Using electronic health records to evaluate a children and young people's social prescribing service: Challenges and implications for research and practice

BackgroundPreliminary evidence indicates that social prescribing (SP) can improve children and young peoples (CYP) wellbeing but is limited by small non-representative samples and often relies on descriptives statistics. Given the wide implementation of SP in the UK, administrative records provide a unique opportunity to understand current practice and assess impacts on wellbeing. ObjectivesO_LITo understand the quality of data captured in SP administrative records C_LIO_LITo explore which CYP are currently receiving SP and what SP entails in practice C_LIO_LITo assess the impact of SP on wellbeing C_LI MethodsWe used administrative records from one CYP SP service in England. Records were extracted from Joy, an online platform for managing SP. Over 18 months, 770 age-eligible CYP were referred to SP, 203 of whom were successfully discharged and completed two measures of wellbeing (the short Warwick-Edinburgh Mental Wellbeing Scale; SWEMWBS) at least seven days apart. We used descriptive statistics, a paired t-test to assess changes in wellbeing, and linear regressions with interactions to test effect modification. FindingsMissing data was the largest issue, with ethnicity missing for 94% of CYP. A lack of detail and inconsistent recording also presented challenges. Despite this, we identified that most CYP were referred by their GP, followed by their school, with 97% referred because of their mental health. The most common pathway was to receive SP for less than 100 days, with 10-15 link worker contacts, and six contact hours. Following SP, SWEMWBS scores improved by 3.72 points (t(202)=17.50, 95% CI=3.30 to 4.14, p<0.001), a 20% relative increase. Exploratory analyses suggested that this increase was greater for those with fewer link worker contacts, no interventions recorded, and lower baseline wellbeing. ConclusionsDespite numerous challenges with missing data and data quality, we found that CYP wellbeing increases following SP (as it is currently implemented). Effect sizes were consistent with larger studies of adults. Clinical implicationsFurther development of online platforms is needed to monitor access to, nature of, and efficacy of SP. For those working in SP, we recommend more training, implementation of standardised guidelines, and designated time to update records. Key messages What is already known on this topicO_LISocial prescribing has been widely implemented in the UK, but there is very little evidence on what it looks like or whether it works for children and young people C_LI What this study addsO_LIWe show that it is feasible to evaluate social prescribing for children and young people using administrative records and identify several priorities for improving data quality C_LIO_LIWe describe the typical social prescribing pathway in one children and young peoples service in England, which includes receiving SP for less than 100 days, with 10-15 link worker contacts, and 6 contact hours C_LIO_LIWe found evidence for clinically significant improvements in children and young peoples wellbeing from their first to their last social prescribing session C_LI How this study might affect research, practice or policyO_LITo meet best practice guidelines for recording and evaluating social prescribing, we need further collaboration between online platform providers and social prescribing services, more training and time for link workers, and for research and policy to emphasize the importance of measuring outcomes C_LI