household, their utilities had been shut off or their dwellings had major structural damage. Thirteen percent of those who reported housing issues reported two or more issues, and nine percent reported at least three.

The study’s purpose was to gauge the prevalence of HRSPs— including housing, income and food security, abusive living situations, and access to healthcare—among low-income families with children between the ages of 0 and six.

It also strove to gauge patients’ “experience getting referrals and interest in getting help within the context of a pediatric office,” Fleegler said.

The study also found 63 percent of families who receive referrals in a healthcare setting act on them, and that of the referrals received by the survey group in the past, 82 percent were considered to be helpful.

Fleegler said it makes sense to offer social service referrals in the context of a doctor’s office because there is already an implicit trust. “There is a sense that these people are here to help me,” he said.

But, he said, social service referrals often fall by the wayside in the course of routine medical check-ups because, “Doctors, nurses and the medical establishment in general are overwhelmed.”

As a solution to this conundrum, the study tested a computerized referral system that presents users with between 90 and 120 questions and offers detailed descriptions of relevant local social service organizations.

Study respondents were invited to test the laptops in the clinic waiting rooms before their appointments. The program was given favorable ratings by 92 percent of respondents, the study said.

If Fleegler has his way, patients will one day be able to use programs modeled on this one in health center waiting rooms across the city and across the country

His team is currently developing a version of the program known as the Enhanced Violence Intervention Advocacy Program (EVIAP), for the Boston Medical Center. EVIAP will, in addition to providing outside referrals, screen for violence risk factors and provide referrals to in-house specialists, he said.

They are also developing a version for Children’s Hospital’s Young Parents Program so adolescent parents can screen themselves and refer themselves to organizations for support.

And, he said, they are trying to finish developing the standard version of the program—enhance its database and clean up its Spanish language translations– and get it out to health centers across the city as quickly as possible.

But he expects needs will be different in different communities. “We are expecting the needs to be different in Chinatown. In different cities and different states, the numbers will be different,” he said.

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