A pediatric approach to poverty

Pediatricians are being urged to add another evidence based screening to the list of developmental and disease states that can be detected and addressed by swift referral and intervention.

Poverty.

Decades after poverty was recognized as a powerful determinant of physical health, the American Academy of Pediatrics now believes there are reliable screening questions and questionnaires that can help pediatricians identify social risk factors that affect their patients and connect them to appropriate interventions.

The Academy has published a strong policy statement (available to the public on the Academy’s web site) that details all the ways poverty pushes children and families into poor health. The policy statement suggests that pediatricians support and promote adoption of various programs that are proven to help families get out of poverty, help children succeed in school, and improve children’s health on every level.

The question for many pediatricians is “now what?”

Three years ago when Dr. Jim Perrin was president of the Academy he boldly claimed that pediatricians addressed poverty in their practices “every day” with the referrals they made to community resources to improve nutrition and address hunger, identify quality child care, locate housing resources for families, and help families find better jobs or job training.

Truth be told, it was an exceptional pediatrician who knew community resources as well as they knew the specialists they recommended for a particular child and family.

But the challenge and the expectation has been laid out by the Academy that pediatricians, in their frequent contacts with young children and their families, will become effective intermediaries in fighting a scourge that affects one in four North Carolina children on any given day.

Beginning with a two-question screen for hunger taken from the American Household Survey, the Academy has developed tools for use in the pediatric office, though it will take some research and relationship building if effective referrals are to be made. Doctors and advocates know full well that “ice cold” referrals – handing out a name, address and phone number is the worst way to connect a family to a specialist or a service. “Warm” and “hot referrals” require knowing who you are referring to, knowing who is more skilled, and knowing who is more convenient.

“One-page wonder” handouts, notebooks, web sites, and United Way 211 call services can’t substitute for knowledge, experience and relationship.

Pediatricians have several clear opportunities to understand the social forces affecting their each of their patient’s lives and to work with their staff to become familiar with local resources. Eleven well child visits are recommended for children before age two, and 16 visits from birth to school entry. The opportunity and challenge are there.

Anyone can go to www.aap.org and click on the button for the policy statement. It is thoroughly cited, and a good educational resource for anyone wanting to understand better the interplay of daily stressors on economically striving families. Physicians are encouraged to use their password-protected access to read the technical review, screening and referral tools, and messaging on poverty.

It may be unusual for some of us to think of the kindly pediatrician in the white coat ‘prescribing’ community resources to a family along with antibiotics for childhood ear infections. But if families are going to succeed in building healthy, successful lives for their children, the pediatrician can play a powerful, trusted and effective supporting role.