(804) Development and Validation of a Social Needs Screening Tool for the Pediatric Intensive Care Unit

Introduction: Inequities based on race, ethnicity, insurance, household income, and zip code contribute to profound, complex, and persistent disparities for critically ill children. Further, disparities influence illness severity, access to care, mortality, and long-term outcomes. Screening for unmet social needs is often championed but rarely implemented. The merits of social needs screening are described in many contexts but there is a paucity of data on and resources for screening in the PICU. To address this need, we developed and validated a strengths-based, trauma-informed, community-supported screening tool to assess critically ill children and their families for unmet social needs.

Methods: Community and family stakeholders were engaged in a series of interviews and focus groups to elicit perspectives, suggestions, and priorities for screening. We then drafted a screening tool after an extensive literature review of published social needs screens and in collaboration with content experts to identify priority domains. Content validity was established by engaging content experts in a series of modified-Delphi panels to refine the proposed screen. Face validity was assessed through cognitive interviews with parents of children with recent PICU admissions.

Results: Qualitative analysis yielded themes in five domains: screening is acceptable, screening in valuable, social needs impact child health, screening for needs without a resource is important, and screening should occur after initial stabilization. Content and face validity were established through a series of modified-Delphi panels and cognitive interviews, respectively. The final screen consists of 15 domains with 44 unique questions.

Conclusions: Admission to the PICU provides an opportunity to screen for and address unmet social needs, potentially for those with a disproportionately high burden of need. Families find screening for social needs in the PICU to be acceptable and valuable. To better support this population, we validated a social needs screening tool with a PICU-sensitive approach that was co-created with families, community-stakeholders, and content experts. Our screening tool addresses an urgent gap in the care of critically ill children and their families.