Working within the nation’s poorest large city, our pediatric emergency department (ED) serves as a safety net for the most vulnerable. We are witnesses to parents stretched beyond their limits – juggling raising a family amidst the stress of work, financial strain, community violence, social injustice, and the many other heavy weights they quietly bear when they bring their children to the hospital. These social needs powerfully influence child health outcomes and demonstrate that the depth of need is becoming more prominent due to the economic devastation of the COVID-19 pandemic.
As schools and daycares closed in mid-March, and the local economy came to a halt, many families stayed home and stopped coming to the pediatric ED out of fear and social responsibility. While our adult medicine colleagues scrambled to meet the demand for ventilators and ICU beds, our daily numbers quickly shrunk, leading to a shift from one of the busiest winters to the quietest spring in recent memory. Although our families were not visiting the hospital ED as frequently, we knew that the social needs and the stressors they faced were still there – if not new and intensified. Furthermore, these needs were often the main cause of their medical visit. This understanding led our group to brainstorm ways to effectively address more than just families’ presenting complaints We aimed to identify and provide resources for their additional needs – especially in the midst of the challenging circumstances brought on by COVID-19.
Our proposed solution was a new program called Family Connects. With the number of children receiving in-person care significantly decreasing throughout the hospital, a large number of our social workers were working remotely. This presented the opportunity to create a new model for reaching out to and supporting families with potential social needs. Through the Family Connects program, social workers call families during their ER visit. This phone call acts as a “warm handshake,” acknowledging that these are unusual and difficult times, and offers an empathetic ear and immediate assistance to connect them with social resources, as needed. Emergent concerns, such as homelessness, intimate partner violence, child abuse, or significant mental health needs, are escalated to an in-person social work consult. Families requesting resources are contacted via a phone follow-up 48-72 hours later, to make sure they were able to access the resources provided.
The Family Connects program has been up and running for nearly three months. During the first month, over 1400 families were reached, with nearly a third requesting some form of assistance. Examples of services requested include information about local primary care doctors, referrals for housing, food, community mental health providers, utility, and rental assistance agencies. The Family Connects team has also provided emotional support to families, actively listening to the struggles that have come with stay at home orders and discussing challenges of different child developmental ages.
The world after COVID-19 will not be the same as the one that we knew before the pandemic began. In many ways, it should not be. It should be a re-examined world, where society as a whole evaluates our successes and failures, and honestly assesses how we treat those who are vulnerable and marginalized; one in which medical treatment seamlessly integrates the social factors with which it so entwined. We view Family Connects as a novel way to begin to achieve that goal. It is a proactive program, acting under the assumption that our families may have needs beyond their presenting complaints in the ED, and that it is the responsibility of the care team to assist. Long after the immediate effects of COVID-19 have passed, Family Connects will continue to exist and adapt. It will address short and long-term stressors and connect families with desired community resources. Beyond the mere existence of the program, it is our aim that Family Connects will contribute to an enhanced appreciation for the impact of social needs on overall well-being and be an integral part of a holistic health care system that more effectively and compassionately cares for those we serve.
Lauren A. Houdek VonHoltz, Danielle Cullen, and Ashlee Murray are pediatric emergency medicine physicians.
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