Enhancing Social Care in the Pediatric Emergency Department: Insights from a Mixed-Method Randomized Controlled Trial

Highlight

• Providing a resource menu rather than solely screening for social risk enhances caregivers’ expressed desire for assistance in the pediatric emergency department (ED).

• Nearly half of caregivers who received resources engaged with them, and over one-third shared resources, indicating meaningful utilization.

• Engagement with social navigation services increases proportionally with the number of requested resource domains, underscoring the need for tailored support.

• Qualitative feedback from caregivers recommends situational awareness, clear communication, timing resource delivery post-acute care, and offering longitudinal follow-up to optimize social care implementation.

Study Background

The emergency department (ED) increasingly serves as a critical setting for addressing patients’ unmet social needs, recognizing that social determinants greatly impact health outcomes. Pediatric populations and their caregivers frequently face complex social challenges that can influence health trajectories, yet standardized approaches to integrate social care in the ED remain underdeveloped. Existing guidance is limited on how best to identify and respond to social risks effectively in this fast-paced environment, balancing efficiency with patient-centeredness. This study addresses this knowledge gap by comparing different approaches—screening versus a menu of resources—to identify and meet social care needs in a pediatric ED setting, while also gathering caregiver perspectives on care delivery.

Study Design

This investigation was a planned secondary analysis of a mixed-method randomized controlled trial conducted in a pediatric ED involving 1,996 families of patients aged 0 to 25 years. Participants were randomized into three arms:

1. Social Risk Screener: Caregivers completed a standardized screening tool to identify social determinants of health risks.
2. Resource Menu: Caregivers received a menu listing various social resources and were invited to indicate which types of assistance they desired.
3. No Assessment (Control): No social risk screening or resource menu was administered.

Despite arm assignment, electronic resources were made available to all families, and all had the option for individualized social navigation support if desired. Primary endpoints included caregiver-reported desire for resources and subsequent engagement measured via follow-up surveys. For qualitative insights, purposively sampled caregivers underwent semi-structured interviews until thematic saturation was reached. Thematic analysis was employed to elucidate caregiver experiences and implementation recommendations.

Key Findings

A higher proportion of caregivers reported desire for social resources in the resource menu arm compared to the screening arm (39.6% vs 31.7%). This suggests that offering a menu allowing caregivers to self-identify preferred resources may be more empowering and effective than screening alone.

Among 441 participants completing the follow-up survey, 45.8% reported using the electronic resources provided, and 36.7% shared these resources with others, demonstrating tangible impact and dissemination within communities.

The likelihood of engaging with individualized navigation services increased significantly with the number of resource domains requested (odds ratio 2.6, 95% confidence interval 2.2 to 3.0). This highlights that caregivers with multifaceted needs tend to seek more direct assistance, underscoring the importance of tiered social care interventions.

Qualitative interviews with 33 caregivers revealed important implementation themes. Participants emphasized the need to maintain situational awareness—recognizing the acute stress and timing in the ED setting. They recommended concise communication of procedures to avoid overwhelming families currently focused on clinical concerns. Additionally, resource provision was preferred after addressing immediate medical issues, allowing caregivers to better absorb social care information. Finally, caregivers valued availability of longitudinal follow-up to support ongoing social needs beyond the ED encounter.

Expert Commentary

This study importantly advances the field of ED-based social care by demonstrating the superiority of a patient-preference-driven resource menu over routine risk screening alone. The findings align with prior literature suggesting that screening without adequate options or follow-up may under-serve families facing social adversity. The tiered approach proposed—universal electronic resources, tailored resource offers per patient preference, and individualized navigation for higher needs—respects family autonomy, optimizes resource allocation, and fits the workflow realities of the ED.

Limitations include its conduct in a single pediatric ED setting, which may affect generalizability. The study also focused on caregiver-reported outcomes rather than long-term clinical or social outcomes. Future research should evaluate how these interventions impact health metrics and social stability over time, as well as test adaptation in adult and diverse ED settings.

Conclusion

This mixed-method randomized controlled trial provides evidence favoring resource menus over pure social risk screening in the pediatric ED context, enabling caregivers to express their social care priorities more effectively. Incorporating patient-centered, tiered social care strategies can enhance engagement and potentially improve outcomes by linking families to appropriate resources and support. Implementation should prioritize sensitive timing and communication, with options for continued follow-up, recognizing the ED’s dual role as both urgent care and a touchpoint for social intervention. Policymakers and ED leaders should consider integrating these findings into social care protocols to improve equity and holistic care delivery in emergency settings.

Funding and ClinicalTrials.gov

Details regarding study funding sources and trial registration were not provided in the abstract and should be sought from the original publication.

References

Brown R, Min J, Fein J, Wright M, Cullen D. Comparing Patient-Centered Approaches to Social Care in the Emergency Department: A Mixed-Method Randomized Controlled Trial. Annals of emergency medicine. 2026 Feb 4;88(1):16-25. PMID: 41636668.

Berry JG, Hall M, Kuo DZ. Addressing pediatric social determinants of health in emergency care settings. JAMA Pediatr. 2021;175(5):449-451.

Gottlieb LM, Adler NE, Wing H, et al. Effects of social needs screening and in-person service navigation on child health: a randomized clinical trial. JAMA Netw Open. 2019;2(9):e1911514.

Garg A, Boynton-Jarrett R, Dworkin PH. Avoiding the unintended consequences of screening for social determinants of health. JAMA. 2016;316(8):813-814.

Institute of Medicine (US) Committee on Integrating Social Needs Care into the Delivery of Health Care to Improve the Nation’s Health. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health. National Academies Press; 2019.