Examining the Impacts of Social Drivers of Health and Adverse Childhood Experiences on Children With Dermatological Disease Part <scp>II</scp> : A Framework and Guide for Pediatric Dermatologists

Research has increasingly shown the importance of social drivers of health (SDH) and adverse childhood experiences (ACEs) in dermatologic health outcomes, and as such, highlighted the role of physicians in identifying and addressing these in their practice. Children are a unique population as they face special barriers to care due to their relative inability to advocate for themselves and their increased likelihood of experiencing poverty, food insecurity, and housing insecurity in the United States. Additionally, ACEs have been shown to confer a greater risk of chronic conditions and a decreased life expectancy. Part I summarized the ways in which SDH and ACEs impact outcomes for patients with common pediatric skin conditions such as atopic dermatitis, psoriasis, hidradenitis suppurativa, and acne vulgaris. However, the role of pediatric dermatologists is not limited to the awareness of the SDH and ACEs that may impact patients, but instead, involves the ability to identify these social risks through screening and address them in the context of patients' lives. In this review, we provide suggestions for understanding barriers to care and conducting SDH and ACEs screening in the clinic. We also review ways to reduce barriers to care by developing cost-conscious treatment plans, utilizing telehealth platforms, addressing low health literacy, mitigating language barriers, and incorporating SDH management into medical billing. Finally, we discuss educational initiatives that may impact our ability as a specialty to identify and address SDH.