636 - Time to Call '911' on '211'? Preliminary Analysis of the National 211 Social Resources Referral Hotline Demonstrates Variability in Resource Availability by State and Social Driver of Health Domain

Publication Number: 3616.636

Sydney Garner, Ann & Robert H. Lurie Children's Hospital of Chicago, Wheaton, IL, United States; Rebecca Asp, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, United States; Manzilat Y. Akande, Children's hospital OKLAHOMA, Oklahoma City, OK, United States; Erin Paquette, Ann & Robert H Lurie Children's Hospital of Chicago/Northwestern University Feinberg School of Medicine/Northwestern University Pritzker School of Law (by courtesy), CHICAGO, IL, United States

Background: Social drivers of health (SDoH) strongly influence pediatric outcomes and health equity. The American Academy of Pediatrics (AAP) recommends routine SDoH screening across pediatric settings. Barriers include lack of standardized tools and limited referral resources for positive screens. United Way 211, a free nationwide helpline (like 911) and online database of local social services, is a potential referral source. While 211 is recommended in AAP guidance, few studies rigorously evaluate its effectiveness in addressing needs in high-risk pediatric populations.

Objective: To evaluate the availability of resources for common SDoH needs in high-need ZIP codes across multiple U.S. states using 211 data.

Design/Methods: The 50 ZIP codes (ZIPs) with the lowest Child Opportunity Index (COI) 2.0 scores were identified for all 50 states and linked to corresponding Social Vulnerability Index (SVI) data from the Centers for Disease Control. 211 websites were located through the national directory and queried for resources in eight SDoH domains: housing, education, transportation, utilities, healthcare, mental health, legal/government, and food. National 211Counts data identified the top five needs per domain. Each ZIP was searched for total resources and resources by SDoH domain. Sites lacking ZIP search, distance features, or functional databases were excluded. Spearman correlations assessed associations between total and domain-specific resources with COI and SVI. Language access was recorded. The study is IRB exempt.

Results: Top needs by category are in Table 1. Data for the lowest COI ZIPs have been collected from 26 of 50 states; 12 were excluded. Fourteen states in 7 regions are included. Resource counts across domains varied widely. COI correlated with total resources in 6/14 (43%) states; SVI correlated in 7/14 (50%), with most significant associations showing fewer resources in higher-risk (low COI/high SVI) ZIPs (Table 2). Eight of 14 (57%) states had no resources in ≥50% of ZIPs for at least one top need (Table 2). Geomaps demonstrated resource deserts, with clusters in urban centers (Figure 1). Ten of 14 (71%) state 211 systems offered Spanish-language access, and nine (64%) provided additional languages beyond English and Spanish.

Conclusion(s): Resource availability within 211 systems varies greatly and is most limited in areas with greatest social need. Resource deserts and inconsistent language access highlight inequities in social service infrastructure. Strengthening resource networks and improving accessibility are essential to support effective pediatric SDoH screening and referral using 211.

Table 1. Most Common Resource Requests by SDoH Domain


Table 2. Correlation Between Childhood Opportunity Index or SVI and SDoH Resources by Domain and Total Resources (Spearman Correlations) and Percentage of High Risk Zip Codes with NO Resources
Bolded numbers show significant Spearman's rho (p < 0.05) or >50% of ZIPs by SDoH domain or in aggregate with NO 211 resources (orange). A positive Spearman's rho between COI and resources means that higher COI COI (lower risk) ZIPs had more resources (yellow); a negative Spearman's rho for COI and aggregate resources means that a higher COI (lower risk) ZIPs had less resources (green). A negative Spearman's rho for SVI and means that higher SVI (higher risk) ZIPs had fewer resources (yellow).

Figure 1. Geospatial Distribution of SDoH Resources in a
Mapping of resources by 50 highest need (lowest COI) Zips shows resource deserts, with more resources clustered around urban centers, leaving less urban areas underresou x