The First Step to Helping: Asking About Poverty
Bibliographic record
Abstract
Abstract BACKGROUND: Canadian children living in poverty are more likely to experience poor health outcomes. Physicians have a unique opportunity to screen for poverty and other social determinants of health (SDOH) in order to intervene early and change their patients' health trajectories. It is well known in the literature to date that addressing SDOH in clinical practice can improve health outcomes, however, significant barriers have been identified that limit a physician’s ability to address these issues. The Child Poverty Assessment Tool (CPAT) was developed by an inter-professional team of physicians, social workers and community child health agency partners to provide healthcare providers with screening questions for the SDOH and resources to address identified SDOH needs. The tool was created to support physicians with links to the community and simple screening approaches to common social issues. OBJECTIVES: To develop an understanding of physicians' current SDOH screening practices and attitudes to screening for the SDOH in clinical practice; To explore the feasibility, accessibility, and relevance of the CPAT for paediatricians at an academic health science centre. DESIGN/METHODS: Using a qualitative grounded theory approach, seven consultant academic paediatricians were individually interviewed. The interviews were conducted using a semi-structured interview guide, and were digitally recorded and transcribed verbatim. Two team members independently coded the transcripts for recurrent themes. This project was undertaken as a Quality Improvement project and was conducted with appropriate ethical approval. RESULTS: Three major themes emerged regarding benefits of screening for SDOH: improved assessment of social issues, increased referrals to community supports and agencies, and appropriate modifications to treatment plans as informed by social issues. In addition to limiting billing models and time constraints, five major themes were identified as challenges to screening for SDOH: lack of knowledge of resources, upsetting family expectations, the physician’s own comfort in asking questions regarding the SDOH, the biomedical model of training, and physicians' understanding of their scope of practice. The CPAT was found to address some, but not all of these challenges. CONCLUSION: The results from the project elucidated important factors that influence the SDOH screening practices of paediatricians. While a structured tool (i.e. the CPAT) may provide support to physicians conducting screening, systemic and medical cultural barriers exist. Further research is needed to examine the effectiveness of implementing screening tools in clinical practice, and to identify solutions for systemic barriers to screening for poverty in paediatric populations.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.009 | 0.017 |
| Meta-epidemiology (narrow) | 0.001 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.018 | 0.009 |
| Scholarly communication | 0.003 | 0.002 |
| Open science | 0.002 | 0.006 |
| Research integrity | 0.002 | 0.004 |
| Insufficient payload (model declined to judge) | 0.008 | 0.001 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".