Recognizing the influence of social determinants on health and development, health care has increasingly advocated for interventions that target upstream factors as part of routine pediatric care delivery. In response, clinic-based social risk screening and referral programs have proliferated wherein patients are screened for health-related social needs (HRSNs, such as food and housing insecurity) and referred to community-based organizations (CBOs) and social service providers to address those needs. In recent years, an array of digital platforms, known as Social Health Access and Referral Platforms (SHARPs), have emerged to facilitate the scale and implementation of these models amidst growing system demand.

Recent evidence on the effectiveness of social risk screen and refer models and SHARPs has been mixed, giving researchers pause and calling for more nuanced understanding of the limitations of such models, especially for promoting child and family health. Design thinking informed by the Life-Course Health Development (LCHD) framework provides a particularly useful lens for synthesizing emerging limitations of such models in the pediatric context, given the dynamic and developmentally-driven circumstances that shape family health and well-being in the early life course. By (1) focusing on addressing deficits-based social risks, (2) scoping to act upon narrow, downstream needs, (3) timing to react to social needs that have already caused harm rather than preventing them, and (4) limiting scale to individual-by-individual responses rather than structural and population-wide interventions, the current design of prevailing social risk screen and refer programs fundamentally limits their potential impact and misses opportunities to improve health equity over the life course.

How can health care, social care, and technology partners move forward in collaboration with families and communities to better support equitable lifelong health and social development? In this narrative review, we will summarize the current design, implementation, and limitations of the predominant social risk screen and refer approach in the context of early childhood and adolescent care delivery. We then will apply LCHD principles to advance and improve on this approach from a reactionary focus towards a Family Journey Model that better supports life course health development.

认识到社会决定因素对健康和发展的影响，医疗保健越来越提倡针对上游因素的干预措施，作为常规儿科护理服务的一部分。为此，基于诊所的社会风险筛查和转诊计划激增，其中对患者进行与健康相关的社会需求（HRSN，例如食品和住房不安全）的筛查，并将其转介给社区组织（CBO）和社会服务提供者来解决那些需求。近年来，出现了一系列被称为社会健康获取和转诊平台（SHARP）的数字平台，以在不断增长的系统需求中促进这些模型的规模和实施。

最近关于社会风险筛查和转介模型以及 SHARP 有效性的证据好坏参半，这让研究人员停下来，并呼吁更细致地了解此类模型的局限性，特别是在促进儿童和家庭健康方面。鉴于早期塑造家庭健康和福祉的动态和发展驱动的环境，生命全程健康发展 (LCHD) 框架提供的设计思维为综合此类模型在儿科环境中出现的局限性提供了一个特别有用的视角。生命历程。通过（1）专注于解决基于赤字的社会风险，（2）确定针对狭隘的下游需求采取行动的范围，（3）适时对已经造成损害而不是预防损害的社会需求做出反应，以及（4）限制规模当前流行的社会风险筛查和转诊方案的设计主要是针对个人的应对措施，而不是结构性和全民干预措施，从根本上限制了其潜在影响，并错失了改善生命全程健康公平的机会。

医疗保健、社会关怀和技术合作伙伴如何与家庭和社区合作，更好地支持公平的终身健康和社会发展？在这篇叙述性评论中，我们将总结幼儿和青少年护理服务背景下主要社会风险筛查和转介方法的当前设计、实施和局限性。然后，我们将应用 LCHD 原则来推进和改进这种方法，从反动的焦点转向更好地支持生命全程健康发展的家庭旅程模型。