PEDIATRICS Vol. 120 No. 3 September 2007, pp. e734-e738 (doi:10.1542/peds.2006-2495)
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
WIC indicates Supplemental Nutrition Program for Women, Infants, and Children.