Unless directly asked, many caregivers of pediatric patients might not associate their life outside the hospital or doctor's office with their child's health concerns. However, social health issues faced by families can negatively impact not only treatment adherence but ultimately health outcomes.

In a recent study published in Pediatrics, over 700 caregivers were randomized to either an computer-based or face-to-face screening regarding socioeconomic and psychosocial health issues to determine which screening format lead to greater disclosure rates.  Researchers found most (96.8%) of the caregivers in the study reported stress for at least one of the assessed social needs, which included income, child-care access, immigration status, employment concerns, transportation, incarceration of family members, drug or alcohol use by family members, physical violence in household, food security, and housing stability and conditions. However, the computer-based group "reported more stress on items related to interpersonal violence or threats in the home (P = .03) and substance abuse in the home (P = .05). They were also more likely to disclose their annual household income (71.7% vs 63.5%; odds ratio, 0.60; P = .02)". Also, caregivers in this group were "more likely to rate their social need with a higher point on the scale".  Such differences between the two groups may be the result of social desirability, according to study author, Laura Gottlieb, MD, MPH, who says, "although face-to-face interviews can build rapport and trust, they may result in more socially desirable responses and underestimate need". 

Given the high percentage of caregivers reporting stress related to social health needs, this study highlights the importance of screening caregivers for distress in some manner. Whether it be a face-to-face or computer based screening, identifying and addressing distress in both patients and their caregivers helps to reduce adverse health outcomes, poor treatment and medication adherence and poor functional outcomes. Straightforward assessments like the DEF Protocol provide an easy way for doctors and nurses to address distress, emotional and family needs of their patients and families.