Annual Dworkin Lecture Focuses on Social Determinants

When Paul Dworkin, MD, formed Connecticut Children’s Office for Community Child Health, he stepped down from serving as physician-in-chief of Connecticut Children’s Medical Center, a position he held for 15 years. To honor his legacy and commitment to children, hospital leadership created the Paul Dworkin Pediatric Chair Lecture in 2013, which is a Pediatric Grand Rounds session held every June.

Current Connecticut Children’s Physician-in-Chief Juan Salazar, MD, MPH, introduced Dr. Dworkin at this year’s fifth annual lecture which drew a crowd of physicians, medical residents, and other child development experts.

“Dr. Dworkin is an innovative and world class leader in children’s optimal healthy development,” said Dr. Salazar. “You are, and will always be, our mentor and role model.”

Every year, Dr. Dworkin selects a different speaker to present the lecture. This year, he chose Arvin Garg, MD, MPH, a former Connecticut Children’s resident who is now a physician at Boston Medical Center Pediatrics and an associate professor of pediatrics at Boston University School of Medicine.

“It is tremendously gratifying and satisfying to welcome him back to his pediatric home to present this lecture,” said Dr. Dworkin.

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Dr. Garg’s lecture focused on the social determinants of health, which include poverty and other circumstances in which people live and work.

“It’s truly an honor to be here for Paul,” said Dr. Garg as he started his lecture. “He’s meant so much to me. He’s been a role model to me and many others in this room.”

During his lecture, Dr. Garg noted that one in five children live in poverty, a key social determinant that contributes to child health disparities. He stated that poverty is associated with increased risk of heart disease, stroke, and other health conditions; increased developmental and behavioral delays; and poorer academic achievements. He also pointed out children from low-income families experience poorer health outcomes across their lifespans compared to those with higher socioeconomic statuses.

Dr. Garg highlighted an innovative program called “We Care” that he launched during his academic general pediatrics fellowship at Johns Hopkins University in Baltimore after reaching out to seek advice from Dr. Dworkin in Hartford. The program was designed to increase the identification of family needs and referrals to services during well-child visits. It included a questionnaire for parents to complete prior to their visit that screened for 10 common social problems such as alcohol abuse, food insecurity, and domestic violence. It also included a family resource book detailing free community services and training for residents.

An initial study of the “We Care” program found that 51 percent of families enrolled in the intervention group were referred to services such as job training, smoking cessation classes, and housing programs, compared to 21 percent of families receiving referrals from the control group.

A second similar study analyzing the identification of six basic needs documented that 70 percent of families enrolled in the “We Care” program received a referral to at least one community-based support, compared to just seven percent in the control group.

The program is now part of the current standard of care at Boston Medical Center Pediatrics.

“His work is preparing and informing our next generation of pediatric leaders with regards to the importance of the social determinants of health,” said Dr. Dworkin.

In concluding his remarks, Dr. Garg encouraged pediatricians to use the following strict guiding principles in screening for social determinants which he outlined with Dr. Dworkin and Renee Boynton-Jarrett, MD, ScD in a viewpoint piece in JAMA, The Journal of the American Medical Association in 2016: 1) ensuring that such screening is family-centered; 2) integrating screening with referrals and linkage to community-based resources; 3) incorporating shared decision making; 4) using a strength-based approach; and 5) making sure to not limit screening practices based on social status.

He urged pediatricians to engage in ongoing surveillance for social determinants to catch potential problems through skilled observations at all visits. He also suggested that, in the future, physicians may want to screen for families needing any help, rather than limiting such discussions to social determinants. He also said all families should receive community resource information sheets at all visits.

He also highlighted an article he co-authored with Dr. Dworkin and others in the Journal of Pediatrics in 2012 which called for turning medical homes into health neighborhoods. Dr. Garg stated health neighborhoods are key to enhancing collaboration across all child-serving sectors to promote children’s optimal healthy development and achieve enhanced outcomes over entire lifespans.

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