To assess the association between double loss (disclosure of social needs without receiving assistance) with low-income children’s health care utilization outcomes.

Data were from a hybrid effectiveness-implementation trial evaluating a social needs screening and referral intervention (WE CARE) implemented in 3 community health centers. WE CARE included 3 components: 1) social risk/need screener assessing parental desire for assistance with unmet social needs, 2) resource information referrals, and 3) patient navigator. A family was defined as experiencing double loss if, at their child’s well-child visits (WCVs) from birth to age 3, there was at least 1 scanned screener with a request for help without a referral documented in the electronic health record. Multiple logistic regression was used to compare rates of double loss with adherence to WCV and immunization schedules.

Among the cohort of children (n = 403), 43.4% were Black, 21.1% Latino/a/e, and 13.9% Asian. Overall, 40.5% of parents experienced double loss. Families who experienced double loss had fewer reported social needs (0.3 vs 1.5, P < 0.001). Children whose families’ experienced double loss had significantly lower WCV adherence ratios in the first 3 years of life (0.40 vs 0.43, P < 0.0001). Similarly, the immunization adherence ratio for children was significantly lower for families who experienced double loss than for families who did not experience double loss (0.79 vs 0.92, P < 0.0001).

Families experienced double loss had significantly lower WCV and immunization adherence. These exploratory findings carry significant implications for pediatric practice, guidelines, and health policy.