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How Should Clinicians Follow Up About Nonresponses to Mandatory SDoH Screening Questions? 临床医生应该如何跟进对强制性SDoH筛查问题无反应的患者？
AMA journal of ethics Pub Date : 2025-09-01 DOI: 10.1001/amajethics.2025.642
Audriana Mooth
{"title":"How Should Clinicians Follow Up About Nonresponses to Mandatory SDoH Screening Questions?","authors":"Audriana Mooth","doi":"10.1001/amajethics.2025.642","DOIUrl":"https://doi.org/10.1001/amajethics.2025.642","url":null,"abstract":"<p><p>Structural determinants of health (SDoH) screening is key to good pediatric care, but fear of life-altering consequences can prevent adults from disclosing information, while time constraints disincentivize clinicians from addressing some awkward but important SDoH topics relevant to good care planning and management. Transparency, clarity, and a nonjudgmental attitude can help cultivate safe multidisciplinary communication and openness during a clinical encounter. Even more important than screening for SDoH is responding to children's unmet needs that screening reveals, which is the focus of this commentary on a case.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"27 9","pages":"E642-648"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972781","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How Should Clinical Teams Integrate Findings From Social Needs Screenings Into Children's Care Plans? 临床团队如何将社会需求筛查的结果整合到儿童护理计划中？
AMA journal of ethics Pub Date : 2025-09-01 DOI: 10.1001/amajethics.2025.634
Stephanie G Menko, Michael J Luke, Aditi Vasan
{"title":"How Should Clinical Teams Integrate Findings From Social Needs Screenings Into Children's Care Plans?","authors":"Stephanie G Menko, Michael J Luke, Aditi Vasan","doi":"10.1001/amajethics.2025.634","DOIUrl":"https://doi.org/10.1001/amajethics.2025.634","url":null,"abstract":"<p><p>Unmet social and structural needs negatively influence children's health outcomes. Even in pediatric health systems in the United States that have implemented social needs screening programs, little guidance exists about best practices for how clinical teams should respond to children's unmet needs. This commentary on a case discusses ethical principles and caregivers' perspectives that can be used to guide best practices for screening and resource referral.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"27 9","pages":"E634-641"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972818","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How Should Children's Medicaid Eligibility Be Monitored? 如何监控儿童的医疗补助资格？
AMA journal of ethics Pub Date : 2025-09-01 DOI: 10.1001/amajethics.2025.686
Gabriella Aboulafia, Adrianna McIntyre
{"title":"How Should Children's Medicaid Eligibility Be Monitored?","authors":"Gabriella Aboulafia, Adrianna McIntyre","doi":"10.1001/amajethics.2025.686","DOIUrl":"https://doi.org/10.1001/amajethics.2025.686","url":null,"abstract":"<p><p>Medicaid provides health insurance for nearly 4 in 10 children in the United States, but this coverage can be unstable as a result of annual eligibility redetermination requirements. After the continuous Medicaid coverage mandate during the COVID-19 pandemic ended in March 2023, states were required for the first time to publicly report standardized metrics on terminations and renewals resulting from eligibility redeterminations. Our understanding of redeterminations and their contribution to coverage gaps had been constrained by data limitations, but states' reporting practices offered researchers and policymakers key insights into these processes and associated coverage outcomes. This article canvasses some of those insights and suggests how federal reporting requirements could be amended to offer actionable insights into redetermination processes.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"27 9","pages":"E686-694"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972783","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Advocacy as an Origin of Pediatrics. 倡导是儿科的起源。
AMA journal of ethics Pub Date : 2025-09-01 DOI: 10.1001/amajethics.2025.708
Jorie Braunold
{"title":"Advocacy as an Origin of Pediatrics.","authors":"Jorie Braunold","doi":"10.1001/amajethics.2025.708","DOIUrl":"https://doi.org/10.1001/amajethics.2025.708","url":null,"abstract":"<p><p>The work of physician Abraham Jacobi was prominent in development of the field of pediatrics. He envisioned clinicians acting as caretakers and advocates for children and families, especially those who were poor. This article summarizes his work as presaging today's appreciation of many structural drivers of children's health.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"27 9","pages":"E708-711"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972753","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
How Should SDoH Screening Happen for Children? 如何对儿童进行SDoH筛查？
AMA journal of ethics Pub Date : 2025-09-01 DOI: 10.1001/amajethics.2025.631
Brigid Garrity
{"title":"How Should SDoH Screening Happen for Children?","authors":"Brigid Garrity","doi":"10.1001/amajethics.2025.631","DOIUrl":"https://doi.org/10.1001/amajethics.2025.631","url":null,"abstract":"","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"27 9","pages":"E631-633"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972748","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Critical Pedagogical Approaches to Structural Drivers of Health. 健康结构驱动因素的关键教学方法。
AMA journal of ethics Pub Date : 2025-09-01 DOI: 10.1001/amajethics.2025.700
Jake Young
{"title":"Critical Pedagogical Approaches to Structural Drivers of Health.","authors":"Jake Young","doi":"10.1001/amajethics.2025.700","DOIUrl":"https://doi.org/10.1001/amajethics.2025.700","url":null,"abstract":"<p><p>Social accountability in health professions education prominently has to do with preparing students and trainees in pediatrics to do 3 key things: prioritize social and structural drivers as preconditions of children's health, work to mitigate health inequity among children by partnering with community members and families, and integrate advocacy for health system improvement for children into practice. This article suggests strategies for health justice advocacy and for strengthening cross-disciplinary teaching about how to screen children for structural drivers of health.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"27 9","pages":"E700-707"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972830","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Three Things Students and Trainees Should Learn About Public Health Insurance for Children. 关于儿童公共健康保险，学生和实习生应该了解的三件事。
AMA journal of ethics Pub Date : 2025-09-01 DOI: 10.1001/amajethics.2025.668
Aubrey D Brown, Lauren Ameden, Brigid Garrity
{"title":"Three Things Students and Trainees Should Learn About Public Health Insurance for Children.","authors":"Aubrey D Brown, Lauren Ameden, Brigid Garrity","doi":"10.1001/amajethics.2025.668","DOIUrl":"https://doi.org/10.1001/amajethics.2025.668","url":null,"abstract":"<p><p>Despite the inclusion of health equity and public health in undergraduate and graduate medical curricula, many medical students and trainees have minimal understanding of health insurance coverage for children of families with low incomes. Since children's eligibility for Medicaid and the Children's Health Insurance Program (CHIP) significantly influence their care, this article proposes that students and trainees, especially in pediatrics, should receive formal instruction about Medicaid and CHIP in 3 key areas: program structure; eligibility determinations, redeterminations, and range of covered or partially covered services; and enrollment requirements and processes. This article also suggests the nature and scope of expertise required to responsibly offer such instruction in classroom- and clinic-based settings.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"27 9","pages":"E668-677"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972765","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
What Would Be Required of Structural Determinants of Health Screening and Follow-Up to Improve Children's Health Equity? 健康筛查和随访的结构性决定因素对改善儿童健康公平有何要求？
AMA journal of ethics Pub Date : 2025-09-01 DOI: 10.1001/amajethics.2025.695
Brigid Garrity, Danielle Cullen, Haeyeon Hong
{"title":"What Would Be Required of Structural Determinants of Health Screening and Follow-Up to Improve Children's Health Equity?","authors":"Brigid Garrity, Danielle Cullen, Haeyeon Hong","doi":"10.1001/amajethics.2025.695","DOIUrl":"https://doi.org/10.1001/amajethics.2025.695","url":null,"abstract":"<p><p>A growing body of evidence considers how addressing adverse structural drivers of health (aSDoH) can improve children's overall health, thereby reinforcing pediatricians' role in advancing health equity early in life. Yet the optimal strategy for aSDoH screening and intervention remains unclear. This article examines barriers to equitable aSDoH screening, referral, and intervention, questioning the necessity of screening tool validation when the primary goal is to connect families with necessary resources. It also explores caregiver engagement, key considerations behind documentation of results, and the need for multilingual screening.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"27 9","pages":"E695-699"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972820","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Centering Social Pediatrics in Graduate Medical Education. 以社会儿科学为核心的研究生医学教育。
AMA journal of ethics Pub Date : 2025-09-01 DOI: 10.1001/amajethics.2025.657
Raquel Selcer, Derek Ross Soled, Rohan Khazanchi
{"title":"Centering Social Pediatrics in Graduate Medical Education.","authors":"Raquel Selcer, Derek Ross Soled, Rohan Khazanchi","doi":"10.1001/amajethics.2025.657","DOIUrl":"https://doi.org/10.1001/amajethics.2025.657","url":null,"abstract":"<p><p>This article problematizes the normalization of social pediatrics as extracurricular or optional rather than necessary for children's health care. Drawing on critical pedagogical frameworks like structural competency and accompaniment, this article illuminates clinical, institutional, and structural obstacles to mainstreaming social pediatrics training. This article also identifies examples of how training programs, health systems, and policymakers can facilitate and sustain care environments that support social pediatrics and advance health equity.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"27 9","pages":"E657-667"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972824","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Trauma-Informed Screening for Structural Drivers of Health. 健康结构性驱动因素的创伤知情筛查。
AMA journal of ethics Pub Date : 2025-09-01 DOI: 10.1001/amajethics.2025.678
Elizabeth Lanphier, James Duffee
{"title":"Trauma-Informed Screening for Structural Drivers of Health.","authors":"Elizabeth Lanphier, James Duffee","doi":"10.1001/amajethics.2025.678","DOIUrl":"https://doi.org/10.1001/amajethics.2025.678","url":null,"abstract":"<p><p>Screening for structural drivers or determinants of health (SDoH), as mandated by recent federal regulations, raises ethical questions about screening processes and tools. Early childhood adversity and trauma, which can influence a person's health throughout their lifespan and contribute to chronic disease and early death, can be identified through standardized screening for SDoH. However, screening without awareness of the potential interface between SDoH and trauma can retraumatize those administering or completing the screening process. This article suggests that implementation of a trauma-informed approach to SDoH screening is consistent with biomedical and public health ethics and contributes to efforts to keep clinical environments emotionally safe.</p>","PeriodicalId":38034,"journal":{"name":"AMA journal of ethics","volume":"27 9","pages":"E678-685"},"PeriodicalIF":0.0,"publicationDate":"2025-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144972767","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
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