Let us stop admiring the problem: we need social prescribing for children with disability now

Anna Basu and colleagues explore and dispel the myths around social prescribing and argue the case for its widespread adoption to support children with neurodisabilities and their families.

This year, the National Academy of Social Prescribing was designated a WHO Collaborating Centre for Social Prescribing Policy and Development, signalling growing policy and research traction worldwide. Social prescribing (SP) involves systematically linking individuals, often via a ‘link worker’, to the health, social and education services that they require. For CYP with disability, SP can address social barriers that undermine therapy effectiveness and shift practice from fractured episodic intervention towards proportionate, needs-responsive support.

Disability follows a steep social gradient. Children conceived and raised in adversity are more likely to have a disability, and those with disabilities are more likely to experience chronic disease, unemployment, premature mortality and intergenerational disadvantage.¹ For CYP with disabilities, inequity is compounded by the systems designed to support them. Many experience difficulties accessing therapy: its effectiveness is reduced by social strain and fragmented delivery. Health, disability, education and social services in many settings operate in silos that compound disadvantage rather than mitigate it.² Parents describe being overwhelmed by complex paperwork and service pathways. There are adverse consequences for parent/carer mental health, careers and financial situations.

Two thirds of families of CYP with disabilities report financial hardship and other social challenges.³ Child health services are under-resourced and poorly structured to deliver complex paediatric care, with funding models that reward transactions over relationships. Adverse social determinants drive health inequities for people with disabilities across the life course. The Inverse Care Law described by Tutor Hart over 50 years ago remains starkly relevant: those who need care most are least likely to receive it. For CYP with disability, this translates into missed opportunities to participate and preventable functional decline.

SP offers a feasible mechanism to operationalise equity for CYP with disability by identifying social needs and connecting families to appropriate support. Yet practical experience of the authors from working with children and young people, their families and professionals and direct lived experience highlights that three myths persist: ‘Not my problem’, ‘No evidence’ and ‘We can’t afford it’. These impede implementation and scale-up, and so we address them here.

Myth 1: ‘Not my problem’

Child health professionals have a clinical and moral obligation to address social determinants of health (SDH) for CYP with disabilities as part of high-quality care. The health system must drive and coordinate a broad multi-sectoral response. This stance is taken in policy documents and position statements by the American Academy of Pediatrics, Royal Australasian College of Physicians and Royal College of Paediatrics and Child Health among others. The WHO views addressing the social determinants of health equity as fundamental—requiring action ‘by all parts of government, the private sector and civil society’. The United Nations Convention on the Rights of the Child and the Convention on the Rights of Persons with Disabilities are foundational guiding principles. In the words of a young person with cerebral palsy:

Without a champion to sway influence, disabled voices aren’t heard. MW.

The challenge is that addressing SDH is not seen as ‘in scope’ by many health services. Clinicians arguing that this is ‘someone else’s job’ or ‘too hard’ are effectively saying they are prepared to tolerate unacceptable inequities for patients and families. Equally, witnessing the impact of SDH on families can result in feelings of inadequacy and clinician burnout. While finding solutions to housing or food insecurity problems may be beyond remit for many healthcare professionals, identifying needs and signposting to support is imperative.

‘Asking about SDH is just opening Pandora’s box’

Clinicians have expressed concern that asking about social problems will lead to a flood of information about situations that they do not have the time or resources to address. Some are concerned about stigma associated with asking about SDH. We have found that many families find it helpful to share their social context even where it may be challenging to ameliorate it. Without understanding the problems families face, it is difficult to optimise health plans. The recommendation from our lived experience advisors has been to ‘Open the Box’. Even if there is no immediate solution, the sharing of this burden builds trust within a therapeutic relationship.

We don’t expect you to fix it, we do expect you to see us as people with lives outside the clinic. MW.

‘It’s the parent’s responsibility’

It is unreasonable to expect parents/carers to take on the full responsibility of coordinating and accessing all the services required to support their child’s health and their families’ social needs. Pathways for seeking support for children with complex health, social and educational needs are often difficult to negotiate. We should not assume that parents of CYP with disabilities simply require resilience training or health literacy interventions rather than pragmatic support.

‘We shouldn’t need to implement this kind of intervention in a civil society’

WHO reports show that inequities have worsened for almost all paediatric conditions especially for children with disability over the last 20 years, despite overall advancements in health.

It’s a sinkhole, once you fall in to low social status you can't get out unless someone gives you a ladder. If someone does nothing the hole gets deeper and deeper. MW.

The economic cost associated with the lack of timely intervention is high. Countless policies, plans and documents have highlighted the adverse impact of SDH and the need to act, yet inequities have become more entrenched. Idealistic visions of imminently achieving a civil society in which prevention and community networks obviate the need for SP programmes should not prevent us from tackling the current reality. We identified high levels of unmet basic needs (including finding food) in a fifth of CYP with disability and their families in Australia, a wealthy country.⁴

Myth 2: ‘There is no evidence /It’s futile to try because nothing works’

The assertion that SP lacks evidence is outdated. A meta-analysis of 12 randomised controlled trials (RCTs) provided moderate-certainty evidence in adults with long-term conditions that tailored SP improves quality of life, strengthens disease-specific psychological outcomes, reduces distress and depressive symptoms, enhances self-management capacity, and may increase physical activity.⁵ These findings are directionally consistent despite predominantly short study durations and risk of bias. Evidence in CYP with disability follows a similar trajectory.⁶ Our systematic review of 18 studies, including five RCTs (73 707 families), demonstrated increased identification of social needs, greater referral uptake, reductions in unmet need, improved quality of life, and reduced primary care and public health service utilisation.⁷

Emerging studies suggest that SP may mitigate the adverse effects of SDH while increasing opportunities for participation. A UK-based hospital-initiated service showed promising results⁸ and an Australian SP model using waiting room screening for social risk followed by 3 months of link worker-supported connection to social services demonstrated implementation feasibility.⁹

Myth 3: ‘We can’t afford it’

Health systems increasingly fund gene therapy and other high-cost interventions. These should be matched with investment into holistic psychosocial support to optimise quality of life and prevent SDH from adversely affecting access to and outcomes from such interventions. To ignore the biopsychosocial context is to miss opportunities for effective, equitable research translation of groundbreaking discoveries. Ironically, this much smaller cost is the one which ‘can’t be afforded’. It would make sense to budget for this support as part of the package offer for such interventions.

An assumption that we can’t afford SP and similar schemes leads to attempts to find cost-free solutions, many of which underestimate, undervalue, or misunderstand the type and quality of support required. For example, while volunteering schemes are valuable ancillary support, it is unreasonable to expect unpaid volunteers to have the time, knowledge, skills, reliability, responsibility and resources to undertake a link worker role for children with disability and their families. Generic websites or artificial intelligence (AI)-based solutions will also rarely address the support needs of distressed, vulnerable families.

I am majorly uncomfortable with my medical info being run through AI. Also, it feels like I’m not worth the time of a person. MW.

Equally invalid is the assumption that current systems are adequately addressing SDH. Clinicians are constrained by time, resources, lack of knowledge of community support: social care teams are overstretched and must prioritise statutory work over prevention. The evidence points to a favourable social return on investment¹⁰ and healthcare cost savings for SP schemes, including reductions in presentation to primary care and hospitals. The assumption that we cannot afford these services is unjustified.

As with other prevention-focused schemes such as the UK-based SureStart, there may be long-term benefits that are challenging to measure. This case study (box 1: The Deep Clean) highlights the potential benefit of including SP in the care of CYP with a disability in a UK setting. However, securing sustainable funding for such SP schemes for CYP remains a challenge globally. Solutions to this challenge will differ depending on how health and social care systems are funded (eg, insurance-based or multi-payer systems) and staffed in any setting. Box 2 contains recommendations for achievable steps towards changing this situation.

Box 1. ‘The Deep Clean’: flexible, solution-focused support.

This case study illustrates how a hospital-initiated social prescribing service for medically complex children (SPACE CYP) delivered flexible, non-clinical interventions that directly contributed to improved patient safety and health service efficiency, facilitating hospital discharge.

A 10-year-old girl was referred to the service while still an inpatient, recovering from a stem cell transplant. The family was living in private rented accommodation with severe damp and mould—conditions that posed a serious risk of fungal chest infection and precluded safe hospital discharge for an immunosuppressed patient. The family faced additional vulnerabilities: English was not their first language, and the father had health and mobility issues, further complicating access to services. Despite successful efforts by a hospital social worker and specialist nurse to secure funding for essential items including a dehumidifier, bedding, and a new bed, no statutory service could address the need for a professional deep clean of the property. The local authority housing team and Children’s Services were unable to intervene, as the case did not meet safeguarding thresholds. No recourse to legal enforcement of landlord responsibilities in relation to damp and mould was available at the time, and the family’s private rental status excluded them from many forms of support.

The link worker, recognising the urgency and health risk, used the project’s discretionary Family Support Fund to arrange a professional deep clean (£150) and provided cleaning materials to help the family maintain hygiene standards. This intervention facilitated the child’s safe discharge home. A comparable case had required a 138-day hospital stay due to similar housing conditions. By facilitating discharge at 67 days, the intervention potentially reduced this patient’s cost to the National Health Service by approximately £162 732 due to reduced length of inpatient stay by 71 days, based on a paediatric elective care bed day cost of £2292 (NHS England National Cost Collection data from 2023/2024).

Beyond discharge facilitation, the link worker also provided holistic support tailored to the family’s broader needs. This included securing charitable funding for a tablet, desk, and art supplies to support the child during a 12 month isolation period and signposting the family to local activity centres for siblings.

Box 2. Recommendations.

• Open Pandora’s Box! Clinicians need to become more comfortable with asking questions about social determinants of health. We need to be prepared to hear about how social determinants of health are impacting the children and families we support, whether we can see an immediate way of helping or not.

• Collect and report the evidence. Published evaluations of social prescribing services for children and young people have been lacking even where services exist.

• Individuals and medical professional bodies should lobby for sustainably funded effective services to support the non-medical needs of children with disabilities and their families, including social prescribing initiatives.

To summarise, children with disabilities experience profound and widening health inequities. SP represents an evidence-informed, scalable response that should move from policy discussion into routine practice. It is an acceptable, affordable, and accessible step towards addressing unmet non-medical needs, while broader structural reform continues.