Social Determinants of Health Screening in the Clinical Setting

Narayan A, Raphael J, Rattler T, Bocchini C
Patient Need Addressed: Financial insecurity, Food insecurity, Homelessness/housing, Transportation, Trauma
Population Focus: Low income
Demographic Group: Child
Intervention Type: Best practices
Type of Literature: Grey


Insights Results

Overview of article

  • Given the relevance of social circumstance, many healthcare organizations are developing innovative methods to address social determinants of health (SDOH) within clinical settings as a possible strategy to enhance patient care, improve health outcomes, and prevent avoidable healthcare utilization. One particular approach endorsed by the American Academy of Pediatrics is SDOH screening, which takes place within clinical care settings and relies on clinical teams to administer a validated and standardized survey to identify unmet social needs or adverse social circumstances. After completion of the survey, providers discuss results with the patients and their families and develop an action plan for their needs to be addressed
  • Despite the numerous benefits associated with pediatric screening, no standardized procedure nor tool exists. This policy brief reviews many of the models which implement screening and the characteristics that individual care settings should consider when selecting a tool for their institution

Key takeaways/implications

  • In terms of policy, innovative funding mechanisms should be implemented to promote screening and care coordination with community resources. Efforts should be made to institutionalize screening. For example, in 2016, the Centers for Medicare and Medicaid Services (CMS) established Accountable Health Communities, a 5-year innovation model that specifically promotes SDOH screening for all Medicare and Medicaid beneficiaries. Participating sites address these needs through three tiers of approaches, with more intensive interventions linked to higher reimbursement. CMS has also formalized an alternative payment model mechanism which should incentivize nonmedical interventions by granting states greater flexibility in dictating the types of services that are covered by health plans. Together, the Accountable Health Communities program along with several changes to Medicaid reimbursement policy signify how addressing SDOH through screening is gaining traction as a federal policy focus
  • In addition, clinical care settings should be proactive in forming relationships with government agencies, health departments, and other organizations which allows for facilitated communication about available resources and eligibility. In addition, some models, like WE CARE have developed a Community Resource Book that organizes information into 1-page handouts that can be easily distributed to patients. The SEEK model similarly includes one-pagers with general information on risky behaviors and information on resources families can contact for help
  • Future research should focus on the following topic areas: 1) Specific financial benefit of standardized screening and accompanying social needs resolution; 2) Standardized metrics that measure benefits accrued by patient outcomes; 3) Relative effects SDOH discussion initiated by different types of providers (residents, social workers, undergraduates) has on patient receptivity, engagement, and willingness to follow through on advice; and 4) Examine the short term impact of screening on pediatric health