Revisiting the Social History for Child Health

Excerpt

PEDIATRICS Vol. 120 No. 3 September 2007, pp. e734-e738 (doi:10.1542/peds.2006-2495)

COMMENTARY

Revisiting the Social History for Child Health

Chén Kenyon, MDa, Megan Sandel, MD, MPHb, Michael Silverstein, MDb, Alefiya Shakir, MDc and Barry Zuckerman, MDb
a Boston Combined Residency Program in Pediatrics, Boston Medical Center, Children's Hospital, Boston, Massachusetts
b Departments of Pediatrics
c Medicine, Boston University School of Medicine, Boston, Massachusetts
New research has helped elucidate the mechanisms by which social circumstances affect health, and new resources have been created to mitigate these factors and thereby improve health. Medical care must evolve to include screening for selective social factors into clinical practice to augment public health and social policy strategies. We suggest that the primary tool that identifies the social circumstances of the patients, the social history, be revisited.

Although eliciting a history of social circumstances with each part based on well-supported connections to health and in areas of patient’s lives that clinicians can actually influence is the goal, we acknowledge that the current level of data may be insufficient to establish a definitive model. Given this constraint, we suggest a practical method for eliciting a social history that focuses on specific social domains. Pediatricians generally address some of these issues already, such as knowing who a child lives with and where they are from. However, basic needs such as income, food sufficiency, and health environments at home and in school, which are crucial to children’s health and well-being, are not routinely addressed.

We propose an explicit set of domains and questions (see Table) that allow for more specific inquiry into areas that are amenable to direct intervention that focuses on basic needs and factors that influence health. Using the mnemonic “IHELLP,” our model addresses income, housing/utilities, education, legal status/immigration, literacy, and personal safety, each of which has been shown to directly impact child health. This approach to the social history could be applied over a series of health care visits or in a focused manner if one of these areas is identified as a significant contributor or risk factor for poor health.

TABLE. Examples of Potential Social History Questions (Using the “IHELLP” Mnemonic) to Address Basic Needs

Domain/Area	Examples of Questions

Income
General	Do you ever have trouble making ends meet?
Food income	Do you ever have a time when you don't have enough food? Do you have WIC? Food stamps?
Housing
Housing	Is your housing ever a problem for you?
Utilities	Do you ever have trouble paying your electric/heat/telephone bill?
Education
Appropriate education placement	How is your child doing in school? Is he/she getting the help to learn what he/she needs?
Early childhood program	Is your child in Head Start, preschool, or other early childhood enrichment?
Legal status
Immigration	Do you have questions about your immigration status? Do you need help accessing benefits or services for your family?
Literacy
Child literacy	Do you read to your child every night?
Parent literacy	How happy are you with how you read?
Personal safety
Domestic violence	Have you ever taken out a restraining order? Do you feel safe in your relationship?
General safety	Do you feel safe in your home? In your neighborhood?

WIC indicates Supplemental Nutrition Program for Women, Infants, and Children.