social visits

Department of Corrections

Dc agency top menu.

• Agency Directory
• Online Services
• Accessibility

document.write(document.getElementById("site-slogan").innerHTML);

Search form

• Attorney Comment Form
• Automated Inmate Deposits
• Inmate Telephone Services
• Online Scheduling for Video Visitation
• Veterans Services
• Victim Information Services
• Attorney or Legal Visitor
• Community Services Provider or General Public
• Crime Victim Seeking Information
• Friend or Family Member
• Volunteer Service Providers
• Community Input
• District-wide Recidivism Reduction Plan
• Preparing Returning Citizens for Success
• Supporting Returning Citizens
• The READY Center
• DOC Program Statements
• Reasonable Accommodation
• Career Opportunities
• Correctional Officers Training
• DC DOC Vision
• Job Announcements
• Correctional Facilities
• DOC Frequently Asked Questions
• Director's Biography
• Open Government and FOIA
• Partner Agencies
• Budget and Financials
• Organizational Chart
• Media Contact
• Programs and Case Management (PCM)
• Programs and Services
• New Correctional Facility
• Staff Wellness Resources

Online Scheduling for Video Visitation/Scheduling for Face to Face Visitation

Effective Monday, January 9, 2023 , in-person visits at the Correctional Treatment Facility (CTF) and face-to-face visits at the Central Detention Facility (CDF) will resume for all residents and visitors according to scheduling services provided by DOC Operations Team. 

COVID-19 vaccinations are no longer required for DOC residents and visitors. 

The Video Visitation Center will be CLOSED on Christmas Day, Sunday, December 25, 2022. 

The video visitation center will be open from 8:00 am to 4:00 pm on new year’s day, sunday, january 1, 2023. , beginning monday, july 19, 2021 video visitation will be resume at the following dcpl satellite locations: .

• Anacostia Library, 1800 Good Hope Rd SE, Washington, DC 20020 – Visits are conducted on Thursdays and Fridays from 2:00 to 4:00 p.m.
• Capitol View Neighborhood Library, 5001 Central Ave SE, Washington, DC 20019 - Visits are conducted on Wednesday and Saturdays from 2:00 to 4:00 p.m.

UPDATE: Saturday, April 4, 2020 – Your health and safety is extremely important to us. Together, everyone needs to play their part in helping to flatten the curve. To mitigate the possible spread of coronavirus (COVID-19) through DC Department of Corrections (DC DOC) facilities, the Department will implement a medical stay-in-place, effective immediately , which will further limit movement of residents and help “flatten the curve”, as we anticipate the pandemic’s peak in the next several weeks. During the medical stay in place, DOC will cease all video visitations.

The VVC is located behind the Correctional Treatment Facility (1901 E Street, SE, Washington, DC 20009), on the ground level of The READY Center.

All visits will continue to be scheduled via the Internet or by calling 1 (888) 906-6394 or (202) 442-6155 (Tuesday through Saturday from 9 am-5 pm).

Social visits at the DC Jail are conducted at the Department’s Video Visitation Center, located at the DC General Hospital complex (adjacent to the jail), and in select community visitation locations. Visits may be scheduled via the Internet  or by calling 1 (888) 906-6394 or (202) 442-6155 (Tuesday through Saturday from 9 am-5 pm). Visits are conducted Wednesdays through Sundays starting at 11 am and ending at 10 pm. The last session begins at 9 pm. Visitation hours at the community locations differ. Please see below for visitation hours for each satellite location. DOC encourages all visitors to arrive at least fifteen minutes prior to the scheduled visit. Visits must start on time and are automatically cancelled if visitors arrive late.

Effective Wednesday, September 12, 2012, inmates are allowed two (2) 45-minute social visits per week--visits are free and by appointment only. However, One adult and up to two minor children (under the age of 18) may enter the video visitation room to visit, effective November 6, 2012. Additional minor children may be rotated in during the forty-five (45) minute visitation period as long as they are supervised by an adult while in the waiting area.

About Face to Face Visitation

The D.C. Department of Corrections offers visitation for the families and loved ones of those incarcerated in our facilities. Most social visits for inmates housed at the D.C. Jail are conducted through video visitation. However, as an incentive for positive behavior, face to face visitation is now available for eligible inmates. This program began on June 22, 2015.

Correctional Treatment Facility:

There will be no weekend or Sunday visitation on Sunday, December 25, 2022, or Sunday, January 1, 2023.

Christmas Day (Observed) Monday, December 26, 2022 - Female Population Only.         Holiday Schedule - 8AM,  9AM, 10AM, 11AM, and 12PM

New Year's Day (Observed) Monday, January 2, 2023 - Female Population Only .         Holiday Schedule - 8AM, 9AM, 10AM, 11AM, and 12PM

Note:  All Mondays are reserved for the female population at the CTF.

En Español

1901 D Street, SE

More Resources

• Skip to main content
• Keyboard shortcuts for audio player

ICE lifted its ban on family visits, but relatives still struggle to see loved ones

Juliana Kim

Demonstrators protest outside the Immigration and Customs Enforcement headquarters in Washington, D.C., in July 2020 to demand the release of people in detention centers. Olivier Douliery /AFP via Getty Images hide caption

Demonstrators protest outside the Immigration and Customs Enforcement headquarters in Washington, D.C., in July 2020 to demand the release of people in detention centers.

It takes months' worth of planning for José Hernandez's parents to visit him in immigration detention.

The drive takes four hours and neither of his parents can drive. His father also needs permission to take time off work. But the biggest uncertainty has been whether the detention center will allow visitors at all.

"The inconsistency with the visitation guidelines has made it more difficult for my parents to see me," said Hernandez, who is currently held in a facility in Bakersfield, Calif.

Hernandez was convicted of assault in 2018 in California. While in prison he furthered his education and completed firefighter training, his lawyer says. But when he was released in 2021, he didn't get to go home — he was sent to U.S. Immigration and Customs Enforcement's Mesa Verde Processing Center.

Hernandez was born in Mexico and was brought to the U.S. as a child. He has a green card, but deportation is still a possibility.

"I just want the chance to see my family and give them a hug before worse comes to worst: I have to leave the country I've called home for 29 years," he told NPR.

Individuals held in immigration detention were barred from visits with relatives and friends for more than two years during the pandemic — far longer than federal prisons . In May, ICE lifted the ban, but immigrant advocates and people in detention centers argue that social visits have not been fully nor consistently reinstated.

There's a range of reasons why people are detained in ICE facilities. Some migrants are detained by Border Patrol agents or Customs and Border Protection officers after arriving at the U.S. border without proper paperwork. Others are arrested by ICE agents, often following a criminal conviction. Many are detained for more than a year while they await their fate in immigration court.

For Hernandez, his felony conviction falls under a category of crimes that can subject even green card holders to automatic deportation, according to his lawyer.

As of Nov. 14, 52 out of 113 ICE sites were listed as yellow or red status, meaning their COVID response includes temporarily restricting in-person visits.

'You can either be a survivor or die': COVID-19 cases surge in ICE detention

An ICE spokesperson told NPR that health protocols are based on several factors, including the number of quarantine units, medical isolation rates, hospitalizations and the Centers for Disease Control and Prevention COVID-19 community risk standards.

Immigrant advocates argue COVID restrictions aren't being implemented in good faith

Individual facilities also have the discretion to employ additional protective measures at any time to prevent the spread of COVID. But advocates for immigrants have raised concerns about the authority given to individual detention centers, most of which are run by private and for-profit companies, and whether judgments to restrict visitation access are made in good faith.

Earlier this month, Freedom for Immigrants and 139 other immigrant advocacy organizations asked the Biden administration to intervene and urge ICE facilities to offer in-person visits regardless of a facility's COVID status. They also said video calls for people in ICE detention should be free of charge.

"Even without visitation, the pandemic was still erupting inside detention centers," Laura Duarte Bateman, the communications manager for the California Collaborative for Immigrant Justice, told NPR.

"We're tired of COVID being used as an excuse to not reinstate visitation," she added.

COVID-19 outbreaks have been a concern in ICE facilities throughout the pandemic and the agency has been under fire over the reported lack of soap, face masks and social distancing in some detention centers.

As of Nov. 7, nearly 30,000 individuals were held in ICE facilities and roughly 600 of them were in isolation or monitoring for testing positive for COVID.

According to ICE data, there have been several facilities in recent weeks that have implemented strict COVID restrictions despite reporting only a single case of the virus.

Hernandez said he understands that health and safety is a priority, but said that should not justify limiting visitation, which is crucial for the emotional and mental health of people detained.

"We're not in good hands," he said. "At the same time, we're deprived of visits with our loved ones, it's not right."

Immigrant Detention For Profit Faces Resistance After Big Expansion Under Trump

ICE says it offers several other forms of communication between detained people and their loved ones, including physical letters and video and phone calls.

The agency's policy states that virtual options should especially be ensured when social visits are restricted. But Duarte Bateman said that is often not the case because video calls can be costly. Hernandez says it costs $3.15 for 15 minutes. ICE didn't respond to questions from NPR about the cost of video calls.

Lack of access to in-person visits can also hinder immigration advocates from monitoring human rights violations, Duarte Bateman said. People in detention centers worry that phone calls and handwritten letters are being closely monitored by ICE officers and could lead to retaliation, she added.

Hernandez's mother, María Hernandez, told NPR that she was initially elated when ICE lifted its restrictions on social visits. But that excitement quickly dissolved when she realized reuniting would be more complicated than she anticipated.

"I want to see my son before the end of the year, I don't know how I'll do it. But I really hope me, his dad and him can all be together soon," she said.

• Trying to Conceive
• Signs & Symptoms
• Pregnancy Tests
• Fertility Testing
• Fertility Treatment
• Weeks & Trimesters
• Staying Healthy
• Preparing for Baby
• Complications & Concerns
• Pregnancy Loss
• Breastfeeding
• School-Aged Kids
• Raising Kids
• Personal Stories
• Everyday Wellness
• Safety & First Aid
• Immunizations
• Food & Nutrition
• Active Play
• Pregnancy Products
• Nursery & Sleep Products
• Nursing & Feeding Products
• Clothing & Accessories
• Toys & Gifts
• Ovulation Calculator
• Pregnancy Due Date Calculator
• How to Talk About Postpartum Depression
• Editorial Process
• Meet Our Review Board

How Supervised Visitation Works for Families

• Changes/Expiration
• Additional Info

Supervised visitation is when a parent is only allowed to visit with their child under the supervision of another individual, such as a family member or a social worker. The visit may take place at the parent’s home or in a designated visitation facility, such as a child care center.

Judges typically order supervised visitation when the visiting parent’s fitness is in question, such as in the event of prior alcohol or substance misuse, or if there have been allegations of abuse or domestic violence .

The purpose of supervised visitation is to ensure that parents have an opportunity to maintain contact with their children in a structured environment that is both safe and comfortable for the child.

How Supervised Visits Work

Typically, the visiting parent will need to report to the designated visitation center to visit with the child, or the judge will arrange for the child to be delivered to the parent’s home. In both cases, the judge will specify who is to supervise the sessions.

Many times, a counselor or social worker supervises contact and ensures that the parent visits with the child in a controlled setting.

Duration of Supervised Visit Orders

A judge may order supervised visitation temporarily or indefinitely. If there are allegations of abuse or domestic violence, a judge may order that visitation with the accused parent be supervised until the allegations are fully investigated.   Judges take allegations of abuse or violence seriously and will investigate these allegations fully.

If a judge has already determined that a parent is not fit for custody, the judge can still allow visitation on an ongoing basis, but require that the visitation is supervised in a controlled setting. In these cases, visitation will remain supervised until the parent can demonstrate that there has been a change in circumstances, such as attendance in a drug rehabilitation program, which impacts the parent’s fitness.

Do Visitation Orders Change or Expire?

Once a judge has determined custody and visitation through a court order, the order remains in place until a parent can demonstrate that there has been a change in circumstances. A change in circumstances can be one parent’s decision to move , a parent’s successful completion of rehabilitation or counseling, or other changes that impact a parent’s suitability.

The parent who wishes to change the court order must return to court and request that the agreement is modified to reflect the change in circumstances.

What Else Should Parents Know?

Parents should understand that supervised visitation is designed to protect the safety of children,   while also allowing parents to maintain contact with their children. If you are a parent whose visitation is supervised, consider how you can demonstrate your fitness to a judge.

If the other parent has accused you of abuse or domestic violence, you should cooperate with any investigation ordered by the judge. In addition, if you are a parent who is worried about the safety of your child in the presence of the other parent, you should inform the judge of this immediately.

Child Welfare Information Gateway. Children’s Bureau/ACYF/ACF/HHS. Determining the Best Interests of the Child .

Christian CW; Committee on Child Abuse and Neglect, American Academy of Pediatrics. The evaluation of suspected child physical abuse .  Pediatrics . 2015;135(5):e1337‐e1354. doi:10.1542/peds.2015-0356

By Jennifer Wolf Jennifer Wolf is a PCI Certified Parent Coach and a strong advocate for single moms and dads. 

Home Visit Checklist for Social Workers

Schedule a home visit date and time.

Prepare essential tools and resources

• 4 Measuring tape
• 5 Specific case resources

Go over case file before the visit

Travel to client's home, introduce yourself and explain the purpose of the visit, inspect living conditions.

• 1 Cleanliness
• 2 Safety measures
• 3 Hygiene practices
• 4 Organization
• 5 Maintenance

Document observed conditions and any potential hazards

Interview clients to gather relevant information, approval: client interview.

• Interview clients to gather relevant information Will be submitted

Observe and assess client interactions with family members

Document all findings during home visit, leave contact information with the client, travel back from client's home, submit report of home visit, approval: home visit report.

• Submit report of home visit Will be submitted

Develop a plan of action based on findings

Schedule follow-up visit if needed, follow up interventions and referrals, update case file accordingly, archive home visit process, take control of your workflows today., more templates like this.

An official website of the United States government

Here's how you know

Official websites use .gov A .gov website belongs to an official government organization in the United States.

Secure .gov websites use HTTPS A lock ( Lock A locked padlock ) or https:// means you’ve safely connected to the .gov website. Share sensitive information only on official, secure websites.

What should I do if I get a call claiming there is a problem with my Social Security number or account?

Securing your today and tomorrow

Check eligibility for benefits

Get a benefits estimate

Plan for retirement

Apply for benefits

Sign up for Medicare

Apply for SSI

After you apply

Check application or appeal status

Appeal a decision we made

Manage benefits & information

Get benefit verification letter

Get tax form (1099/1042S)

Update direct deposit

Repay overpaid benefits

Request to withhold taxes

View benefit payment schedule

Number & card

Replace card

Request number for the first time

Report stolen number

Change name

Update contact information

Update citizenship or immigration status

Change sex identification

Report a death

my Social Security account

Use your account to access many of our personalized online services

Are you registered to vote?

Frequently Asked Questions

Latest news.

Last Thursday, the Social Security Administration published a final rule, “Expansion of the Rental Subsidy Policy for Supplemental Security Income (SSI) Applicants and Recipients.” This rule provides the second of several updates to the agency’s SSI regulations that will help people receiving and...

Stay on top of the latest Social Security news for the media, advocate community, and the public. 

Follow us on

• Introduction
• Conclusions
• Article Information

eMethods 1. Semi-Structured Interview Guide for Primary Care Team Members

eMethods 2. Discussion Questions for Patient Engagement Studio (PES) With Patient Stakeholders

eTable 1. Descriptive Statistics for Social Determinants of Health (SDOH) Screening Responses

eTable 2. Descriptive Statistics for Practices, Providers and Patients With Unrestricted Sample (N = 147 096)

Data Sharing Statement

See More About

Sign up for emails based on your interests, select your interests.

Customize your JAMA Network experience by selecting one or more topics from the list below.

• Academic Medicine
• Acid Base, Electrolytes, Fluids
• Allergy and Clinical Immunology
• American Indian or Alaska Natives
• Anesthesiology
• Anticoagulation
• Art and Images in Psychiatry
• Artificial Intelligence
• Assisted Reproduction
• Bleeding and Transfusion
• Caring for the Critically Ill Patient
• Challenges in Clinical Electrocardiography
• Climate and Health
• Climate Change
• Clinical Challenge
• Clinical Decision Support
• Clinical Implications of Basic Neuroscience
• Clinical Pharmacy and Pharmacology
• Complementary and Alternative Medicine
• Consensus Statements
• Coronavirus (COVID-19)
• Critical Care Medicine
• Cultural Competency
• Dental Medicine
• Dermatology
• Diabetes and Endocrinology
• Diagnostic Test Interpretation
• Drug Development
• Electronic Health Records
• Emergency Medicine
• End of Life, Hospice, Palliative Care
• Environmental Health
• Equity, Diversity, and Inclusion
• Facial Plastic Surgery
• Gastroenterology and Hepatology
• Genetics and Genomics
• Genomics and Precision Health
• Global Health
• Guide to Statistics and Methods
• Hair Disorders
• Health Care Delivery Models
• Health Care Economics, Insurance, Payment
• Health Care Quality
• Health Care Reform
• Health Care Safety
• Health Care Workforce
• Health Disparities
• Health Inequities
• Health Policy
• Health Systems Science
• History of Medicine
• Hypertension
• Images in Neurology
• Implementation Science
• Infectious Diseases
• Innovations in Health Care Delivery
• JAMA Infographic
• Law and Medicine
• Leading Change
• Less is More
• LGBTQIA Medicine
• Lifestyle Behaviors
• Medical Coding
• Medical Devices and Equipment
• Medical Education
• Medical Education and Training
• Medical Journals and Publishing
• Mobile Health and Telemedicine
• Narrative Medicine
• Neuroscience and Psychiatry
• Notable Notes
• Nutrition, Obesity, Exercise
• Obstetrics and Gynecology
• Occupational Health
• Ophthalmology
• Orthopedics
• Otolaryngology
• Pain Medicine
• Palliative Care
• Pathology and Laboratory Medicine
• Patient Care
• Patient Information
• Performance Improvement
• Performance Measures
• Perioperative Care and Consultation
• Pharmacoeconomics
• Pharmacoepidemiology
• Pharmacogenetics
• Pharmacy and Clinical Pharmacology
• Physical Medicine and Rehabilitation
• Physical Therapy
• Physician Leadership
• Population Health
• Primary Care
• Professional Well-being
• Professionalism
• Psychiatry and Behavioral Health
• Public Health
• Pulmonary Medicine
• Regulatory Agencies
• Reproductive Health
• Research, Methods, Statistics
• Resuscitation
• Rheumatology
• Risk Management
• Scientific Discovery and the Future of Medicine
• Shared Decision Making and Communication
• Sleep Medicine
• Sports Medicine
• Stem Cell Transplantation
• Substance Use and Addiction Medicine
• Surgical Innovation
• Surgical Pearls
• Teachable Moment
• Technology and Finance
• The Art of JAMA
• The Arts and Medicine
• The Rational Clinical Examination
• Tobacco and e-Cigarettes
• Translational Medicine
• Trauma and Injury
• Treatment Adherence
• Ultrasonography
• Users' Guide to the Medical Literature
• Vaccination
• Venous Thromboembolism
• Veterans Health
• Women's Health
• Workflow and Process
• Wound Care, Infection, Healing

Get the latest research based on your areas of interest.

Others also liked.

• Download PDF
• X Facebook More LinkedIn

Rudisill AC , Eicken MG , Gupta D, et al. Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care : A Qualitative Study . JAMA Netw Open. 2023;6(11):e2345444. doi:10.1001/jamanetworkopen.2023.45444

Manage citations:

© 2024

• Permissions

Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care : A Qualitative Study

• 1 Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, Greenville
• 2 Department of Medicine, Prisma Health, Upstate, University of South Carolina School of Medicine Greenville, Greenville
• 3 Department of Epidemiology/Biostatistics, Arnold School of Public Health, University of South Carolina, Greenville
• 4 Department of Biomedical Sciences, University of South Carolina School of Medicine Greenville, Greenville
• 5 Addiction Medicine Center, Prisma Health, Greenville, South Carolina

Question   Are patient and clinician factors associated with early implementation of social determinants of health (SDOH) screening in primary care, and what strategies can improve these efforts?

Findings   In this qualitative study of 78 928 primary care visits from the inception of primary care–based SDOH screening, visits with a physician assistant, belonging to a racial minority group, and having noncommercial/nonprivate health insurance were associated with greater screening likelihood. Stakeholders suggest that patient-clinician rapport, practice champions, streamlined questions, and referral follow-up ability may improve screening implementation.

Meaning   Results of this study suggest that primary care SDOH screening is feasible but limited by barriers that can be overcome with consideration of stakeholder feedback.

Importance   Health systems in the US are increasingly screening for social determinants of health (SDOH). However, guidance incorporating stakeholder feedback is limited.

Objective   To examine patient and care team experiences in early implementation of SDOH screening in primary care.

Design, Setting, and Participants   This qualitative study included cross-sectional analysis of SDOH screenings during primary care visits from February 22 to May 10, 2022, primary care team member interviews from July 6, 2022, to March 8, 2023, and patient stakeholder engagement on June 30, 2022. The setting was a large southeastern US health care system. Eligible patients were aged 18 years or older with completed visits in primary care.

Exposure   Screening for SDOH in primary care.

Main outcomes and Measures   Multivariable logistic regression evaluated patient (eg, age, race and ethnicity) and care team characteristics (eg, practice type), and screening completeness. Interviews contextualized the quantitative analysis.

Results   There were 78 928 visits in practices conducting any SDOH screening. The population with visits had a mean (SD) age of 57.6 (18.1) years; 48 086 (60.9%) were female, 12 569 (15.9%) Black, 60 578 (76.8%) White, and 3088 (3.9%) Hispanic. A total of 54 611 visits (69.2%) were with a doctor of medicine and 13 035 (16.5%) with a nurse practitioner. Most had no SDOH questions answered (75 298 [95.4%]) followed by all questions (2976 [3.77%]). Logistic regression analysis found that clinician type, patient race, and primary payer were associated with screening likelihood: for clinician type, nurse practitioner (odds ratio [OR], 0.13; 95% CI, 0.03-0.62; P  = .01) and physician assistant (OR, 3.11; 95% CI, 1.19-8.10; P  = .02); for patient race, Asian (OR, 1.69; 95% CI, 1.25-2.28; P  = .001); Black (OR, 1.49; 95% CI, 1.10-2.01; P  = .009); or 2 or more races (OR, 1.48; 95% CI, 1.12-1.94; P  = .006); and for primary payer, Medicaid (OR, 0.62; 95% CI, 0.48-0.80; P  < .001); managed care (OR, 1.17; 95% CI, 1.07-1.29; P  = .001); uninsured or with Access Health (OR, 0.26; 95% CI, 0.10-0.67; P  = .005), and Tricare (OR, 0.71; 95% CI, 0.55-0.92; P  = .01). Interview themes included barriers (patient hesitancy, time and resources for screening and referrals, and number of questions/content overlap) and facilitators (communication, practice champions, and support for patient needs).

Conclusions and Relevance   This qualitative study presents potential guidance regarding factors that could improve SDOH screening within busy clinical workflows.

Health systems in the US recognize the importance of social determinants of health (SDOH) in patient outcomes and care. The SDOH are economic and social conditions affecting health outcomes, 1 health care use, 2 and health inequities. 3 Health systems are increasingly engaging in SDOH screening. 4 Although such screening can potentially improve health outcomes and reduce health care use, 5 , 6 there is limited peer-reviewed evidence incorporating patient and clinician or care team characteristics and perspectives when describing early screening initiatives.

Given the personal nature and limited evidence guiding SDOH screening adoption, 7 - 9 it is critical to understand stakeholder perspectives. Prior research indicates that health care professionals recognize the importance of addressing patient SDOH needs and strive to adopt patient-centered approaches 10 but face ethical and time-related challenges. 8 , 11 , 12 Existing work reports greater SDOH screening uptake in primary care vs specialist visits and lower completion among patients requiring interpreters and patients with racial and ethnic minority status. 7 Studies on patient and caregiver perspectives have documented SDOH screening acceptability and preferences. 13 The role of practice and care team characteristics in screening uptake has not been assessed within a multistakeholder analysis.

To address this research gap, we conducted a qualitative study of a large southeastern US health care system's experiences during the early stages of SDOH screening in primary care. Quantitative analysis examined practice, care team, and patient characteristics and SDOH screening uptake. Qualitative analysis engaged team member feedback. Patient experts informed interview protocols and finding interpretation. Our goal was to identify barriers and facilitators to SDOH screening within primary care to inform future screening.

This qualitative study was classified as exempt by the Prisma Health institutional review board in accordance with 45 CFR §46. In February 2022, Prisma Health, South Carolina’s largest nonprofit health system with approximately 1.5 million unique patients annually, began screening adults for SDOH needs in primary care practices with the goal of annual screening. Practices had implementation flexibility and determined how and when to screen during the clinical workflow. Patients were screened using a 16-question electronic health record (EHR)–embedded survey (eTable 1 in Supplement 1 ). Questions were chosen using validated questionnaires and clinical input on system priorities and resource availability. Answers triggered automated input of community-based service information curated to patient SDOH needs and location into patient after-visit summaries using an EHR-compatible platform connecting patients to community-based organizations (NowPow; Unite Us). Practices provided the after-visit summaries to patients at visit end. Reporting follows the 21-item Standards for Reporting Qualitative Research ( SRQR ) reporting guideline.

The study population included patients aged 18 years or older with a visit in a family or internal medicine practice in the northwestern region of South Carolina from February 22 to May 10, 2022. Visits classified as future, cancelled, no show, or left without being seen were excluded. The last screen on a day was the patient final value, and the same patient could have multiple visits over the study period. In 2021, the northwestern region (4 counties) had 813 069 inhabitants, with 14.2% in poverty (11.4% nationally) and 13.9% uninsured (10.2% nationally). The population is 75.8% White, 14.6% Black, 6.5% Hispanic, 0.4% American Indian or Alaska Native, 1.6% Asian, and 0.1% Native Hawaiian or Other Pacific Islander. 14

The primary outcome was SDOH screening completion status. Visits with a response to at least 1 question were deemed partial screening while complete screening included responses to all questions. Our primary outcome compared visits with complete or partial screening (any screening) with no screening. Secondary outcomes compared visits with complete vs partial or no screening and visits with complete screening vs partial screening.

Potential explanatory variables included practice type (family or internal medicine), clinician qualification (medical doctor, doctor of osteopathic medicine, nurse practitioner, and physician assistant), patient demographic characteristics (age, sex, race and ethnicity [treated as classified in the electronic medical records as separate fields], preferred language, primary payer), and SDOH risk (calculated as the ratio of screener questions with positive responses to the total number of questions answered by patients). Race and ethnicity came from the EHR and thus were primarily patient self-reported. Race is reported as Asian, Black, White, 2 or more races, other race, patient refused, or unknown. Other race comprises American Indian or Alaska Native, Native Hawaiian or Other Pacific Islander, and other as reported in the EHR. Ethnicity is reported as in the EHR. We included SDOH risk to test whether patients with a need might be more likely to be screened (ie, care team members suspect a need or patients are more likely to answer questions).

Binary logistic regression was used to determine the odds of screening completion. Standard errors were clustered by practice to account for practice-specific differences. A 95% CI not including 1 indicated statistical significance. We tested for multicollinearity using variance inflation factors and omitted variable bias using the Ramsey Regression Equation Specification Error Test (RESET). Analysis was conducted using Stata/MP, version 11 (StataCorp LLC).

Six practices were categorized as higher-adopting facilities as they performed SDOH screening during at least 4.0% of visits over the study period. Two of these practices were excluded because of involvement in other SDOH-related studies. Lower-adopting practices performed at least 10 screenings but in less than 2.0% of visits. Four practices met this criterion, but 1 practice was excluded because of involvement in SDOH pilot efforts. Higher- and lower-adopting was defined by quantitative analysis. We excluded practices performing no or minimal screening because we wanted to learn from those practices with some screening familiarity and those screening at both higher and lower levels. These 7 practices were approached for interviews of primary care team members (ie, physicians, administrative staff, nursing staff, and allied health professionals). Six practices participated in a total of 9 interviews (at least 1 interviewee from each of these 6 practices). Interview findings contextualized the quantitative analysis.

Two trained medical students (E.K. and M.J.) conducted and recorded 9 semistructured interviews online between July 6, 2022, and March 8, 2023. The students had not met the interviewees or worked in these clinics prior to the interviews. Interview questions focused on potential barriers and facilitators to screening (eMethods 1 in Supplement 1 ). Oral consent was obtained prior to interviews. Interviews were transcribed verbatim by a speech-to-text service (rev.com). Interview recordings were accessible only to interviewers and the team member uploading for transcription. Interviewers asked questions aimed to not yield identifying information. Additionally, transcripts were kept either on secure file-sharing systems or on password-protected computers. Using a web application (Dedoose), transcripts were coded by 2 research team members (D.G. and M.M.) and analyzed using an inductive grounded theory approach, in which important concepts and themes are derived from close reading of the text, and similar concepts are grouped into conceptual categories (codes). No further interviews were necessary as theme saturation was achieved.

To ensure the research was relevant and ethical for patients and the broader community, we included a meeting with patient experts from the University of South Carolina Patient Engagement Studio (PES) in our research strategy. 15 - 17 The PES is built on guidance from the Patient-Centered Outcomes Research Institute and provides structured opportunities for research teams to engage with community-recruited patient experts. Patient expert refers to individuals or caregivers with substantial health system interaction due to their health conditions who are trained in communication, research methods, and team building.

The research team met with patient experts on June 30, 2022, prior to interviews with primary care practices. In accordance with standard PES processes, 18 patient experts were provided the health system SDOH screening tool as presession reading material. Discussion topics at that meeting included screening and referral processes (eMethods 2 in Supplement 1 ). Patient expert feedback was incorporated into the research process through practice interview topics and by incorporating what we heard from patient experts when discussing study results.

Over the study period, there were 147 096 practice visits, with 3630 (2.5%) involving complete (2976 [3.8%]) or partial (654 [0.8%]) SDOH screening. In the restricted sample, 22 of 58 practices (37.9%) performed any screening during the study period ( Table 1 ). Of the 78 928 visits (mean [SD] age of 57.6 [18.1] years; 48 086 [60.9%] were female, 12 569 [15.9%] Black, 60 578 [76.8%] White and 3088 [3.9%] Hispanic) in the restricted sample, 41 574 (52.7%) were in family medicine and 37 354 (47.3%) in internal medicine practices. Most visits were with medical doctors (54 611[69.2%]), followed by nurse practitioners (13 035 [16.5%]), doctors of osteopathic medicine (5877 [7.4%]), and physician assistants (2958 [3.8%]). On average, patients had a mean (SD) of 0.08 (0.13) (95% CI, 0.08-0.09) positive responses per SDOH question answered.

The SDOH screener responses in order of question appearance are given in eTable 1 in Supplement 1 . Earlier questions were more likely to be asked and answered. Overall, patient response refusal was low (≤3.3%). Descriptive statistics for the unrestricted sample (visits to all practices) are given in eTable 2 in Supplement 1 .

Table 2 displays regression results examining factors associated with any SDOH screening (complete or partial screening vs no screening) in the restricted (model 1) and unrestricted (model 2) practice samples. In model 1 (restricted), compared with visits with a medical doctor, visits with a physician assistant had 3.11 (95% CI, 1.19-8.10; P  = .02) greater odds of any screening done, while visits with nurse practitioners had significantly lower odds (odds ratio [OR], 0.13; 95% 0.03-0.62; P  = .01) of any screening done. Visits with patients identifying as Asian (OR, 1.69; 95% CI, 1.25-2.28; P  = .001), Black (OR, 1.49; 95% CI, 1.10-2.01; P  = .009), or 2 or more races (OR, 1.48; 95% CI, 1.12-1.94; P  = .006) were more likely to have any screening compared with visits with patients identifying as White. With regard to primary payer, visits where patients had managed care had 1.17 (95% CI, 1.07-1.29; P  = .001) greater odds of any screening compared to visits where patients had private or commercial payers. Visits where patients had Medicaid (OR, 0.62; 95% CI, 0.48-0.80; P  < .001), were uninsured or had Access Health (OR, 0.26; 95% CI, 0.10-0.67; P  = .005) or had Tricare (OR, 0.71; 95% CI, 0.55-0.92; P  = .01) had lower odds of any screening. Practice type, patient age, sex, language, and ethnicity had no significant associations with screening likelihood. Results were consistent in model 2 (unrestricted) except for visits with physician assistants and uninsured patients, where the finding was not significant.

We also compared visits completing the entire screening questionnaire vs partial or no screening ( Table 3 ) for the restricted practice sample. In model 3, compared with visits with a medical doctor, visits with a physician assistant had 3.78 times (95% CI; 1.43-10.0; P  = .007) greater odds of screening completion while visits with a nurse practitioner had lower screening completion odds (OR, 0.15; 95% CI, 0.03-0.75; P  = .02). Visits where patients identified as Black had greater odds of screening completion (OR, 1.33; 95% CI, 1.01-1.74; P  = .04) than visits where patients identified as White. Visits where patients had managed care had 1.15 (95% CI, 1.05-1.26; P  = .002) times greater screening completion odds than visits where patients had private or commercial payers. However, screenings were less likely to be complete if patients had Medicaid (OR, 0.53; 95% CI, 0.40-0.72; P  < .001), Tricare (OR, 0.76; 95% CI, 0.58-0.98; P  = .04), or were uninsured or had Access Health (OR, 0.14; 95% CI, 0.05-0.40; P  < .001). Results were consistent in model 4 comparing the odds of complete vs partial screening.

Model 5 extended model 4 to include patient SDOH risk from screening responses. Patient SDOH risk was not associated with screening completion (OR, 1.03; 95% CI, 0.56-1.88; P  = .93). Results in model 5 are consistent with model 4.

All models had variance inflation factors of less than 10 indicating absence of multicollinearity. Models 4 and 5 had omitted variable bias.

We identified 7 themes regarding barriers and facilitators from health care team member interviews for implementing SDOH screening ( Table 4 ). Care team members reported patient reluctance in responding to screener questions. Hesitancy was attributed to perceptions about questions being intrusive or offensive. Interviewees reported patients reacting unfavorably to sensitive questions (eg, violence/abuse, financial strain). Time to administer the screener, interpret results, and address identified needs posed challenges with existing workloads.

Clinicians expressed concerns about potential patient response burden and overlap with routine care questions (eg, stress and Patient Health Questionnaire 2). Clinicians suggested streamlining the screener by combining multiple related questions and then tailoring subsequent questions based on patient initial responses.

Some clinicians felt inadequately trained in navigating the screening tool and expressed uncertainty about effective use of screening results. Many practices lacked social workers or resource navigators to connect patients with resources and follow up on referrals. Clinicians felt their attention diverted from the primary goal of medical care provision.

Care team members reported that screening facilitated patient care by uncovering socioeconomic issues not identified in routine care. Practices that informed patients about the screening purpose, assured them it would not affect care, and obtained verbal consent prior to screener administration perceived more successful uptake.

Some practices identified practice champions as being responsible for screening implementation and supporting patient needs. Some practices had a referral coordinator or social worker who connected patients to community-based resources and provided follow-up support. Clinicians reported they would benefit from training on how to best use screening.

Table 5 presents feedback from patient experts. Patient experts preferred that screening be done at annual appointments to allow for discussion time and in the examination room to ensure privacy. Patient experts emphasized rapport building between patients and care teams and providing information about the screening purpose. They expressed the importance of empathetic clinicians performing screening. Recommendations for rephrasing questions included expanding the partner violence or abuse questions (eTable 2 in Supplement 1 ) to include safety concerns related to family members, neighborhoods, and caretakers. Patient experts expressed concern about timely referral follow-up.

This qualitative study assessed factors associated with SDOH screening completion in primary care and explored patient and care team member perspectives on screening. We found that clinician type, patient race, and primary payer were linked to any screening but that practice type, patient age, sex, language, ethnicity and SDOH risk were not.

Completion rates differed in this study (3.8%) from previous research (58.7%) 7 also examining systemwide SDOH screening implementation. This may be related to study duration, timing (intra–COVID-19 pandemic vs pre–COVID-19 pandemic), or implementation (recommendation for all primary care patients vs preassigned screening). 7 Based on qualitative interviews, our study completion rates may be affected by the desire to receive more resources to support patient referrals.

Our findings suggest that primary care visits with nonphysician clinicians, such as physician assistants, may be favorable for SDOH screening. However, this result did not hold for nurse practitioners and deserves further research, as previous studies demonstrated nonphysician clinician confidence in addressing SDOH needs and greater community-based resource awareness. 19 Clinician type could be serving as a proxy for visit type as our data set did not include visit reason. Consistent with previous studies, 20 our interview-based findings suggest that clinicians faced an additional time burden from incorporating SDOH screening, which they perceived to affect care provision.

We found patients with managed care to be more likely to be screened, while those with Medicaid and those who were uninsured or had Access Health and Tricare were less likely. Medicare and Medicare Advantage had no effect relative to private or commercial payer status. Patients with Medicaid and uninsured or had Access Health may benefit most from screening; therefore this finding is critical for further implementation. Of note, these patients may have been screened via other programs at the health system thus, lack of screening in primary care is not necessarily reflective of screening otherwise.

A lack of association between screening and other patient characteristics (age, gender, language, ethnicity, SDOH risk) suggests that perhaps these characteristics are not associated with SDOH needs in the perceptions of those performing screening. These results differed from previous research that found members of racial and ethnic minority groups less likely to be screened, 7 thereby providing support for universal implementation across primary care practices as a potential mitigation against screening disparities. 7

In our quantitative analysis, questions appearing later in the screener were less likely to be completed. Interviews further explained this finding as questionnaire length and repetitive questions led to a greater perceived patient response burden by health care clinicians. Although there is no consensus on screener length, existing tools range from 6 to 23 questions. 21 Generally, short-form surveys are more acceptable to patients. 22 Notably, patients did not express the same concerns as clinicians about survey length or repetitiveness.

Interviews and patient expert feedback found that patient–care team communication is crucial for screener uptake. Sensitive questions about patient needs may lead to incomplete or untruthful responses if patients have privacy concerns, 10 , 23 feel embarrassed, or fear stigmatization. 24 Patient experts and health care team members emphasized rapport building and communicating the screening purpose to mitigate patient concerns and build trust. Future investigation should include assessment of standard phrasing to introduce the screener rationale and consideration of the best location and visit type for screening. Last, patient experts and care team members expressed concerns about referral follow-up, perceiving that care would benefit from an enhanced ability to follow up on referral outcomes.

Our study has a few limitations to be considered. First, findings are restricted to primary care practices within 1 health system in 1 region, limiting generalizability. However, this study is comprehensive by including all primary care practices in 1 region covered by a large health system that statewide serves approximately 25% of residents. 14 Second, we used a convenience sample of practice staff for our qualitative assessment. This restricted our examination of how qualitative themes differed based on practice characteristics. However, practice choice for interviews was based on screening implementation to intentionally capture those screening at higher and lower adoption rates. Third, our data set included whether a survey was taken on MyChart (Epic). No surveys were done on MyChart. Accordingly, we were unable to test screening modality association with screening completion. We also had no information on screening completion via telemedicine vs office visits and did not include this topic in our interview guide. In addition, we do not know at what rate patients refused to verbally consent to screener administration if a practice asked for such consent.

Although health systems face different challenges in implementing SDOH screening, identifying and addressing common barriers are critical for improved patient activation and care collaboration. Future research should focus on robust assessment of strategies to improve screening uptake.

Accepted for Publication: October 19, 2023.

Published: November 28, 2023. doi:10.1001/jamanetworkopen.2023.45444

Open Access: This is an open access article distributed under the terms of the CC-BY License . © 2023 Rudisill AC et al. JAMA Network Open .

Corresponding Author: A. Caroline Rudisill, PhD, MSc, Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 300 E McBee Ave, Ste 401, Greenville, SC 29601 ( [email protected] ).

Author Contributions: Dr Rudisill and Ms Gupta had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Concept and design: Rudisill, Eicken, Macauda, Self, Thomas, Hartley.

Acquisition, analysis, or interpretation of data: Rudisill, Eicken, Gupta, Macauda, Self, Kennedy, Kao, Jeanty.

Drafting of the manuscript: Gupta, Kao, Hartley.

Critical review of the manuscript for important intellectual content: Rudisill, Eicken, Macauda, Self, Kennedy, Thomas, Jeanty.

Statistical analysis: Rudisill, Gupta, Self.

Obtained funding: Rudisill, Eicken.

Administrative, technical, or material support: Rudisill, Kennedy, Thomas, Kao, Jeanty.

Supervision: Rudisill, Eicken, Macauda.

Conflict of Interest Disclosures: Dr Rudisill reported grants from the Prisma Health Transformative Seed Grant Program during the conduct of the study and The Duke Endowment, Centers for Disease Control and Prevention, Viiv Healthcare, University of Michigan/National Institute on Aging/National Institutes of Health, South Carolina(SC)/NIA/NIH, SC Research Foundation (SCRF)/BlueCross/BlueShield Foundation of SC and National Heart, Lung, and Blood Institute/NIH. Dr Eicken reported grants from Prisma Health Transformative Seed Grant Program during the conduct of the study; grants from the Duke Endowment and grants from the Prisma Health Transformative Seed Grant Program outside the submitted work; Dr Eicken sits on the board of the Piedmont Health Foundation. Ms Gupta reported grants from Prisma Health during the conduct of the study; and support from the Duke Endowment. Dr Self reported grants from Prisma Health during the conduct of the study; personal fees from Companion Animal Parasite Council and personal fees from Merck outside the submitted work. Dr Kennedy reported grants from Prisma Health The Patient Engagement Studio received a portion of the grant to provide feedback during the conduct of the study; and has received 2 Eugene Washington Engagement Awards for capacity building with patients from the Patient-Centered Outcomes Research Institute in 2020 and in 2021. Ms Kao reported grants from Prisma Health Seed Grant during the conduct of the study. Ms Jeanty reported grants from Prisma Health Seed Grant Program during the conduct of the study. Mr Hartley reported grants from Prisma Health Seed Grant Program during the conduct of the study. No other disclosures were reported.

Funding/Support: This research was funded by the Prisma Health Research Seed Grant program.

Role of the Funder/Sponsor: The funding organization had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

Data Sharing Statement: See Supplement 2 .

• Register for email alerts with links to free full-text articles
• Access PDFs of free articles
• Manage your interests
• Save searches and receive search alerts

An official website of the United States government

The .gov means it’s official. Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

The site is secure. The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

• Publications
• Account settings

Preview improvements coming to the PMC website in October 2024. Learn More or Try it out now .

• Advanced Search
• Journal List
• HHS Author Manuscripts

Social support and dental visits

Melanie w. gironda.

Division of Public Health and Community Dentistry, School of Dentistry, University of California, Los Angeles

Division of Public Health and Community Dentistry, Division of Oral Biology and Medicine, School of Dentistry, University of California, Los Angeles

Marvin Marcus

Department of Biostatistics, School of Public Health, University of California, Los Angeles

Division of Public Health and Community Dentistry, School of Dentistry; Department of Biostatistics, School of Public Health; and Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles

Background.

The authors conducted a study to examine the influence of social support on dental visits among an adult population.

Using 2003–2004 National Health and Nutrition Examination Survey data, the authors analyzed information pertaining to adults 40 years and older (N = 2,598) (with the exclusion of edentulous people), who represent about 108 million people in the United States. They weighted logistic regression models for dental visits, while controlling for demographic characteristics (age, race/ethnicity, sex, education, insurance, income), socioenvironmental characteristics (marital status, emotional and financial support, number of close family members and friends, years lived in the neighborhood) and physical and mental health status.

The study findings show that the odds of having had a timely dental visit (that is, within the preceding year), a self-care–related dental visit (that is, a visit initiated by the patient for a checkup, examination or cleaning more than one year previously but less than three years previously) or both were decreased significantly by not having had any financial help if needed and by having fewer close family members and friends. The authors did not find any association between marital status, emotional support or years lived in the neighborhood and having had a timely or self-care–related dental visit.

Conclusions and Clinical Implications.

Timely or self-care–related dental visits depend in part on financial support and the number of one’s close friends and family members. Clinicians should engage appropriate members of the patient’s social network to facilitate dental visits.

Former U.S. Surgeon General Dr. C. Everett Koop stated, “You are not a healthy person unless you have good oral health.” 1 Oral health is related to sustained and proactive health behavior, notably dental visits that are scheduled regularly and related to self-care.

In a study comparing perceptions of self-care among socioeconomically vulnerable versus nonvulnerable older adults, Clark and colleagues 2 found that keeping medical appointments was of primary importance to participants in the vulnerable group in their perception of self-care. To understand factors that contribute to timely dental visits, Osterberg and colleagues 3 conducted a study among a sample of elderly Swedish people, the results of which showed that functional ability and general health were not as important as were socioeconomic, lifestyle and social support factors. In a study of people 65 years or older conducted in the United Kingdom, McGrath and Bedi 4 used “living alone” as an indicator of social support and found that this was an important predictor of a participant’s reason for the last dental visit. Hanson and colleagues 5 and Rickardsson and Hanson 6 measured several aspects of social support and found various associations with dental care utilization. In an intervention study testing the association between four types of social support and dental care utilization among children of Latina immigrants in North Carolina, Nahouraii and colleagues 7 found that some types of social support were associated with dental care visits.

Researchers generally consider social support to derive from social networks. Berkman 8 defined it as “the emotional and instrumental assistance that is obtained from people who compose the individual’s social network.” A common explanation for the link between health and social support is that strong social ties provide a buffering effect from stress, reducing the vulnerability resulting from stress-related health problems, facilitating adaptation and speeding recovery, as well as encouraging health promotion activities. 8 , 9 In a study examining social support (that is, presence of a partner) and self-care among patients who experienced heart failure, Gallagher and colleagues 10 found that patients with a high level of support reported significantly better self-care than did those with low or moderate levels of support.

Although the size of one’s social network is important, other aspects of supportive relationships, such as frequency of contact and type of available support, may be more important for dental visits. Preventing oral disease involves engaging in personal health practices, including timely dental visits. We conducted this study to examine the influence of social support on timely dental visits (that is, within the preceding year), self-care–related dental visits (that is, initiated by the patient not by the dentist) or both among an adult population, while controlling for sociodemographic and physical health characteristics.

Sampling and data collection.

A number of publicly available national surveys contain oral health information. The nationally representative National Health and Nutrition Examination Survey (NHANES) is designed to assess the health and nutritional status of adults and children in the United States. 11 The survey involves the use of a stratified, multistage probability sampling design of the civilian noninstitutionalized U.S. population, with oversampling of low-income people, African Americans, Hispanics, people aged 12 through 19 years, and people 60 years and older. The NHANES offers comprehensive dental and oral health data sets, with both self-reported and clinical examination measures. An ongoing survey since 1999, NHANES has had a substantial history of collecting oral health data and has matured through four waves, with its results released in two-year waves. We used data from the 2003–2004 NHANES, 11 which offered the best available, although limited, information related to dental visits and social support. For NHANES 2003–2004, investigators selected 12,761 people for the sample; they interviewed 10,122 of these participants (79.3 percent) and examined 9,643 participants (75.6 percent) in a mobile examination center. 11

Inclusion criteria.

We included only adults 40 years and older whose interviews included social support and oral self-care–related questions (n = 3,008), representing 120,455,464 people in the U.S. population. In the analysis and modeling of this study, we excluded those who were edentulous, resulting in a final sample size of 2,598, representing 107,569,688 people in the United States.

Dependent variable.

We created the self-care proxy variable by combining two questions from the survey. The first question asked participants to specify about how long it had been since they had last visited a dentist. Respondents were instructed to include all types of dentists, such as orthodontists, oral surgeons and all other dental specialists, as well as dental hygienists. The second question instructed participants to indicate the main reason for their last visit to the dentist. We dichotomized responses by using a binary measure. We recorded a code of “1” for patients who had visited the dentist for a checkup, an examination or a cleaning within the preceding year, or who had visited the dentist on their own for a checkup, an examination or a cleaning more than one year previously but less than three years previously; we considered these patients to have had a timely dental visit, a self-care–related dental visit or both. We coded as “0” all other reasons for the last dental visit, including the patient’s feeling that something was wrong, bothering him or her or causing pain, as well as treatment of a condition that a dentist discovered at an earlier checkup or examination.

Covariates.

NHANES investigators collected all covariate data from study participants in the home interview. We selected specific covariates for their known association with dental visits, on the basis of results from previous studies. These covariates include sociodemographic variables (age, ethnicity, sex, education, insurance, income), socioenvironmental variables (marital status, emotional and financial support, number of close family members and friends, years in the neighborhood) and health status variables (number of days of inactivity due to poor physical or mental health and general health status).

We used five NHANES variables to measure social support, as it was the main focus of this study:

• What is your current marital status?
• Can you count on anyone to provide you with emotional support such as talking over problems or helping you make a difficult decision?
• If you need some extra help financially, could you count on anyone to help you, for example, by paying any bills, housing costs or hospital visits or providing you with food or clothes?
• In general, how many close friends do you have? By “close friends” I mean relatives or nonrelatives with whom you feel at ease, can talk to about private matters and can call on for help.
• How many years have you lived in the neighborhood?

Data and statistical analysis.

We used nationally representative oral health data from NHANES 2003–2004 for our analyses. 11 This wave of NHANES data includes a total of 10,122 participants older than 20 years, 3,008 of whom were 40 years or older and answered both self-care–related questions and social support questions. We excluded those who were edentulous, resulting in a final sample size of 2,598. The measures used in our analysis included demographics, number of years living in the neighborhood, emotional and financial support, and health behaviors. The dependent variable measured the nature of dental visits as timely, self-care–related or both (dental visit = 1) and other types of dental visits (dental visit = 0).

We analyzed the data at three levels. First, through univariate analysis, we calculated the marginal distribution of each of the outcome measures, predictors and covariates. For the continuous variables, we calculated the weighted mean, standard deviation and minimum and maximum range. For categorical variables, we calculated the weighted frequency distributions, modes and percentages in the population. We used a weighted bivariate analysis to examine the association between each of the continuous or categorical outcome measures and each of the predictors and covariates. Finally, we built weighted logistic regression models for the binary categorical outcomes, adjusted for demographic characteristics such as age group, race/ethnicity, sex, education and income. We used statistical software (SAS Version 9.2, SAS Institute, Cary, N.C.) for all analyses.

Forty-nine percent of participants reported having had a timely dental visit, a self-care–related visit or both ( Table 1 , page 189). As expected, all covariates indicated in the literature to be associated significantly with dental visits were statistically significant at the bivariate level ( Table 2 , pages 190–191). In a logistic regression model including all statistically significant relationships at the bivariate level, the odds of having had a timely dental visit, a self-care–related visit or both were predicted ( Table 3 ).

Weighted frequency of having had a dental visit. *

Bivariate analysis of dental visits. *

Weighted logistic regression model.

With regard to sociodemographic characteristics, all bivariate relationships except race/ethnicity remained statistically significant in the multivariate model. Compared with participants 54 years and younger, those older than 75 years were significantly more likely to have had a timely or self-care–related dental visit during the previous year. Female sex significantly increased the odds of having had a timely or self-care–related dental visit. The odds of having had a timely or self-care–related dental visit were significantly decreased for participants who did not have a college degree compared with those who had a college degree. The estimated odds of having had a timely dental visit, a self-care–related dental visit or both for those who had medical insurance but no dental insurance and for those who had no insurance at all were 0.69 ( P = .002) and 0.37 ( P < .001) times, respectively, the estimated odds for participants who had both medical and dental insurance. We tested the interactions between insurance status and social support with regard to having had timely or self-care–related dental visits and found that only financial support exhibited a slightly significant interaction with dental insurance. The odds of having had a dental visit were significantly lower for participants with an annual family income of less than $20,000 compared with the odds for those with an annual family income of $65,000 or more.

Self-reported physical and mental health status also was associated significantly with timely or self-care–related dental visits in the logistic regression model. Compared with participants who reported having had no days of inactivity as a result of physical or mental health issues, those reporting more than one week of inactivity were significantly less likely to have had a dental visit. Similarly, compared with those who reported having excellent general health, those who reported having poor general health were significantly less likely to have had a timely or self-care–related dental visit.

The logistic regression model revealed a complex picture of the relationship between social support and having had timely or self-care–related dental visits. We found no statistically significant association between marital status or having someone available to provide emotional support (such as talking over problems or helping make a difficult decision) and the odds of having had a dental visit. Social connection, as measured by the number of years lived in a neighborhood, also was not a significant predictor of having had a timely or self-care–related dental visit in this model. On the other hand, not having anyone to provide financial help if needed significantly decreased the odds of having had timely or self-care–related dental visits. In addition, compared with having a large number (10 or more) of close friends and family members, having only a few (one through three) close friends and family members significantly decreased the odds of having had a dental visit ( Table 3 ).

Our study findings show that timely or self-care–related dental visits were influenced by some, but not all, components of social support. The relationship between social support and dental visits is affected by who is providing the support and the type of support provided. We found that marital status was not associated with dental visits. As Gallagher and colleagues 10 reported, it is not simply the presence of a spouse that influences self-care, but the quality of the relationship and the functional support provided by the spouse that matters. In a clinical setting, it is not enough for a practitioner to ask a patient if he or she has a partner or is living with someone. The more important questions pertain to the quality of the relationship.

Because the NHANES data set includes both relatives and nonrelatives in the category of “close friends,” interpreting the significant odds ratios was challenging. It may be that among those who had only a few close friends or family members, these one, two or three people were less available or less inclined to help facilitate a dental visit compared with a larger group of family members or friends or compared with no family members or friends. This varying support also was reported by Lim and colleagues 12 in their study of patients’ responses to a course of instruction in plaque control. These authors found that gingivitis levels decreased in participants who had a higher number of reported discussions with friends and parents, but gingivitis levels actually increased among those who reported having had discussions with spouses. Sabbah and colleagues 13 found marital status and number of friends, but not emotional support, to be associated with oral health in terms of the extent of loss of periodontal attachment.

Engage family members and friends.

Optimal oral health depends on the timely use of oral health services. One practical clinical intervention toward this goal is to identify and engage appropriate members of the patient’s social network to facilitate timely self-care–related dental visits. Patients, especially older adults, often are accompanied to dental appointments by a close family member or friend. This provides an opportunity for the dentist or a staff member to have a brief conversation with the companion and acknowledge his or her role in supporting the patient’s oral self-care activities. Such acknowledgment of support by health care professionals sends the message that family members, friends and even the community are important to a patient’s self-care.

By reviewing with patients the specific challenges related to attending dental visits and who might be able to assist them, practitioners can help patients begin to formulate their own strategies for receiving timely dental care. Gironda and Lui 14 presented a sample of assessment tools appropriate for clinical settings to help practitioners determine social support needs. Ideally, the practitioner should conduct an assessment at the first patient encounter to ensure that the best possible social support is in place to facilitate timely self-care–related dental visits. Practitioners also should consider socioeconomic barriers because limited education, low income, lack of dental insurance and not having a source of financial assistance if needed significantly reduced the odds of a patient’s having had a dental visit.

Study limitations.

Although NHANES data were limited with regard to the number and type of social support variables, NHANES is one of the few large data sets with both social support and oral health behavior variables. 11 Our ability to measure the full range of social support and to identify those who specifically provide the support was constrained by the limited number of variables and the way in which they were worded in the NHANES. For example, combining support from family members and friends into one question about the number of close friends limits our ability to interpret and translate the findings. Investigators in future studies of the relationship between social support and dental visits should use some of the well-validated measures of social support found in the literature.

Timely or self-care–related dental visits depend on some, but not all, elements of one’s social support network. From a clinical standpoint, it may be worthwhile to identify those members of the patient’s network who either facilitate or impede timely or self-care–related dental visits. Engagement of appropriate members of the patient’s social network may help clinicians facilitate timely dental visits. ■

Acknowledgments

This work was supported by grants R21DE019538 and R03DE019838 from the National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Md., to Dr. Liu. The authors thank the agency for its support.

ABBREVIATION KEY.

Disclosure. None of the authors reported any disclosures.

Contributor Information

Melanie W. Gironda, Division of Public Health and Community Dentistry, School of Dentistry, University of California, Los Angeles.

Carl Maida, Division of Public Health and Community Dentistry, Division of Oral Biology and Medicine, School of Dentistry, University of California, Los Angeles.

Marvin Marcus, Division of Public Health and Community Dentistry, School of Dentistry, University of California, Los Angeles.

Yan Wang, Department of Biostatistics, School of Public Health, University of California, Los Angeles.

Honghu Liu, Division of Public Health and Community Dentistry, School of Dentistry; Department of Biostatistics, School of Public Health; and Division of General Internal Medicine and Health Services Research, Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles.

Social Work Home Visits to Children and Families in the UK: A Foucauldian Perspective

Affiliations.

• 1 School of Sociology, Social Policy and Social Work, Queen's University Belfast, Belfast, BT7 1NN, UK.
• 2 School of Social and Political Science, University of Edinburgh, Edinburgh, EH8 9LD, UK.
• PMID: 27559221
• PMCID: PMC4985720
• DOI: 10.1093/bjsw/bcv069

The home visit is at the heart of social work practice with children and families; it is what children and families' social workers do more than any other single activity (except for recording), and it is through the home visit that assessments are made on a daily basis about risk, protection and welfare of children. And yet it is, more than any other activity, an example of what Pithouse has called an 'invisible trade': it happens behind closed doors, in the most secret and intimate spaces of family life. Drawing on conceptual tools associated with the work of Foucault, this article sets out to provide a critical, chronological review of research, policy and practice on home visiting. We aim to explain how and in what ways changing discourses have shaped the emergence, legitimacy, research and practice of the social work home visit to children and families at significant time periods and in a UK context. We end by highlighting the importance for the social work profession of engagement and critical reflection on the identified themes as part of their daily practice.

Keywords: Social work theory; child protection; children and families; social work and sociology.

Morning Rundown: Trump lawyer backs away from absolute immunity argument, China warns against 'downward spiral' in U.S. relations, and key takeaways from the NFL draft

Did TikTok videos inspire a teen’s suicide? His mom says she found graphic evidence

After Mason Edens took his own life, Jennie DeSerio looked for answers. She believes she found them in his TikTok account, where he had liked dozens of graphic videos about breakups, depression and suicide.

Editor’s note: This story includes graphic descriptions of videos that refer to self-harm. If you or someone you know is in crisis, call 988 to reach the Suicide and Crisis Lifeline. You can also call the network, previously known as the National Suicide Prevention Lifeline, at 800-273-8255, contact the Crisis Text Line by texting HOME to 741741 or visit SpeakingOfSuicide.com/resources .

It had been four months since Jennie DeSerio’s son died by suicide. Wracked by grief and wondering what she didn’t know, she picked up his phone and decided to go through his TikTok account.

What she found horrified her.

Shortly before he died, she found, her 16-year-old, Mason Edens, had liked dozens of graphic videos about breakups, depression and suicide. She knew Mason had recently been through a bad breakup — she didn’t know what he was watching on a platform that he was increasingly engrossed with. 

DeSerio said she found at least 15 videos Mason liked that directly promoted suicide, some of which are still on the platform more than a year later. At least five specifically promoted the method he had used. 

NBC News reviewed the videos and found that some had accrued tens of thousands of likes. TikTok uses likes as a signal for its “For You” page algorithm, which serves users videos that are supposed to resonate with their interests. 

“I completely believe in my heart that Mason would be alive today had he not seen those TikTok videos,” DeSerio said.

She’s now part of a lawsuit with eight other parents against several social media companies over what they say are product defects that led to their children’s deaths. The lawsuit alleges that TikTok targeted Mason with videos that promoted suicide and self-harm. Their suit is one of a group of lawsuits pursuing a novel legal strategy that argues that social media platforms like TikTok are defective and dangerous because they are addictive for young people. Advocates hope that can be a way for people to get justice for harms allegedly caused by social media.

In at least four other active lawsuits brought against TikTok and other social media companies, parents have said TikTok content contributed to their children dying by suicide. In another lawsuit , filed this month, two tribal nations sued TikTok, Meta, Snap and Google alleging that addictive and dangerous designs of social media platforms have led to heightened suicide rates among Native Americans. Google said the allegations are “not true,” and Snap said it was continuing to work on providing resources around teenage mental health.  Suicide is a complex issue, and the Centers for Disease Control and Prevention says it is rarely caused by a single circumstance or event. “Instead, a range of factors — at the individual, relationship, community, and societal levels — can increase risk. These risk factors are situations or problems that can increase the possibility that a person will attempt suicide,” the CDC says on its suicide prevention website .  

A TikTok spokesperson said the company couldn’t comment on ongoing litigation but said, “TikTok continues to take industry-leading steps to provide a safe and positive experience for teens,” noting that teen accounts are set to private by default and that teens have an opt-out 60-minute screen time allowance before they’re prompted to enter a passcode. 

TikTok has clear policies against content that promotes suicide or actions that could lead to self-harm, but in a sea of billions of videos, some content that glorifies suicide is still slipping through the cracks.     

DeSerio said Mason became so hooked on TikTok that he struggled to sleep sometimes, which led to anxiety issues. Friends said he found an emotional outlet on TikTok in particular as he was going through his first heartbreak.  

“A 16-year-old boy should never be sent videos like that on TikTok. They’re not going to self-regulate until there’s true accountability,” she said of social media companies.

Mason loved sports and the outdoors. “We were always playing basketball, throwing the football. We were always just outside doing something,” his friend Braxton Cole-Farmer said. “Mason didn’t like just sitting at home doing nothing. If we didn’t have anything to do, we’d just go drive.”

“He was always there for everybody. If anybody just needed a friend to talk to, he wouldn’t judge you based on what’s going on in your life,” he said.

Cole-Farmer said that Mason would retreat into his phone when he was having a tough time but that it wasn’t a cause for concern. 

“I mean, all of us are teenagers. We’re all addicted to our phones. So, like, seeing that, we didn’t really catch a red flag on it, because my generation of teenagers are always on their phone.”

In the months before he died, Mason had been in a turbulent relationship that family and friends said ended in a breakup. He was heartbroken, and the fallout rippled through his life at school. At first, Mason’s parents thought it was normal teenage sorrow. But a few weeks after the breakup, Mason and his mom decided he might need professional help and began actively trying to arrange a therapy visit.

DeSerio said Mason knew the breakup had made his anxiety worse and was taking proactive steps to try to feel better.

“He was showing some anger that he didn’t usually express,” she said.

DeSerio said the family had very open lines of communication, talking about mental health, anxiety and potential treatments in the week leading up to Mason’s death. She said what she heard and saw from him didn’t seem like an emergency. 

“There were also a lot of really happy times in those two weeks, too,” she said.

What she didn’t see was what Mason was consuming online — videos that included graphic and detailed depictions and methods of self-harm.

Mason liked one video in which an audio overlay said, “I wanna put a shotgun to my f------ mouth and blow my brains out,” with accompanying text about depression. The audio from that post was eventually removed, but the video remains up. Another described a plan to die by suicide, along with commentary about relationship issues.

One video he liked — it had over 67,000 likes — has text reading “what are your plans for the future?” over slow-motion video of a firearm discharging. That video is no longer available on the platform. 

Even though the videos clearly allude to suicide when their elements are taken together, it appears that many of them avoided detection by TikTok’s automated moderation system. According to TikTok, the auto-moderation system is designed to pick up various types of signals that might indicate a community guidelines violation, including keywords, images, titles, descriptions and audio in a video. 

TikTok declined to comment on how or why the videos Mason liked evaded its moderation system.

In addition to watching and liking the videos that mentioned suicide, Mason posted TikTok content the day he died about a rapper named Lil Loaded. Lil Loaded gained notoriety on TikTok after he reportedly died by suicide following a breakup. 

After he died, Lil Loaded became a frequently cited figure among some communities on TikTok, where dozens of videos that are still on the platform glorified his death, some with over 1 million views. Most of the videos use Lil Loaded’s image or name as shorthand for dying by suicide in reaction to a breakup.

One video that was still on the platform as of early April and had over 100,000 views included an audio clip saying “oh god, why am I even living bro, why do I live?” along with text over a video reading, “bout to pull a lil loaded.”

Mason’s stepbrother, Anthony, 16, said Mason changed his TikTok profile photo the day he died to a photo of Lil Loaded and joked with him before school that he was going to “pull a Lil Loaded.” 

Anthony said he asked Mason whether he was suicidal, but Mason said he was just joking around. 

That evening, Nov. 14, 2022, DeSerio tried to take Mason’s phone away from him so he could get a good night’s sleep, something she said she regularly did for his mental health. But Mason has just gotten his phone back after having been grounded for fighting at school, DeSerio said. When she tried to take it away from him again, he ran across the room and punched her.

DeSerio said she was shocked. He had never been violent toward her, and it wasn’t like the Mason she knew.

Mason’s mother and stepfather, Dave, took his phone away. 

While Jennie and Dave regrouped, Mason, crying and emotional, went to his room and locked the door without their realizing.

When Dave realized that Mason had gone to his room, he ran there and pounded on the door, trying to get him to unlock it.

But Mason was already gone. The 16-year-old died from a self-inflicted gunshot wound. 

Social media companies have been immunized from legal responsibility for most content on their platforms by Section 230, a law enacted by the passage of the 1996 Communications Decency Act that says the platforms can’t be treated as publishers of content posted by third parties. The law has generally insulated social media companies from lawsuits about content on their platforms, but advocates of stricter regulations have recently been pushing to find novel legal strategies to hold tech companies accountable. 

DeSerio’s lawsuit and hundreds of others aim to sidestep Section 230 by tying their claims to the legal concept of defective product design.

DeSerio’s suit describes TikTok’s design as manipulative, addictive, harmful and exploitative.

“TikTok targeted Mason with AI driven feed-based tools,” it says. “It collected his private information, without his knowledge or consent, and in manners that far exceeded anything a reasonable consumer would anticipate or allow. It then used such personal data to target him with extreme and deadly subject matters, such as violence, self-harm, and suicide promotion.”

California courts and a federal court are both waiting to begin hearing groups of cases making such arguments, which could open social media companies to a variety of claims around product safety.

Matthew Bergman and his firm, the Social Media Victims Law Center, are representing DeSerio and the other plaintiffs in her case. 

“It is our contention that TikTok in particular is an unreasonably dangerous product, because it is addictive to young people,” he said. 

Bergman contends that Mason took his own life because of what he viewed on TikTok.

“TikTok, in order to maintain his engagement over a very short period of time, deluged him with videos promoting that he not only take his life, but that he do so” in a specific way, Bergman said. 

Content that promotes suicide and self-harm has been a persistent issue for TikTok and other social media platforms for years. In November, Amnesty International released a research report that found that teens’ accounts on TikTok that expressed interest in mental health quickly went down a rabbit hole of videos about the topic that eventually led to numerous videos “romanticizing, normalizing or encouraging suicide.” 

Suicide rates among young people in the U.S. increased 67% from 2007 to 2021, according to the Centers for Disease Control and Prevention. In 2022, suicide rates for young people slightly decreased. Mental health professionals have said the U.S. is in the midst of a teen mental health crisis .

Lisa Dittmer, a researcher at Amnesty International, told NBC News that through interviews with teens, the organization found that “there were times they just weren’t in a capacity to actively counter that impulse to seek out depressive thinking. That would amplify the voice in their heads that said ‘life is all pain and pointless.’”  TikTok criticized Amnesty International’s research in a statement, saying its categorizations of mental health-related videos were overly broad.

The TikTok app immediately presents users with short-form videos, often from the “For You page,” which uses an algorithm that chooses which videos to serve people next. The recommendation system is one of the most powerful features of the platform. It has been repeatedly characterized as addictive by groups like Amnesty International and the Social Media Victims Law Center and as knowing users better than they know themselves . In a document reportedly seen by The New York Times in 2021, TikTok explained that the algorithm was optimized to keep users on the platform for as long as possible and coming back for more, analyzing how every person who uses it interacts with each video. According to the Times report, the equation considers what videos users like, what they comment on and how long they watch certain videos. NBC News hasn’t verified the document.

TikTok has said it has made efforts to try to prevent content rabbit holes, providing tools to enable users to restart their recommendation algorithms and filter out videos including certain words. TikTok also allows parents to oversee teen accounts and further customize screen time and content controls.

But Dittmer said teens who tried using the tools described them as ineffective in their interviews. 

Dittmer said young people dealing with mental health issues were susceptible to falling into depressive rabbit holes on TikTok.

“It’s not so much that your average teenager will automatically turn depressive or suicidal from being on TikTok, but for young people who have that thinking in their head, TikTok will just latch on to your interest and your vulnerability and amplify that relentlessly,” she said. 

Megan Chesin, a psychology professor at William Paterson University in New Jersey who has studied the connection between media and suicide, said the primary risk of social media for susceptible people is that the content could be encouraging or instructive.

“The risk, of course, is that individuals, like this adolescent that you’re writing about, learn something or are given permission or capability to die by suicide through what they see or understand on social media,” Chesin said. “The more you are exposed to something, the lower your threshold for acting on your own thoughts or desires to die can be.”

At a House of Representatives hearing last May, Rep. Gus Bilirakis, R-Fla., played videos found on TikTok that promoted suicide for TikTok CEO Shou Chew, asking him whether TikTok was fully accountable for its algorithm. Two of the videos included graphic descriptions of suicide via firearms. Chew responded by saying, “We take these issues very seriously, and we do provide resources for anybody that types in something suicide-related.”

While DeSerio waits for her own story to be heard in court, she has poured her efforts into bringing attention to how social media can affect children and teens.“Every day I wake up knowing that I need to share the larger message in order to save another child, another mother from this grief,” DeSerio said.

DeSerio agreed to be filmed for a documentary about Mason’s story that is in production, and in January, she and Mason’s stepfather flew to Washington, D.C., to be present as Chew testified in front of the Senate Judiciary Committee along with other tech CEOs about child safety issues and social media.

“It’s standing in front of all of society and challenging the ‘norm.’... Sometimes it’s really scary,” she said. 

Along with other parents, DeSerio was in the audience, holding a photo of Mason.

As Meta CEO Mark Zuckerberg stood in an unprecedented moment during the hearing, apologizing to parents for their suffering, DeSerio stood, as well, holding Mason’s photo above her head. 

The image would be broadcast around the world in photos and videos of the deeply emotional confrontation between one of the world’s most powerful people and the parents who have been trying to get his attention for years.

“I thought my purpose as his mom died that night with him,” DeSerio said. “Little did I know that my purpose just transformed.” 

Ben Goggin is the deputy editor for technology at NBC News Digital.

• Search Please fill out this field.
• Manage Your Subscription
• Give a Gift Subscription
• Newsletters
• Sweepstakes

Prince William Visits School After Getting Invited on Social Media as Kate Middleton Continues Cancer Treatment

The Prince of Wales is in the West Midlands of England visiting a school and community projects tackling better well-being

Prince William is continuing his work to highlight better mental health for young people — and showing that you never know what might come out of a social media post.

The Prince of Wales, 41, stepped out amid his wife Kate Middleton 's ongoing  cancer treatment to visit a school that had caught his eye for their award-winning student-led initiatives. William headed to Birmingham, in England's West Midlands, on April 25 to see St. Michael’s Church of England High School in Sandwell.

Samir Hussein/WireImage

The school came on the royal's radar after 12-year-old Freddie Hadley wrote a letter to Prince William and Princess Kate, 42, that was shared on social media for World Mental Health Day in Oct. 2023. Freddie invited the couple to their school group's #AmIManlyEnough campaign launch, writing, "Through our work, we discovered that suicide is the biggest killer in young males, and this won't change until people start the conversation."

Prince William personally replied to the letter on X (formerly Twitter) by writing, "Good afternoon Freddie, I’m so sorry Catherine and I can’t be with you and the rest of the students at St Michael’s today. Tackling mental health challenges and stigmas head on is so important, please keep up this important work." The Prince of Wales signed the tweet with a "W," the sign that the note came directly from the royal rather than his team.

“Your letter worked,” Prince William told Freddie Hadley, 12, from Sandwell, West Midlands when they met on Thursday.

They then chatted about how Freddie and his school pals talk about their feelings.

“They open up?” William asked. “What’s been the biggest thing? Talking about things?”

Prince William got to see firsthand the work of the Matrix Project, which Freddie highlighted in his letter for bringing boys aged 11 to 14 together for weekly meetings that develop ideas and projects to tackle mental health challenges. The royal joined a session with some of the boys and was told how the group launched the #AmIManlyEnough campaign last year to encourage males to communicate more about their feelings and tackle the stigma of mental health.

William also met representatives of Student Voice to hear about their projects set up at the school to promote positive mental health and joined a workshop with students discussing issues related to well-being, including designing their own calm kits and their dream well-being hub. 

“What a beautiful opportunity for our youngsters to shine a spotlight on everything we do in school," headteacher Christina Handy-Rivett tells PEOPLE. "And to have His Royal Highness, who pioneers and supports mental health, it was such a special moment.”

Oli Scarff - WPA Pool/Getty Images

“We are extraordinarily excited and so proud. It’s such a unique response to help support and raise awareness of what we are undertaking as a school community to really engage strategies to support mental health and well-being," she says.

Handy-Rivett adds that they were “shocked” at the overwhelming response to the letter which they posted on social media.

”We are always encouraging children to dream big — I say to them the sky’s the limit and don’t put limitations on yourself and if you don’t ask, you don’t get. And this is a perfect example of that," Kerry Whitehouse, senior mental health lead at the school, tells PEOPLE. 

“For us to have members of the royal family who are actively championing mental health is incredible. For young people to look at the future king and see him championing work and being passionate about the same things as they are is incredibly important," Whitehouse says. “It’s a huge issue which often gets overlooked. There is no price tag you can put on seeing influential people, on another scale — and these are global influencers — championing the messages our students believe in.”

Can't get enough of PEOPLE's Royals coverage?  Sign up for our free Royals newsletter  to get the latest updates on Kate Middleton, Meghan Markle and more!

Freddie tells PEOPLE that it was a "massive shock" to see Prince William arrive at his school, sharing that at first, "I couldn’t see who it was — I thought it was just like security. When he started getting closer, I thought, 'That’s Prince William,' and I was so shocked. It’s insane."

Despite his surprise, Freddie later told the Prince of Wales that he had "no doubt" that the royal would visit "someday" because of his dedication to mental health awareness.

"He is a very nice guy," the student says. "When I sat down with him about what we do in school with our Matrix Project, I got more comfortable and I felt like I got into his way of thinking about it. He asked us about why we do our stuff and why he is an advocate for male mental health."

Freddie adds that William "said from working with charities for mental health he realizes — as he’s a male himself — he’s gone through those things before. He realizes it is such a massive thing in today’s society, and he wanted to step up and get these issues sorted out."

Freddie said that Prince William "seems the same guy" as the when he's seen on TV or online — and even found out they share a love for Aston Villa's soccer team.

"I said my favorite players are John McGinn and Olly Watkins, and he said, 'I can totally agree because they’re really great players,' " Freddie shares.

The entire school buzzed during the visit, with students lining the stairs to catch a glimpse of the royal. Outside the building, Prince William went on a walkabout, smiling as he shook the hands of as many excited pupils as possible.

Haney-Rivett tells PEOPLE that a highlight of the royal visit was seeing Freddie's face when he first released who their mystery VIP visitor was.

"Then, just being able to stand back and watch the busyness in the room and watch some truly inspirational engagement of Prince William and the young people engaging with him. It was free-flowing and spectacular," she says. "They were overwhelmed initially, but he settled their nerves so quickly. It’s because he’s genuine and authentic. And they can see that — it permeates."

Prince William also left with some thoughtful presents for Princess Kate. Whitehouse tells PEOPLE they gave her Lego sunflowers because "building things is therapeutic and sunflowers represent happiness positivity and strength" as well as sunflower seeds "to sow seeds of positivity" in addition to other goodies.

"We didn’t want to give flowers but something significant to represent the theme of the day," Whitehouse says, adding that Prince William commented that the Legos would "go down well in the house."

Later on Thursday, Prince William is set to see two more organizations focused on giving a second chance to those who are homeless and fighting addiction.

Max Mumby/Indigo/Getty

Since Princess Kate made her announcement on March 22 that she was undergoing treatment for cancer, William has curtailed his public duties, making sure he is home as much as possible for the couple's three children —  Prince George , 10,  Princess Charlotte , 8, and Prince Louis , who celebrated his sixth birthday on April 23 — and helping Kate.

Both Prince William and Princess Kate have prioritized the promotion of mental health for much of their public life. Alongside Prince Harry , they spearheaded the successful Heads Together campaign that did much for raising awareness of the challenges many people face.

Related Articles

• FanNation FanNation FanNation
• SI.COM SI.COM SI.COM
• SI Swimsuit SI Swimsuit SI Swimsuit
• SI Sportsbook SI Sportsbook SI Sportsbook
• SI Tickets SI Tickets SI Tickets
• SI Showcase SI Showcase SI Showcase
• SI Resorts SI Resorts SI Resorts

© Ricardo B. Brazziell / USA TODAY NETWORK

Social Media Posts Sum Up Surprising Buffalo Bills' Trade

The Buffalo Bills traded back in the first round at the NFL Draft, gifting Texas speedster Xavier Worthy to the Kansas City Chiefs in the process and sparking social media criticism.

• Author: Ralph Ventre

In this story:

The Buffalo Bills pulled off a head-scratching draft night trade with the AFC rival Kansas City Chiefs.

They swapped first-rounders with Kansas City, dropping back to No. 32 overall and allowing the Super Bowl champions to move up to the No. 28 slot. The Chiefs used the pick on Texas receiver Xavier Worthy.

In exchange for moving down four spots in Round 1, the Bills turned the No. 133 and No. 248 overall selections into the No. 95 and No. 221 picks.

Acquiring another Top 100 selection allows Buffalo to move back into the third round. The Bills' original third-rounder belongs to the Green Bay Packers as a result of the midseason trade for starting cornerback Rasul Douglas. General manager Brandon Beane was anticipating a third-round compensatory pick , but the NFL awarded the Bills a fourth-rounder instead.

The Jacksonville Jaguars took LSU receiver Brian Thomas Jr. off the board at No. 23 overall, potentially prompting the Bills to trade back.

It is slightly surprising that Buffalo would allow Kansas City to move up and pick its preferred player. The Chiefs have been responsible for eliminating the Bills from the postseason in three of the last four years, including a 27-24 decision in the divisional round this past January.

Social media user @DaveKludge and others summed up the disappointment running throughout Bills Mafia.

I feel bad for Bills fans. Almost every fan expected the team to trade up for a WR tonight. Instead, they traded back and gift-wrapped Xavier Worthy to their biggest foe. — Dave Kluge (@DaveKluge) April 26, 2024

Feels like this trade will come back to haunt the Bills. — Kylie Winfrey (@thekyliewinfrey) April 26, 2024

Chiefs get fastest receiver in draft and it’s in trade up with Bills. You can’t make it up. — Adam Schein (@AdamSchein) April 26, 2024

Latest Bills News

Bills Sign Two-Time Super Bowl Champion

Bills Hosting Chargers DT for Free Agent Visit

NFL Mock Draft: Bills Land Big Ten DPOY

Giants to Meet with Free Agent CB Tre'Davious White

Bills Ex Tre'Davious White Schedules Two More Visits

Queensland premier visits Molly the magpie after family's successful social media campaign for his return

The Queensland premier has made a special visit to Molly the magpie on the Gold Coast, but denies bowing to social media pressure to intervene in the case.

Molly the magpie's story captivated the public after the Instagram-famous bird was voluntarily surrendered to the Queensland Department of Environment, Science and Innovation (DESI) earlier this year.

The bird's online page has now amassed more than 900,000 followers on the popular social media platform, originally created by Gold Coast couple Juliette Wells and Reece Mortensen to document Molly's unlikely friendship with their Staffordshire terrier dog, Peggy .

Molly was given to DESI after authorities found the couple did not have the required permit to care for native wildlife despite being given years to do so.

Ms Wells has said the pair rescued the bird as a fledgling in 2020 and raised it alongside Peggy and their other pet dog, Ruby.

The department previously said in a statement that independent expert veterinary advice had shown that Molly was highly habituated and may have developmental issues, meaning he can never be rehabilitated or returned to the wild.

Following a sustained social media campaign to return Molly, Premier Steven Miles threw his support behind reuniting the bird with the family .

After more than six weeks apart, Molly with given back to the Yatala home earlier this week with strict conditions including that Ms Wells and Mr Mortensen agree to not to receive any commercial gain from the bird or its image.

They are also ordered to undertake wildlife carer training and to continue engaging with authorities to ensure the bird is receiving adequate care.

The couple are also encouraged to publicly educate others how to appropriately care for native wildlife.

Premier defends prioritising bird

Mr Miles defended criticism he bowed to social media pressure by insisting this was a "common sense" approach.

"The choice between having Molly in a sanctuary or worse still, euthanased, versus being in a home where he's cared by carers that care for [him] as well as surrounded by by other animals, I think it's a better outcome," the premier said.

"That's what the act requires — either a sanctuary or euthanasia. I clearly wouldn't want to see either of those things happen."

Mr Miles said he was confident the couple would abide by the conditions set by the department.

"I'm not a bird expert but he looks really well and healthy to me," he said.

Mr Miles said by continuing to post on social media Ms Wells and Mr Mortensen have not breached their agreement.

"As I understand that they are fully complying with the conditions at this time. They're not making a commercial gain from having Molly at home," he said.

"Going forward, though, they're eager to use Molly to support wildlife carers and to educate the public about our Australian wildlife, and I'm really keen for them to be able to do that."

• X (formerly Twitter)

Related Stories

Molly the magpie singing with joy as video of long-awaited reunion with canine best friend released.

Premier announces impending reunion of Molly the magpie with best friend Peggy the staffy

'Real-life Winnie-the-Pooh and Piglet story' comes to an end after magpie surrendered to authorities

• Activism and Lobbying
• Community and Society
• Government and Politics