Social Navigation for Adolescents in ED

NCT03239041 | Completed DMC

• 1 other identifier: CNMCPro00007768
• Study Type: interventional
• Target: 395
• Locations: 1 country
• Sites: 1

Brief Summary

Social determinants of health affect patients throughout the life course. They may be particularly relevant for pediatric emergency department (ED) patients. Computerized screening for social and behavioral determinants of health has been deemed effective and acceptable. This pilot study will characterize the cumulative burden of health related social problems experienced by patients and families in a pediatric ED. It will specifically examine those patients with a subset of 9 high-risk chief complaints, patients with obesity, patients with poor asthma control, and patients with a high number of non-urgent visits, who may be at particularly high risk for health related social problems. Our analysis will compare these subsets of patients with the general ED population, hypothesizing that these groups will have a higher number of health related social problems than the general ED population. Parent and adolescent participants will be approached during ED visits and administered a computerized screening tool. For patients aged 0-13, a survey administered to parents will test for thirteen distinct health related social problems. Two surveys will be administered to adolescent-parent dyads. The adolescent survey will test for thirteen health related social problems, seven of which overlap with those on the parent survey. The average total number of health related social problems in patient groups hypothesized to be at high risk will be compared to the average total number of HRSPs in the general ED population. For adolescent patients, an intervention group will receive social navigation consisting of rapid referrals to community resources based on survey responses by a community health liaison. Their ED recidivism, community resource use and number of unmet social needs at 12-month follow up will be compared with that of a control group that receives screening and written resources only.

Conditions

Adolescent Behavior; Social Stress; Emergencies

Outcome Measures

Primary Outcomes (1)

• Emergency Department Recidivism

  Number of ED visits

  12 months

Secondary Outcomes (1)

• Community Resource Use

  12 months

Study Arms (2)

Intervention Arm

ACTIVE COMPARATOR

The intervention group will have access to the services of a social navigation team. The social navigation team will consist of trained community health liaisons, a clinician and a social worker. The social navigation team will function as follows: The research assistant will then instruct the community health intern to review the results of the completed computerized survey. The community health intern will review the results, create a plan of action, i.e. specific referrals to community agencies and next steps needed by the caregiver and or adolescent (e.g., documents to gather, appointments to make, etc.), following pre-developed protocols for each risk area. Each plan will be reviewed with the social worker prior to presentation to the family. Each family will also receive a packet of community resources relevant to each social domain covered in the screening survey, similar to that provided to the enhanced usual care group.

Behavioral: Social navigation team

Enhanced Usual Care Arm

NO INTERVENTION

The enhanced usual care arm will only receive printed information regarding community resources.

Interventions

Social navigation team BEHAVIORAL

Social navigation team

Intervention Arm

Eligibility Criteria

• Age: 0 Years - 21 Years
• Sex: all
• Healthy Volunteers: Yes
• Age Groups: Child (0-17), Adult (18-64)

You may qualify if:

• between 13 and 21 years of age for intervention and control arms
• English or Spanish speaking

You may not qualify if:

• Not English or Spanish speaking
• Caregiver or adolescent developmentally delayed or altered mental status
• Patient in custody of police or child protective services

Sponsors & Collaborators

• Children's National Research Institute: lead

Study Sites (1)

Children's National Health System

Washington D.C., District of Columbia, 20010, United States

Location

Related Publications (1)

• Rucker A, Watson A, Badolato G, Jarvis L, Patel SJ, Goyal MK. Social Navigation for Adolescent Emergency Department Patients: A Randomized Clinical Trial. J Adolesc Health. 2024 Feb;74(2):292-300. doi: 10.1016/j.jadohealth.2023.08.030. Epub 2023 Oct 7.

  PMID: 37804303 DERIVED

MeSH Terms

Conditions

Adolescent Behavior; Emergencies

Condition Hierarchy (Ancestors)

Behavior; Disease Attributes; Pathologic Processes; Pathological Conditions, Signs and Symptoms

Study Officials

• Alexandra C Rucker, MD

  Children's National Research Institute

  PRINCIPAL INVESTIGATOR

Study Design

• Study Type: interventional
• Phase: not applicable
• Allocation: RANDOMIZED
• Masking: SINGLE
• Who Masked: OUTCOMES ASSESSOR
• Purpose: OTHER
• Intervention Model: PARALLEL
• Sponsor Type: OTHER
• Responsible Party: PRINCIPAL INVESTIGATOR
• PI Title: Assistant Professor of Pediatrics

Study Record Dates

• First Submitted: August 1, 2017
• First Posted: August 3, 2017
• Study Start: August 1, 2017
• Primary Completion: December 30, 2022
• Study Completion: December 30, 2022
• Last Updated: July 29, 2024

Record last verified: 2024-07

Data Sharing

• IPD Sharing: Will not share

Locations

US (1)