New Docs Learning to Address Social Determinants of Health

Hunger is often invisible, making it that much more difficult to address, but now resident physicians at Cincinnati Children’s Hospital Medical Center are joining the battle-lines to find and reduce its incidence.

They’re doing so by learning to ask a different type of question.

Dr. Melissa Klein

Dr. Melissa Klein, a lead for the initiative, says she sees this new way of training of resident pediatricians as a powerful means to improving the health-care that’s provided in Cincinnati and beyond.

“If we can train them early on, the ripple effect is huge,” says Klein, recalling one of her favourite stories of the change that’s possible when physicians ask that extra question.

A mother had visited the hospital several times, worried about the lack of weight gain in her breastfed baby, and it wasn’t until a resident asked about her food security that her real story began to emerge.

She had been denied food stamps through no fault of her own and was living on a diet of oatmeal, which was evidently affecting her baby’s health as well.

The resident physician was able to intervene with the hospital legal and social workers, clear up the food stamp issue, which was due to a paperwork error, and within twenty-four hours the mother was getting proper food. Follow-up confirmed the baby was “thriving and doing fabulous.”

“I think the neatest part of this story is the mom was a college graduate and had just finished graduate school, so everyone assumed she was okay financially, and honestly she wasn’t,” says Klein.

“It took this residents asking the extra question to find out, which really points to the fact that hunger is invisible and we really need to think (it’s possible) in every child.”

The Cincinnati Children’s Hospital has been making a concerted effort to address social determinants of health disparities for several years now, beginning with a partnership it formed between the pediatric primary care centre and Legal Aid Society of Greater Cincinnati.

Seeing the challenge this partnership presented for trained physicians — “As you can imagine, this is kind of a different concept for many doctors, to consult a lawyer while they’re seeing a patient in clinic,” says Klein — the team leading this initiative turned to resident pediatricians.

This is where Klein has been putting her energy; training new pediatricians to first screen for social determinants before seeking paths to addressing them, including making referrals to the legal aid society.

In the past three years, almost 150 pediatric residents of Cincinnati Children’s Hospital have been trained to screen for social determinants of health.

There are about 500 referrals per year to the legal society, the bulk of them from resident pediatricians.

The Cincinnati hospital has also been able to learn from and share its experiences with the approximately 200 institutions and many pediatric residencies doing similar work around legal aid partnerships across the U.S.  

What’s unique is that the partnership with the legal aid society has sparked others, including one with the local food bank, Freestore Food Bank, specifically to address food insecurity in infants.

This was done after a survey confirmed families served still have about a 30 per cent food insecurity rate, and about 15 per cent of families said they ran out of baby formula and had to stretch it.

“Now we teach residents very strongly how prevalent (infant food insecurity) is and that they should be looking for it; and if they look for it – there is a number of things we can do,” says Klein, noting follow-up options include offering additional formula, as well as information on food and other types of resources in the community.

John Young

Freestore CEO John Young speaks to the potential he sees in the training of resident physicians to consider more than medication prescription for patients who visit the hospital.

“Those doctors will ask those questions the rest of their careers. I think it’s marvelous,” says Young.

He adds the next step is to expand this kind of food bank/hospital partnership — the only one he’s aware of in the country — and training to other pediatric clinics around the country.

“If we can train so many doctors at our local children’s hospital, how many could we train nationwide?” he says.

“Wouldn’t it be wonderful for that question (about food insecurity) to routinely be asked by every doctor, every pediatrician in this country?”

For a related story, click here: On the Path to Sparking Communal Regeneration

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