Table 3

SDH-Q in action. Case study—Sam*

The Presentation
Sam, aged 6 years with attention deficit hyperactivity disorder (ADHD), was referred to clinic for an autism spectrum disorder (ASD) assessment
Using the SDH-Q
Sam’s mother, Suzie, was happy to fill out the SDH-Q (see figure 1), on the basis of which her clinician was able to explore the following issues:
Areas of concern on SDH-Q Exploration in clinic
“Worries about not enough space at homeSuzie lives in a two-bedroom council flat with her three sons (Sam’s brothers are aged 16 months and 8 years) and her own mother. They were allocated the house when she lived with her ex-partner but the house is now too small; they do not have enough space for homework or play. Worse, Suzie struggles to find the space to help Sam with activities suggested by his therapists, and often misses appointments because she cannot afford the time or bus fare it takes to get there
“Lack of access to transport”
“Worries about paying for housing and/or bills”Suzie works full time in a hair salon, but her wage barely covers food and other essentials for her family. She is not always able to pay her bills, and stress about her finances prevents her from being able to fully focus on Sam’s extra needs or engage with his healthcare
“Providing enough food for the family”
“Unable to always afford everyday items for her children”
When asked how she felt about filling in the survey, Suzie said she felt relieved: “It’s nice that someone cares about these issues—I’ve never been asked about my living situation before! But when you think about it, it’s actually really important for my doctor to know why I struggle so much”. She felt that most advice she’d been given on managing Sam’s behaviour was simply impossible given her current situation. “I often feel like a bad mother for not being able to do what’s best for Sam”. Suzie said she would feel comfortable discussing her home situation with other healthcare professionals but that “It’s not easy to bring it up if I’m not asked about it”
After the discussion, Suzie was given a copy of our leaflet with relevant local services highlighted. She was grateful that someone had taken the time to address her concerns and felt that the leaflet would help, as she had not heard of all of the services available
A few months later
At follow-up, Suzie told Sam’s clinician that the leaflet had prompted her to seek help. Advice from the Citizen’s Advice Bureau was already helping her to save money on housing and amenities, and visiting a clothes and toy bank meant that she could “now replace clothes that Sam is growing out of, and give him toys and books right for his age. It’s taken off a lot of pressure”. Suzie had also been receiving significant support from a local community centre, which gives access to clubs and sports for her sons. Suzie now finds she has “more time and headspace to spend with Sam” and follow healthcare professionals’ advice. Although not all of her social concerns have been relieved, Suzie was a lot more optimistic about the future, and felt more empowered to engage in Sam’s healthcare
  • *‘Sam’ is a pseudonym—all names and identifying details have been changed to protect the privacy of individuals.