The Social Needs Assistance for Hospitalized Kids Trial

This multi-center randomized clinical trial (RCT) will compare the effectiveness of two interventions that help families connect with community-based resources to address social and economic needs (e.g., food insecurity, housing instability) on the health of hospitalized children: 1) passive referral (providing information to families about community-based organizations [CBOs] that can help address their social/economic needs and an introduction to an online resource to search for resources; vs. 2) active assistance by navigators -additionally providing the support of trained navigators to help connect families to CBOs both during and after enrollment.

The study's Specific Aims are:

AIM 1 (RCT): Conduct a multicenter, pragmatic, RCT among hospitalized children to determine the comparative effectiveness of passive referral versus active assistance by navigators on long-term, child health outcomes.

H1: Both interventions will lead to improvements, but active assistance by navigator (the higher intensity intervention) will lead to significantly more improvement in health among hospitalized children.

Aim 1B: Explore how intervention effects vary by child and family characteristics using heterogeneity of treatment (HTE) effect analyses HTE hypothesis: Children with high social needs will experience greater benefit with active assistance by navigators.

AIM 2 (Qualitative Interviews): Conduct interviews with caregivers who received resources and CBOs to identify barriers, facilitators, and mechanisms involved in connecting caregivers to CBOs and improving child health outcomes.

H1: Navigators' local knowledge of CBOs will be a key facilitator in addressing social needs.

H2: When social needs/competing demands are reduced, caregivers can focus more on their child's health.

For Aim 1, research staff will identify potentially eligible hospitalized patients through the electronic health record (EHR) and approach their caregivers about participation. Participants will first complete an eligibility screener and identify any social risks factors (e.g., food insecurity). If caregivers are deemed eligible, study staff will obtain informed consent from interested caregivers. All participating families will receive a tailored list of community resources to address their social needs informed by Findhelp, a web-based platform that helps individuals identify and connect with resources to address their social needs based on zip code. Families will also receive information on how to access and use Findhelp. Families will be randomly assigned to either: 1) the passive referral arm, for which no additional intervention activities will be provided, or 2) the active assistance by navigators arm, for which families will additionally receive hands-on support from a navigator, including follow-up contact every two weeks for three months, to help assist families in connecting with resources. The study will support both English- and Spanish-speaking families. Caregivers and their children will be followed over a 12-month period to assess health and social outcomes, with the primary outcome being assessed at 6 months after enrollment.

Aim 2 will involve interviewing a subset of caregivers who participated in Aim 1 and staff from CBOs serving recruitment site areas. Staff will conduct semi-structured interviews to explore perspectives on barriers and facilitators of connecting to CBOs to address social needs and mechanisms through which the interventions influence child health outcomes.

Inclusion criteria

Aim 1 - Caregiver-Child Dyads Sample

Caregiver-child dyads will be eligible to participate in the study if they meet the following criteria assessed during the recruitment and enrollment process:

• children are hospitalized on the general pediatric/pediatric hospital medicine (PHM) team/service
• the child is between the ages of 0-17
• the child's caregiver is >17 years-old
• the caregiver speaks English or Spanish
• the family lives in the same county as the hospital or in a neighboring county to the hospital
• the child is not in Child Protective Services custody
• the family has not previously been enrolled in the study
• the caregiver screens positive for >=1 of the following social risks: food insecurity, housing instability, housing quality concerns, transportation needs, utilities needs, child care needs, or financial strain
• the family is not enrolled in another social needs assistance-related research study (e.g., another social needs navigation study)

Aim 2 - Caregiver and Community-based Organization (CBO) Qualitative Interviews Sample Caregivers of children enrolled in Aim 1 will be eligible for study interviews.

CBO staff will be eligible to participate if they are:

• > 17 years old
• speak English or Spanish
• work at a CBO serving the area in which patients at the study sites live

Exclusion criteria

Aim 1 - Caregiver-Child Dyads Sample

Participants will be excluded from participation if they are:

• not hospitalized or hospitalized outside of general/PHM SERVICE
• children are 18 years of age or older
• caregiver/guardians are under the age of 18 years of age
• caregivers are do not speak English or Spanish
• the family does not live in the same or neighboring county of the recruitment hospital
• the child is under the care of Child Protective Services custody
• the family has already been previously enrolled in the study
• the caregiver does not screen positive for any of the following social risks: food insecurity, housing instability, housing quality concerns, transportation needs, utilities needs, child care needs, or financial strain
• the family is already enrolled in a social needs assistance-related research study (e.g., another social needs navigation study)

Aim 2 - Caregiver and CBO qualitative interviews Caregivers of children not enrolled in Aim 1 will not be eligible to participate study interviews.

CBO staff will not be eligible to participate if they are:

• under 18 years of age
• do not speak English or Spanish
• do not work at a CBO serving the recruitment site areas