It’s About Trust: How Pediatricians Can Screen Children for Social Factors

Low-income parents are willing to discuss with pediatricians the social and economic concerns that impact their children’s health, but fear being reported to child welfare agencies

NEW YORK, NY—June 24, 2019—Pediatricians seeking to address the social and economic concerns that can affect the health of their young patients must first build trusting relationships with parents and alleviate concerns that child protective services may be alerted, according to a report released today by United Hospital Fund and the nonprofit research organization Public Agenda.

Health care providers increasingly recognize that they must address economic and social factors outside the clinic if they are to improve patient health. Pediatricians bear an extra responsibility, as numerous studies have shown that adversity and stress in early childhood can interfere with healthy physical, cognitive, and emotional development well into adulthood. By screening for such health risks as food insecurity, unsafe housing, parental depression, adult employment needs, and household literacy—often referred to as social determinants of health—pediatric practices can identify vulnerable children and families and connect them through community partners to appropriate services and supports. 

The report, It’s About Trust: Low-Income Parents’ Perspectives on How Pediatricians Can Screen for Social Determinants of Health, is based on discussions conducted over two months with 88 low-income New York City parents, all with children age five and under, in eight focus groups. They were asked about their perceptions and reactions to pediatricians screening for social and behavioral health needs.

Based on these focus groups, report authors David Schleifer, PhD, vice president, director of research at Public Agenda, and Public Agenda research associates Antonio Diep and Kirk Grisham, found that parents understood that their children’s health was linked to many non-medical factors, but the idea of discussing social and behavioral health needs with pediatricians was relatively new. Although they indicated they would be comfortable discussing certain topics with their child’s doctor, such as nutrition, education, and minor behavioral issues, other issues were far more sensitive, such as parents’ mental health, legal problems, and domestic violence. 

The parents’ reluctance stemmed from concerns about being judged and discriminated against, about fitting discussions of complex topics into short appointments, and that they wouldn’t get help even if they did share sensitive information. Most of all, parents worried that such screening would invite scrutiny by child welfare agencies. 
“Parents were afraid that if they shared information about their lives with their pediatrician they might be investigated or even lose their kids,” Dr. Schleifer said. “Parents told us that physicians must build trust if they want parents to open up about their lives.”  

Despite their reservations, parents in the focus groups enthusiastically shared their ideas about how pediatricians can approach discussions of social needs. The parents emphasized that such discussions must be approached respectfully, without shaming them. They also wanted assurance that if they were to be asked about sensitive issues, then they would be provided with helpful resources and supports. 

Among the parents’ recommendations to pediatricians for effectively screening for social needs:
•    Choose the right moment to ask about social needs.
•    Don’t ask in front of the children.
•    Signal confidentiality, where appropriate, and be transparent about what would trigger a report to child welfare.
•    Do not ask just for the sake of asking.
•    Make clear that screening is standard protocol.

“Parents bring their young children to the pediatrician up to 11 times within the first two years of life, and each of these visits offers an opportunity to identify unmet social needs and coordinate care with community-based services,” said Suzanne Brundage, director of UHF’s Children’s Health Initiative. “As screening for social determinants of health becomes more common in pediatric practices, qualitative and quantitative research can help us understand and improve how parents experience these screenings.”

Parents in four of the focus groups were recruited by community-based organizations that are part of UHF’s Partnerships for Early Childhood Development initiative, set up to help pediatric practices routinely screen young children and their families for social determinants and connect them with social services that can address those risks. The rest of the parents were recruited by professional market research facilities. Two of the eight focus groups were conducted in Spanish.

Support for the report was provided by a grant from United Hospital Fund. UHF’s Children’s Health Initiative, which commissioned and collaborated on this work, is funded in part by the William J. & Dorothy K. O’Neill Foundation and the Ira W. DeCamp Foundation. 

The full report can be downloaded here.

About Public Agenda
Public Agenda works to strengthen democracy and expand opportunity in America by fostering thoughtful public opinion, meaningful public participation and responsive public institutions. Founded in 1975 by the social scientist and public opinion research pioneer Dan Yankelovich and soon-to-be secretary of state Cyrus Vance, Public Agenda is a nonpartisan, nonprofit research and public engagement organization. Find Public Agenda online at, on Facebook at and on Twitter at @PublicAgenda. 

About United Hospital Fund
United Hospital Fund works to build a more effective health care system for every New Yorker. An independent, nonprofit organization, we analyze public policy to inform decision-makers, find common ground among diverse stakeholders, and develop and support innovative programs that improve the quality, accessibility, affordability, and experience of patient care. For more on our initiatives and programs please visit our website at and follow us on Twitter.