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Map Out a Plan to Help Families Survive and Thrive

Scott Krugman, M​​D, FAAP​
May 6, 2016


Every pediatrician has a story about a family struggling to make ends meet and whose social circumstances prevent optimal health in their child. Some are dramatic and unforgettable. Others are as basic as not being able to afford asthma medicines and, as a result, a child ending up in the emergency room. But do we really know which patients in our practices or communities are facing challenges? Do we know who struggles to put food on the table? Do we know who doesn't have money for medications? Do we know whose mother is a victim of domestic violence, which often rises with economic hardship?

​In April, the long-awaited AAP Policy Statement on Poverty was released, and came with strong recommendations for pediatricians to screen families for Social Determinants of Health (SDOH). While this may seem daunting for many of us, the release of the policy statement came with Practice Tips for pediatricians. These tips include evidence based screening tools as well as a resource referral template for pediatricians to complete for their local community. The Council on Community Pediatrics has already received positive feedback about these tools, and one State Chapter used the referral template to fill in resources for pediatricians across their state.

"But do we really know which patients in our practices or communities are facing challenges?"

 Still, it takes effort. And we are all busy. But there are ways pediatricians can simplify the process of incorporating SDOH screening into a pediatric practice:

  • Get help filling out the resource template. Empower your staff to complete the template, as they may know about a lot of resources in your community. Empower your families, because chances are they have used many resources already. Phone a friend – the United Way, local health departments and local social services offices all likely are aware of a number of resources. You do not need to re-invent the wheel. An example of a complete template from New Mexico can be found on the AAP website.

  •  Partner with other health care providers. You are not alone in your community, and your colleagues need the same information. Work as a team with other pediatricians or family physicians to pool knowledge and share the resource template. Talk to your local hospital. If it's a non-profit hospital, they are required by law to provide community benefits. Chances are they have done a local community health needs assessment and have a good idea of local issues and resources.  View my hospital's example​.

  •  Don't be afraid to start screening. No, you won't necessarily know every resource in your community. And no, you won't be able to solve every social problem. That is not your job. But by getting started two things will happen: 1. Parents will know that you care about the well-being of the whole family, and 2. You will get a better idea of the needs in your community. And if there aren't resources available, you can start to advocate for what your patients need – based on data, not anecdote.

"​Pediatricians alone are not going to solve child poverty, but we play a vital role as advocates and caregivers of children."

 Taking the leap into opening Pandora's Box surrounding poverty and social determinants is one that we all should do. Poverty is not localized to inner cities. It's prevalent in rural areas, and even suburbs (over 100,000 people in "rich" Baltimore County are food insecure).  By connecting families with resources that can help them survive better, they will be more likely to follow our recommendations for optimizing the health of their children.

Pediatricians alone are not going to solve child poverty, but we play a vital role as advocates and caregivers of children. Helping society understand that reducing poverty improves child health, family health and community health is a responsibility I, for one, am willing to embrace.


​​Ab​out the ​​Author


Scott Krugman, MD, MS, FAAP is Chairman, Department of Pediatrics, and Director of Medical Education at MedStar Franklin Square Medical Center (MFSMC). He is the Associate Dean for Medical Education at MFSMC, Georgetown University School of Medicine and Professor of Pediatrics at Georgetown University Medical Center. He is a serves on the executive committee for the American Academy of Pediatrics (AAP) Council on Community Pediatrics and is the immediate past-president of the academy's Maryland chapter. He is also a member of the AAP's Section on Child Abuse and Neglect and Council on Communication and Media. He can be found on Twitter at Dr_Scottk.​