Treating the Whole Child: How Maimonides Children’s Hospital Uses Social Determinants of Health
As patients, we rely on our doctors to take care of our health but there's more to our health than how we're feeling right now. Join us as Dr. Yonit Lax discusses social determinants of health, how they impact wellness, and what steps Maimonides is taking to support your good health.
Featured Speaker:
Yonit Lax, MD
Yonit Lax, MD is an Attending Physician in the Division of General Pediatrics, Hospital Medicine, and Population Health at Maimonides Children's Hospital and an Assistant Professor of Clinical Pediatrics at SUNY Downstate Medical Center. As a pediatrician who believes in treating the whole child, she takes a holistic approach to understanding more than what makes you sick but also what makes you healthy. She loves working with families from birth up to adolescence, and helping them navigate their path. Dr. Lax attended The George Washington University Honors Program at the Elliott School of International Affairs where she concentrated on Global Health, graduating Summa Cum Laude with Phi Beta Kappa enrollment. She received her post-baccalaureate in premedical studies at The Johns Hopkins University, and acquired her Doctor of Medicine from The George Washington University School of medicine where she was made a member of the Gold Humanism Honors Society. Dr. Lax completed an internship, residency, and chief residency in Social Pediatrics at the Children's Hospital at Montefiore where she received the Chairman's Award for Distinction in Research, the Daniel Leicht Award for Outstanding Achievement, and was inducted into the Leo Davidoff Society for Excellence in Teaching. Dr. Lax's research focus is on social determinants of health and medical education. While at Montefiore she had a grant from the American Academy of Pediatrics and the Association of Pediatric Program Directors to start a curriculum on advocacy for pediatric residents and medical students. She has presented her work nationally and published several papers. Dr. Lax is the principal investigator for two HRSA Healthy Tomorrow Grants at Maimonides Children's Hospital that integrate mental health into primary care- one which focuses on school age children and one on early childhood, and the recipient of the Maimonides Research and Development Foundation Grant for her research on Social and Emotional Needs for Children Before and During COVID 19. Transcription:
Treating the Whole Child: How Maimonides Children’s Hospital Uses Social Determinants of Health
Evo Terra (Host): As patients, we rely on our doctors to well take care of our health, but there's more to our health than how we're feeling right now, or what specific health concern brought us or a loved one to a health provider on any given day.
Allow me to give you a definition of a term. You'll be hearing a lot in this interview, social determinants of health. This is a term used to refer to nonmedical factors that influence health, and this can be on an individual community or societal level. The medical community has begun to focus on identifying what these elements are and how they affect.
Here to talk about how social determinants informed pediatric patient care at my monities is Dr. Yoni lax attending physician in the division of general pediatrics hospital medicine and population health at my moderate is children's hospital.
Evo Terra (Host): This is Maimo Med Talk. I'm your host Evo Terra. Welcome to the show Dr. Lax.
Yonit Lax, MD (Guest): Thank you. I'm delighted to be here.
Host: So, tell me a little bit about the work that you do at Maimonides.
Dr. Lax: Sure. So first and foremost, I'm a pediatrician and I am our Chief of Pediatric Community Health. So what that means is that I really take into consideration the health of our entire pediatrics community that we serve at Maimonides in Brooklyn being a children's hospital. We serve a very diverse population and our goal in the Community Health Department is to really think a little bit more critically about the needs of our patients and how we can best serve those needs as a children's hospital.
We here at Maimonides in 2019, started screening for social determinants of health to focus on the individual social needs of our community. So we screen our pediatric patients in our primary care department. Those patients who are coming in with their families for their well-child visits which are done fairly frequently in the first few years of life. And then annually after that. We screen for 12 different social determinants of health. Started screeningin 2019 after we conducted a needs assessment of our community and seeing what were the social needs that our patients were facing. What kinds of things did people have needs for and what did they want help with?
And after that, we developed a community advisory board of over 10 community-based organizations that serve as advisors for us in creating this screening tool. And also are partners with us where we can refer our patients when any of these needs arise. So, what does that mean? That means that we screen for food insecurity and we have partners who are providing food stamps and coming into our office and screening patients who are saying that they would like food stamps and helps with enrollment in there. And we have a partnership with our Maimonides WIC office who comes and sits in our pediatric primary care department and will provide lactation services for our families to help them with breastfeeding. We have a partnership for English as second language classes so that our parents who don't speak English can be empowered to learn English and then better navigate the healthcare system when they're bringing their children.
And we have partnerships with health care organizations that focus on the law like NYLAG, which is New York Legal Aid Group who helps with any medical legal problems that our patients are facing, with immigration, housing, family court. Any legal needs, really. And they also come and sit in our office and serve our patients there. It's a really robust program.
And this was formed back in 2019 prior to COVID. And within the last about two and a half years, we have screened over about 20,000 patients for social needs. We've been able to kind of see what are the needs that are arising and then change what our, how we're focusing it each month as we look at these needs and see, do we need an organization who can, you know, start to look at this differently because wow, we're seeing our needs are really increasing in one of these.
And so it's been a continuous quality improvement project on our end. Just recently, in the last six months we've expanded this to be on the inpatient unit as well. So that families with hospitalized, children who often have even larger needs are screened for this universally as well. And are able to be given resources while their child is hospitalized, that will hopefully help prevent any unnecessary hospitalizations, which we know are linked to some of these social factors.
Host: This sounds a lot different than taking my kid to the doctor because an injury or the sniffles and the doctor saying the equivalent of where does it hurt, I'll make it better. Clearly we were going a lot deeper with this program, is this something that patients or their parents have to opt into or are you screening everyone that comes in?
Dr. Lax: So, we are universally screening. Patients can opt out of it if they don't feel comfortable or don't want to participate. However, the screen is offered to everybody. Part of that is we know we all have implicit biases of kind of who might have the highest needs. And sometimes families who we never would have guessed would have had needs have really great needs and are so appreciative that we're asking them because they haven't had the opportunity to ask anybody before this. It's not a service that patients necessarily expect when they come to the doctor, but it is one that we're finding they're really grateful to have.
Host: Yeah, I would imagine it's nice to have someone listen. Someone ask the questions and again, making it a little different than just the normal, hey, I'm here for one thing and that is your bodily health, but clearly there are other non-health determinants of health, if you will or non-medical determinants of health that really matter. So you mentioned that you have screened up, I believe it was 20,000 patients thus far.
Dr. Lax: Yep. We've screened about 20,000 patients. Yeah. During COVID-19 we, during the lockdown here in New York which was March of 2020, we stopped seeing patients really coming in for their routine well-child visits and which is when we were screening for this. So we decided we needed to approach things a little differently and started a Telemedicine outreach program for our families in which we called families and conducted these screens over the phone and saw how we could connect them remotely to whatever resources existed at the time. And that also evolved for families and not only you know, was it a time where they weren't coming in to see us, it was also a time of really high needs, as we know, across the nation where people were out of work. The economy was really down and the ability to get resources like you were getting before was more difficult. We saw families who used to be able to go into WIC office to get their WIC checks.
And now the WIC offices were closed and they couldn't get their formula the same way they were getting them before and they couldn't afford to buy it. So, what were they to do? And so we really had to change around some of our resources and reach out to families who didn't know where to turn to. So we started this Telemedicine outreach program over the summer. And we screened about 400 patients just given our manpower at the time to do so. And were able to follow that cohort at 400 patients every six months throughout the pandemic thus far. So we've screened them three times and seeing, you know, was it helpful what we were giving you? Do you need additional help and rates that we were finding not only of the needs identified, but of, you know, the referrals that were requested and determined to be helpful.
Host: Very positive.
Dr. Lax: Yeah, over the course of the pandemic, as we've been looking at this, you know, as one might imagine in the beginning of the pandemic, a lot of the needs were really heightened. We saw that patient's needs everything pretty much jumped up. We saw an increase in food insecurity, housing needs really increased. Needs, especially because of remote education children was a huge issue for, especially for our patient population where perhaps language was a barrier and access to wifi and navigation of the remote system. And legal needs also increased over that time.
But the interesting thing that we have found is as we've given out these resources and over the course of the last year and a half as we've been following them, we were able to compare their needs to from previous to the pandemic, to what they are throughout the pandemic, including most recently. From prior to pandemic to the height of the pandemic they increased significantly. But then over that course, once we were giving them resources, they have decreased to lower rates than it was prior to the pandemic at this point.
Host: Oh, that's positive.
Dr. Lax: Yeah. So it's a very encouraging outcome that we're seeing.
Host: What do you see as the future for the program?
Dr. Lax: You know what, I think it's highlighting for us, I think just as medicine right now is, is evolving from being a solely you know, you've come to the doctor and get your needs met to becoming increase in Telemedicine opportunities and the ability to communicate with your doctor at different times. This may be also something that we need to think about with our screening tools. Should this be something that we reach out to our patients independent of their time at the doctor's office to see if we can reach out to those who are in high need and not able to come in? We also would really love to expand this. So we've expanded it to our three primary care clinics, our inpatient unit, and hopefully in the future, you know, the entire hospital system will be screening for this, including our emergency room, our critical care units, our sub-specialists. You know, I, I think one of the things that this study highlights to me is the more times that you have contact with a family and are able to see them through their needs, the better off they are. And so if we can touch a patient at each time that they touch a doctor's office, we have a higher chance of making a difference.
Host: Absolutely. Dr. Lax, before I let you go, is there anything else you wanted us to get into that we didn't cover?
Dr. Lax: One of the things that we're screening for is poor housing conditions. And what we do for that is we send letters from physicians to the landlord. This is all embedded in our electronic health record. Physicians with a click of a button can generate a letter to a landlord stating that their patient is currently in a house that is infested with cockroaches, mold, mice, whatever the concern is, and states that their medical conditions, if they have asthma, eczema, allergies, are placed at risk or heightened due to the fact that they have this exposure and therefore it's really imperative for the landlord to change these housing conditions.
And we did research on this recently calling the families back and asking them, after we gave you this letter, what happened? Did your landlord change anything or was it the same? And what we found was that the majority of landlords actually did act on, on this. We saw that not only did the majority act on it, but they also resolved their problems. So, you know, it was really encouraging for us to see that over 89% acted to resolve the issue and 74% had complete resolution.
Host: That's fantastic.
Dr. Lax: What we're doing is making a difference. And I hope it encourages other physicians to, you know, think outside the box and when we're approaching some of these conditions that we see.
So, in thinking about this, it's really thinking about the whole child and what can we do to really support our community, as we're all going through this trying experience.
Host: And it sounds like your doing a lot to support that community right now. So thank you very much for your efforts, Dr. Lax.
Dr. Lax: Thank you.
Host: And thanks to you for listening. To learn more about Maimonides Medical Center, please visit maimo.org. That's M-A-I-M-O.org. This has been Maimo Med Talk. I'm your host, Evo Terra. Stay well.
Treating the Whole Child: How Maimonides Children’s Hospital Uses Social Determinants of Health
Evo Terra (Host): As patients, we rely on our doctors to well take care of our health, but there's more to our health than how we're feeling right now, or what specific health concern brought us or a loved one to a health provider on any given day.
Allow me to give you a definition of a term. You'll be hearing a lot in this interview, social determinants of health. This is a term used to refer to nonmedical factors that influence health, and this can be on an individual community or societal level. The medical community has begun to focus on identifying what these elements are and how they affect.
Here to talk about how social determinants informed pediatric patient care at my monities is Dr. Yoni lax attending physician in the division of general pediatrics hospital medicine and population health at my moderate is children's hospital.
Evo Terra (Host): This is Maimo Med Talk. I'm your host Evo Terra. Welcome to the show Dr. Lax.
Yonit Lax, MD (Guest): Thank you. I'm delighted to be here.
Host: So, tell me a little bit about the work that you do at Maimonides.
Dr. Lax: Sure. So first and foremost, I'm a pediatrician and I am our Chief of Pediatric Community Health. So what that means is that I really take into consideration the health of our entire pediatrics community that we serve at Maimonides in Brooklyn being a children's hospital. We serve a very diverse population and our goal in the Community Health Department is to really think a little bit more critically about the needs of our patients and how we can best serve those needs as a children's hospital.
We here at Maimonides in 2019, started screening for social determinants of health to focus on the individual social needs of our community. So we screen our pediatric patients in our primary care department. Those patients who are coming in with their families for their well-child visits which are done fairly frequently in the first few years of life. And then annually after that. We screen for 12 different social determinants of health. Started screeningin 2019 after we conducted a needs assessment of our community and seeing what were the social needs that our patients were facing. What kinds of things did people have needs for and what did they want help with?
And after that, we developed a community advisory board of over 10 community-based organizations that serve as advisors for us in creating this screening tool. And also are partners with us where we can refer our patients when any of these needs arise. So, what does that mean? That means that we screen for food insecurity and we have partners who are providing food stamps and coming into our office and screening patients who are saying that they would like food stamps and helps with enrollment in there. And we have a partnership with our Maimonides WIC office who comes and sits in our pediatric primary care department and will provide lactation services for our families to help them with breastfeeding. We have a partnership for English as second language classes so that our parents who don't speak English can be empowered to learn English and then better navigate the healthcare system when they're bringing their children.
And we have partnerships with health care organizations that focus on the law like NYLAG, which is New York Legal Aid Group who helps with any medical legal problems that our patients are facing, with immigration, housing, family court. Any legal needs, really. And they also come and sit in our office and serve our patients there. It's a really robust program.
And this was formed back in 2019 prior to COVID. And within the last about two and a half years, we have screened over about 20,000 patients for social needs. We've been able to kind of see what are the needs that are arising and then change what our, how we're focusing it each month as we look at these needs and see, do we need an organization who can, you know, start to look at this differently because wow, we're seeing our needs are really increasing in one of these.
And so it's been a continuous quality improvement project on our end. Just recently, in the last six months we've expanded this to be on the inpatient unit as well. So that families with hospitalized, children who often have even larger needs are screened for this universally as well. And are able to be given resources while their child is hospitalized, that will hopefully help prevent any unnecessary hospitalizations, which we know are linked to some of these social factors.
Host: This sounds a lot different than taking my kid to the doctor because an injury or the sniffles and the doctor saying the equivalent of where does it hurt, I'll make it better. Clearly we were going a lot deeper with this program, is this something that patients or their parents have to opt into or are you screening everyone that comes in?
Dr. Lax: So, we are universally screening. Patients can opt out of it if they don't feel comfortable or don't want to participate. However, the screen is offered to everybody. Part of that is we know we all have implicit biases of kind of who might have the highest needs. And sometimes families who we never would have guessed would have had needs have really great needs and are so appreciative that we're asking them because they haven't had the opportunity to ask anybody before this. It's not a service that patients necessarily expect when they come to the doctor, but it is one that we're finding they're really grateful to have.
Host: Yeah, I would imagine it's nice to have someone listen. Someone ask the questions and again, making it a little different than just the normal, hey, I'm here for one thing and that is your bodily health, but clearly there are other non-health determinants of health, if you will or non-medical determinants of health that really matter. So you mentioned that you have screened up, I believe it was 20,000 patients thus far.
Dr. Lax: Yep. We've screened about 20,000 patients. Yeah. During COVID-19 we, during the lockdown here in New York which was March of 2020, we stopped seeing patients really coming in for their routine well-child visits and which is when we were screening for this. So we decided we needed to approach things a little differently and started a Telemedicine outreach program for our families in which we called families and conducted these screens over the phone and saw how we could connect them remotely to whatever resources existed at the time. And that also evolved for families and not only you know, was it a time where they weren't coming in to see us, it was also a time of really high needs, as we know, across the nation where people were out of work. The economy was really down and the ability to get resources like you were getting before was more difficult. We saw families who used to be able to go into WIC office to get their WIC checks.
And now the WIC offices were closed and they couldn't get their formula the same way they were getting them before and they couldn't afford to buy it. So, what were they to do? And so we really had to change around some of our resources and reach out to families who didn't know where to turn to. So we started this Telemedicine outreach program over the summer. And we screened about 400 patients just given our manpower at the time to do so. And were able to follow that cohort at 400 patients every six months throughout the pandemic thus far. So we've screened them three times and seeing, you know, was it helpful what we were giving you? Do you need additional help and rates that we were finding not only of the needs identified, but of, you know, the referrals that were requested and determined to be helpful.
Host: Very positive.
Dr. Lax: Yeah, over the course of the pandemic, as we've been looking at this, you know, as one might imagine in the beginning of the pandemic, a lot of the needs were really heightened. We saw that patient's needs everything pretty much jumped up. We saw an increase in food insecurity, housing needs really increased. Needs, especially because of remote education children was a huge issue for, especially for our patient population where perhaps language was a barrier and access to wifi and navigation of the remote system. And legal needs also increased over that time.
But the interesting thing that we have found is as we've given out these resources and over the course of the last year and a half as we've been following them, we were able to compare their needs to from previous to the pandemic, to what they are throughout the pandemic, including most recently. From prior to pandemic to the height of the pandemic they increased significantly. But then over that course, once we were giving them resources, they have decreased to lower rates than it was prior to the pandemic at this point.
Host: Oh, that's positive.
Dr. Lax: Yeah. So it's a very encouraging outcome that we're seeing.
Host: What do you see as the future for the program?
Dr. Lax: You know what, I think it's highlighting for us, I think just as medicine right now is, is evolving from being a solely you know, you've come to the doctor and get your needs met to becoming increase in Telemedicine opportunities and the ability to communicate with your doctor at different times. This may be also something that we need to think about with our screening tools. Should this be something that we reach out to our patients independent of their time at the doctor's office to see if we can reach out to those who are in high need and not able to come in? We also would really love to expand this. So we've expanded it to our three primary care clinics, our inpatient unit, and hopefully in the future, you know, the entire hospital system will be screening for this, including our emergency room, our critical care units, our sub-specialists. You know, I, I think one of the things that this study highlights to me is the more times that you have contact with a family and are able to see them through their needs, the better off they are. And so if we can touch a patient at each time that they touch a doctor's office, we have a higher chance of making a difference.
Host: Absolutely. Dr. Lax, before I let you go, is there anything else you wanted us to get into that we didn't cover?
Dr. Lax: One of the things that we're screening for is poor housing conditions. And what we do for that is we send letters from physicians to the landlord. This is all embedded in our electronic health record. Physicians with a click of a button can generate a letter to a landlord stating that their patient is currently in a house that is infested with cockroaches, mold, mice, whatever the concern is, and states that their medical conditions, if they have asthma, eczema, allergies, are placed at risk or heightened due to the fact that they have this exposure and therefore it's really imperative for the landlord to change these housing conditions.
And we did research on this recently calling the families back and asking them, after we gave you this letter, what happened? Did your landlord change anything or was it the same? And what we found was that the majority of landlords actually did act on, on this. We saw that not only did the majority act on it, but they also resolved their problems. So, you know, it was really encouraging for us to see that over 89% acted to resolve the issue and 74% had complete resolution.
Host: That's fantastic.
Dr. Lax: What we're doing is making a difference. And I hope it encourages other physicians to, you know, think outside the box and when we're approaching some of these conditions that we see.
So, in thinking about this, it's really thinking about the whole child and what can we do to really support our community, as we're all going through this trying experience.
Host: And it sounds like your doing a lot to support that community right now. So thank you very much for your efforts, Dr. Lax.
Dr. Lax: Thank you.
Host: And thanks to you for listening. To learn more about Maimonides Medical Center, please visit maimo.org. That's M-A-I-M-O.org. This has been Maimo Med Talk. I'm your host, Evo Terra. Stay well.