The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) is a validated social needs screening tool widely used in primary care but rarely adapted for the emergency department (ED). We evaluated the feasibility of implementing an abridged PRAPARE tool in a high-volume ED using an operational model designed to minimize burden on clinical staff.

From October 2021 to October 2023, trained student volunteers administered an 11-item abridged PRAPARE survey to adult ED patients during waiting-room time, parallel to routine clinical workflows. This retrospective quality improvement analysis evaluated deidentified data from these encounters. Items were selected via multidisciplinary consensus based on local resource alignment and analyzed descriptively.

Of 6,931 patients approached, 683 (9.8%) completed screening. Most identified as non-Hispanic Black (62%) and female (61%). Nearly all (94%) reported at least one unmet social need, and 56% reported three or more. The most common were food insecurity (47%), medication access (39%), and utility insecurity (37%). Substantial proportions also reported transportation barriers (28%), housing instability (27%), unemployment (26%), and feeling unsafe at home (15%). Black patients were overrepresented relative to the ED census (62% vs 40%). Among those with unmet needs, 96% expressed willingness to engage with assistance.

An abridged PRAPARE tool was successfully implemented using a low-burden, volunteer-driven model and identified a high prevalence of unmet social needs. These findings support streamlined screening delivered outside the clinical workflow and offer operational lessons on volunteer staffing, workflow integration, and referral infrastructure.

Neurodevelopment deficits are common among survivors of CHD and affect their future health and quality of life. Patients who have undergone cardiopulmonary bypass in infancy should have early, dedicated neurodevelopmental evaluation. There are many barriers to implementing this guidance. Our study examines the patterns of neurodevelopmental follow-up and outcomes in CHD patients in a rural, underserved, and resource-limited region.

We conducted a single-centre chart review of CHD patients seen from 2012 to 2024 and analysed trends in neurodevelopment follow-up, including the number of scheduled appointments, attended appointments, and missed appointments. We looked at whether area deprivation index was associated with differences in neurodevelopmental referral, attendance, and missed appointments. Area deprivation index is a composite measure of neighbourhood disadvantage based on income, education, employment, and housing quality.

Out of 1,060 patients in total, neurodevelopment appointments were scheduled for 270 (25%) of patients. The incidence of neurodevelopment diagnoses was similar across area deprivation index quartiles. Patients across area deprivation index quartiles had similar rates of attending at least one appointment, but children in the third and fourth quartiles had more than twofold higher odds of missing visits compared with those in the least deprived quartile. There was no significant difference in the age at which children received a neurodevelopment diagnosis.

CHD patients from more socially disadvantaged neighbourhoods were more likely to miss neurodevelopmental appointments. Area deprivation index, which is routinely available in major health record systems, may help identify patients at higher risk of poor follow-up.

This study aimed to explore patient perspectives on standardized screening for social needs within the context of primary care in Canada.

Social determinants of health significantly influence patient health outcomes. While standardized screening for patient social needs has gained momentum, patient perspectives on the utility of said screening, particularly within the Canadian context, remains underexplored.

Semi-structured interviews were conducted with participants aged 18 and older (n = 195), recruited from a larger multi-site study, using purposive maximum-variation sampling across four Canadian provinces (Ontario, Manitoba, Saskatchewan, and Newfoundland and Labrador). Questions asked during the interviews focused on financial well-being (ability to afford basic needs), housing status, social well-being, transportation, ability to afford utilities, and employment status. These interviews followed another study component where participants were asked to complete a short social needs questionnaire (the SPARK tool). Data was analysed using a thematic content analysis. Five themes were generated, including (1) openness to screening for social needs, (2) value in healthcare providers knowing patients’ social needs, (3) overall scepticism and trust/distrust in the healthcare system and professionals; (4) potential for harm; (5) meaningful engagement and provider training on social needs.

Participants were generally comfortable being asked about their social needs but stressed the importance of privacy, especially regarding financial well-being (ability to afford basic needs and extended health-care related expenses), as well as clear usefulness of the data and building physician-patient trust. Participants were generally open to social needs screening, though discomfort emerged when discussing race, employment, housing, and financial well-being, largely driven by concerns about privacy, trust, and data use. These findings highlight the importance of transparent communication, robust data governance, and explicit informed consent to support acceptable and effective implementation of social needs data collection.

Children with CHD require long-term follow-up, but missed visits among patients are common. Missed appointments likely contribute to excess morbidity and mortality. Our study seeks to identify social factors that could predict patients at risk of missing cardiology visits and to determine if missed visits and these social factors contribute to increased emergency department utilisation.

We conducted a single-centre chart review of CHD patients seen from 2012–2024 and analysed trends in paediatric cardiology clinic attendance, particularly the number of missed appointments. We also looked at emergency department visits and subsequent admissions among these groups. The primary exposure was the area deprivation index, a composite measure of neighbourhood disadvantage based on income, education, employment, and housing quality. We also compared the number of acute visits between patients with more missed visits.

We included 1,060 patients with CHD, and 46% of our population had ≥2 missed clinic visits, 31% had ≥5 emergency department visits, and 32% had ≥2 admissions. The number of missed visits increased across area deprivation index quartiles, though the number of emergency department visits and admissions was not significantly affected by area deprivation index. Patients with more missed visits were more likely to have more emergency department visits and admissions.

Our data suggest a relationship between community deprivation and missed clinic visits, and missed clinic visits seem to confer a greater risk of emergency department visits and unplanned admissions. Area deprivation index is a parameter available in major electronic health records and could be used to identify patients at risk for missed visits.

To examine how co-located community and health services in primary care could support disadvantaged groups.

Co-locating services is thought to improve access, collaboration, and patient outcomes. There are thousands of primary care premises across the UK. At a time of stagnating or widening health inequalities, they present an ideal opportunity to support communities, especially in disadvantaged areas.

We conducted a systematic umbrella review. Articles were retrieved from Ovid MEDLINE and Ovid Embase with supplementary snowball and grey literature searches. Reviews of co-located services supporting disadvantaged groups in primary care between 2010 and February 2024 were included. Quality and risk of bias were assessed using the Joanna Briggs Institute checklist. Two reviewers assessed eligibility, extracted data and assessed quality. Outcomes relating to health, welfare, healthcare utilization, and activity and processes were assessed. Data were narratively synthesized using a convergent integrated approach.

2626 studies were screened, supplemented by snowball and grey literatures searches. Thirteen reviews were included for synthesis. One review included meta-analysis. Three models of care were identified; legal advice, welfare advice, and complementary health care. Data were synthesized according to themes: access and engagement, quality of care, efficiency, improved health, and improved social factors. We found co-located services can improve access to care, engagement in treatment, and quality of care for disadvantaged groups. Improvements to social determinants of health and mental health and well-being outcomes were reported. Findings were inconsistent when considering the impact of co-location on efficiency. We conclude that co-located services in primary care have the potential to improve identification of people most in need and improve their access to high quality health care and social support. Policy makers and practitioners should maximize the use of primary care estates to support disadvantaged groups and communities.

To evaluate the need, feasibility, and acceptability of parental mental health screening in cardiology clinics and explore the relationship between social risk factors and parental mental health.

Single-centre pilot study in two outpatient cardiology clinics. Participants were parents or caregivers of a fetus or child with CHD. Parental mental health was assessed using the Depression, Anxiety, and Stress Scale – 21 Items and the Edinburgh Postnatal Depression Scale. A validated social risk factor screener was also completed. Parents with positive screening results were referred for follow-up with the clinic social worker.

A total of 131 participants enrolled, with an 83% consent rate. A total of 30% of participants screened positive for depression, anxiety, and/or stress. Among participants with a positive mental health screen, 36% did not have a previous mental health diagnosis; most were not currently receiving mental health services, and more than half were interested in receiving mental health services. Rates were similar between the prenatal and postnatal/early childhood years. Participants with a positive mental health screen had higher rates of several social risk factors. Acceptability was high, and the clinic social worker spent an average of 34 min per participant providing follow-up care.

Stress, anxiety, and depression are common in parents/caregivers of a fetus or child with CHD. Longitudinal mental health screening in paediatric cardiology clinics identifies parents at risk for psychosocial challenges and structures related supports. Intervention sustainability using this approach is dependent on post-screening follow-up from social work support or staff with similar expertise.

Social prescribing (SP) is increasingly recognised as a key component of primary care, implemented in at least 25 countries by 2023. In England, SP has been nationally rolled out through Primary Care Networks (PCNs), though many areas, including Redbridge in East London, had pre-existing VCSE-led models. How national and local approaches integrate in practice remains underexplored.

This study used a two-step qualitative design. First, documentary analysis of service planning and evaluation documents mapped the SP referral pathway in Redbridge before and after the national rollout. Second, 16 semi-structured interviews were conducted with purposively sampled stakeholders from PCNs, RedbridgeCVS, the local authority, and the Clinical Commissioning Group, exploring service integration and delivery experiences. Data were analysed using the Framework Method, combining deductive coding against predefined themes with inductive identification of emergent categories.

RedbridgeCVS was widely valued for its expertise, especially in managing complex cases, training link workers, and facilitating access to local services. However, integration across PCNs was inconsistent. Participants reported variation in GP engagement, referral processes, and support structures. PCN link workers faced capacity pressures, unclear role boundaries, and limited access to clinical supervision, affecting the sustainability and coherence of service delivery.

Integrating national and local SP models requires clearer leadership, standardized referral pathways, and consistent support for link workers. Without greater alignment across primary care and VCSE partners, the full potential of SP risks being undermined. Link workers must be recognized and supported as core members of the primary care team.

Few studies have examined the relationship between racial identity and baseline assessment performance in collegiate athletes, and even fewer have contextualized results using structural factors linked to test performance. This study examined racial differences in baseline assessment performance before and after controlling for performance on a word-reading task as a proxy for education quality. We hypothesized that there would be racial differences in baseline performance but that controlling for education quality would reduce these differences.

For this observational cross-sectional study, 875 collegiate athletes were grouped based on racial identity (White = 661, Black = 165, Another Race = 49) and underwent a comprehensive neuropsychological battery. Cognitive composite scores and intraindividual variability (IIV) were calculated for two neurocognitive domains: attention/processing speed and memory. Education quality was assessed with the Wechsler Test of Adult Reading (WTAR). ANCOVAs were used to examine racial differences in these cognitive domains before and after controlling for WTAR scores.

There were significant racial differences in both composite scores and in attention/processing speed IIV, p’s < .001, f = 0.13–0.21. However, there were no significant racial differences in memory IIV, p = .97. After controlling for WTAR scores, there were no significant racial differences in the attention/processing (p = .530, f = 0.03) or memory (p = .183, f = 0.06) composite scores, and the relationship between racial identity and attention/processing speed IIV was less prominent (p = .014, f = 0.10).

Results suggest that racial differences at baseline assessment can be largely accounted for by education quality as assessed by the WTAR, which underscores the importance of considering sociocultural context when assessing racially diverse athletes.

The goal of the present study is to understand whether youth with Noonan Syndrome Spectrum Disorder (NSSD) are at increased risk of neurocognitive difficulties when living in resource depleted communities.

Youth (5–17 years; Mage = 9.48 years) with NSSD (n = 140) and unaffected youth (4–15 years; Mage = 9.63 years; n = 85) were included. We ascertained the Child Opportunity Index Health and Environment Index (COI H/E) national-level Z-scores and assessed academic achievement and executive function. Multiple regressions were run to analyze the effects of diagnosis (whether the child had NSSD), COI H/E Z-scores, and diagnosis × COI H/E Z-score interaction on academic achievement (i.e., word reading, math, spelling, and sentence comprehension) and executive skills (i.e., performance-based working memory and processing speed and parent-rated measure of daily executive skills).

Diagnosis was a significant predictor in each model. COI H/E Z-score was a significant predictor of spelling and a marginally significant predictor of sentence comprehension scores. There was a significant diagnosis × COI H/E Z-score interaction for working memory, and marginally significant interactions for spelling and sentence comprehension scores. Higher H/E Z-scores were associated with better working memory in the NSSD group and better academic achievement in the unaffected group.

While the effects of NSSD are large on all assessed domains, there is an additional burden of resource depletion on working memory abilities of youth with NSSD. Academic achievement in the NSSD group was lower than the unaffected group across resource-depleted/enriched environments, demonstrating the profound effects of NSSD on academic functioning.

Assessment for children with acquired brain injury (ABI) often includes measures of preinjury functioning; however, there is limited understanding of how social determinants of health (SDOH) are associated with preinjury measures. This study investigated the association of the Area Deprivation Index (ADI) with measures of preinjury functioning.

196 caregivers of children with ABI completed the Adaptive Behavioral Assessment System-3rd Edition (ABAS-III), and 188 children with ABI completed the Wide Range Achievement Testing-4th Edition or 5th Edition word reading subtest (WRAT-Word Reading). Two linear regressions were performed: 1) ADI × WRAT-Reading and 2) ADI × ABAS-III.

The ADI demonstrated significant associations with the ABAS-III and WRAT-Reading scores. Children in lower deprivation areas demonstrated higher preinjury functioning and word reading scores.

These findings have implications for recovery from brain injury, considerations for incorporating social determinants of health into neuropsychological evaluations, and implications for clinician interpretation of a child’s testing.

Medical-Legal Partnerships (MLPs) integrate attorneys into health care settings to provide free legal care for low-income families. Our objective was to explore MLP client experiences of a neonatal MLP integrated into a neonatal intensive care unit and fetal care program.

We used a qualitative descriptive inquiry methodological approach to conduct interviews with clients of the neonatal MLP clients. Interviews were conducted via telephone, recorded, and transcribed. We conducted a reflexive thematic analysis of the data.

Sixteen neonatal MLP clients completed qualitative interviews. We found that MLPs may facilitate supportive, holistic, and interdisciplinary care that mitigates parental distress and addresses structural barriers to family stability. The program would be improved with more transparency, capacity, and visibility.

Medical-Legal Partnerships offer an innovative strategy to address social determinants with legal implications that impact the health and well-being of neonatal intensive care unit and fetal care therapy patients and families.

Parental adverse childhood experiences have been associated with poorer health outcomes for children in the general population. This single-centre study examined the prevalence of parental adverse childhood experiences in a sample of young children with single ventricle CHD, the associations between parental adverse childhood experiences and child health outcomes, and the moderating effects of parental stress and social support on the relationship between parental adverse childhood experiences and child health outcomes.

Parents (N = 72) responded to questionnaires assessing demographic characteristics, parental adverse childhood experiences, social support, and stress. Child health outcomes (hospital admissions, length of stay, missed appointments) were assessed via parent-report and medical record review.

Half of parents (52.8%) endorsed exposure to at least one adverse childhood experience. In univariate analyses, children whose parents had a history of adverse childhood experiences were 1.78 times as likely to have more parent-reported hospital admissions (p = 0.002) and 2.22 times as likely to have more missed visits (p = 0.03) compared to children of parents without a history of adverse childhood experiences. Parental social support significantly moderated the relationship between parental adverse childhood experiences and total hospital length of stay (p = 0.03). Specifically, for each unit increase in parents’ social support total score, parents with a history of adverse childhood experiences were likely to have an 83% reduction in their child’s length of stay.

Parental adverse childhood experiences may be associated with poorer single ventricle CHD outcomes. Strengthening parental social support may improve health outcomes for children with single ventricle CHD in the setting of pre-existing psychosocial risk.