Implementing a Social Determinants of Health Screening Tool for Child Abuse Risk Factors in a Rural Pediatric Clinic

Background: Child abuse and neglect are substantial public health problems. Child abuse is preventable when risk factors are recognized and addressed. The purpose of this quality improvement project was to determine if using the SEEK PQ-R parental questionnaire in a rural clinic would a) increase clinic staff awareness of Social Determinant of Health (SDOH) needs associated with child abuse risk factors, b) increase the rates of screening for targeted child abuse risk factors and, c) increase the provider's delivery of resources to address targeted child abuse risk factors. Local Problem: In 2020, there were over 10,000 confirmed victims of child abuse in Utah. Unfortunately, young children in rural communities experience the highest child abuse rates. Methods: This project utilized pre- and post-educational presentation surveys to determine the clinic staff's knowledge of Social Determinants of Health (SDOH) and child abuse prevention and to ascertain current practices and perceived barriers to screening. Staff surveys following implementation measured feasibility, usability, and satisfaction with the SEEK PQ-R screening tool. Interventions: This project implemented a SDOH screening tool for caregivers of children aged 0-5. Screening sheet data determined the number of caregivers screened, the number of positive screens, and the number of resources delivered. Results: Pre-implementation survey data indicated that all staff agreed that SDOH needs impact a young child's health and well-being, but most staff were less familiar with SDOH. All staff reported there was no current standardized process for screening for SDOH needs or child abuse risk factors. During project implementation, 49 caregivers were eligible for screening, with 44 3 completing a screening sheet; 61% of caregivers had a positive screen (n=27) and were given resources by the provider. Within those positive screens, 74% (n=20/27) or 45% (n=20/44) of all caregivers screened had a positive screen for a targeted SDOH need. Overall, all clinic staff were satisfied with the screening tool and found the project useful; 80% (n=4/5) of staff supported the continued use after project completion. Conclusion: The outcomes of this project demonstrate that implementing a targeted screening tool increased the provider's identification of SDOH needs and improved the delivery of resources to caregivers. Clinic staff reported an increased understanding of SDOH and child abuse risk factors. This project showed that the clinic staff found it feasible, practical, and helpful to implement the SEEK screener into routine pediatric healthcare visits to improve the well-being of children.