# Implementing an Intervention to Address Social Determinants of Health in Pediatric Practices

> **NIH NIH R01** · BOSTON MEDICAL CENTER · 2022 · $83,672

## Abstract

Project Summary
It is known that social determinants influence children’s health trajectories, particularly for low-income children.
Pediatric primary care provides a unique opportunity to address children’s social conditions; however, recent
national data demonstrates that few providers routinely screen for unmet needs at visits. Our prior work has
focused on developing a pediatric primary care-based intervention, “WE CARE,” aimed at addressing poor
families’ material needs – food security, employment, parental education, housing stability, household heat,
and childcare – by systematically screening for these needs and referring families to existing community-based
services. To date, we have tested WE CARE primarily in community health centers (CHCs); our RCT
demonstrated WE CARE’s efficacy on parental receipt of community-based resources. Although demonstrating
WE CARE’s impact in this setting is important, over 80% of low-income children receive care from providers in
traditional pediatric practices (i.e. non-CHCs). Given the Affordable Care Act’s mandate for high-value, patient-
centered primary care and pediatric professional guidelines, along with WE CARE’s efficacy data, we believe
we are well-positioned to test and implement WE CARE in traditional pediatric practices. We propose a large-
scale, Hybrid Type 2 effectiveness-implementation trial in twenty eight pediatric practices in the US. A stepped
wedge study cluster RCT design will be used to implement WE CARE in all practices using two common
strategies used to integrate systems-based interventions into primary care – our previously facilitated “on-site”
strategy in which content experts provide training sessions and on-going consultation; and a self-directed
“web-based” method modeled after the American Academy of Pediatrics’ practice transformation strategy. The
proposed study’s specific aims are to: 1) demonstrate the non-inferiority of the self-directed, web-based
strategy for implementing WE CARE, in comparison to the facilitated on-site strategy; 2) demonstrate WE
CARE’s effectiveness on increasing parental receipt of community resources; and 3) assess the sustainability
of WE CARE in pediatric practices. We hypothesize that WE CARE will have equivalent fidelity via the two
strategies. Based on our prior work, we hypothesize that WE CARE will significantly increase parental receipt
of community resources six months post-visit compared to usual care. We also expect WE CARE to be
sustained 1-, 2-, and 3-years post-implementation. We expect to gather data from over 9,000 chart reviews,
2,800 parent-child dyads, and 150 providers and office staff. Our proposal is innovative because it challenges
current pediatric practice for addressing social determinants at visits. This proposal has significant public
health implications for the delivery of primary care to low-income children and is aligned with the mission of the
NICHD. Our long-term goal is to disseminate an evidence-based interv...

## Key facts

- **NIH application ID:** 10328931
- **Project number:** 5R01HD090191-05
- **Recipient organization:** BOSTON MEDICAL CENTER
- **Principal Investigator:** Arvin Garg
- **Activity code:** R01 (R01, R21, SBIR, etc.)
- **Funding institute:** NIH
- **Fiscal year:** 2022
- **Award amount:** $83,672
- **Award type:** 5
- **Project period:** 2017-07-20 → 2022-04-01

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10328931

## Citation

> US National Institutes of Health, RePORTER application 10328931, Implementing an Intervention to Address Social Determinants of Health in Pediatric Practices (5R01HD090191-05). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10328931. Licensed CC0.

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