Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial

Authors

Alexandra Rucker, Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C. Electronic address: arucker@childrensnational.org.
Ar'Reon Watson, Division of Emergency Medicine, Children's National Hospital, Washington, D.C.
Gia Badolato, Division of Emergency Medicine, Children's National Hospital, Washington, D.C.
Lenore Jarvis, Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C.
Shilpa J. Patel, Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C.
Monika K. Goyal, Division of Emergency Medicine, Children's National Hospital, Washington, D.C; School of Medicine and Health Sciences, The George Washington University, Washington, D.C.

Document Type

Journal Article

Publication Date

10-7-2023

Journal

The Journal of adolescent health : official publication of the Society for Adolescent Medicine

DOI

10.1016/j.jadohealth.2023.08.030

Keywords

adolescent; community resources; emergency service; food insecurity; social conditions

Abstract

PURPOSE: Adolescent emergency department (ED) patients have unmet social needs that contribute to ED use. This study aimed to evaluate the effect of social needs navigation for adolescents on subsequent ED visits and community resource use and to identify characteristics associated with elevated social risk. METHODS: Between July 2017 and August 2019, we used a random date generator to establish intervention and control group enrollment dates. All adolescents completed a social needs survey. Adolescents enrolled on intervention dates received in-person, risk-tailored social needs navigation. Those enrolled on control dates received a preprinted resource guide. We used chart review and follow-up calls to assess 12-month ED revisits and community resource use. Logistic regression was used to compare these outcomes between groups. We measured the association between ≥3 reported unmet needs and characteristics hypothesized a priori to be associated with elevated social risk (nonurgent visits, obesity, or any of nine "socially sensitive" chief complaints) using logistic regression. RESULTS: A total of 399 adolescents were randomized. There was no difference between groups in the number of ED revisits. There was increased community resource use in the intervention group (adjusted odds ratio [aOR]: 3.5 [95% confidence interval {CI}: 1.5, 8.2]). Adolescents with a socially sensitive chief complaint had increased odds of ≥3 unmet needs (aOR: 2.2 [95% CI: 1.3, 3.6]), as did those with food insecurity in a post hoc analysis (aOR: 9.9 [95% CI: 4.0, 24.6]). DISCUSSION: Social needs navigation increased community resource use but not subsequent ED visits. Adolescents with socially sensitive chief complaints or food insecurity reported increased unmet needs.

APA Citation

Rucker, Alexandra; Watson, Ar'Reon; Badolato, Gia; Jarvis, Lenore; Patel, Shilpa J.; and Goyal, Monika K., "Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial" (2023). GW Authored Works. Paper 3627.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/3627

Department

Pediatrics