TY - JOUR
T1 - From Policy Statement to Practice
T2 - Integrating Social Needs Screening and Referral Assistance With Community Health Workers in an Urban Academic Health Center
AU - Fiori, Kevin
AU - Patel, Milani
AU - Sanderson, Dana
AU - Parsons, Amanda
AU - Hodgson, Sybil
AU - Scholnick, Jenna
AU - Bathory, Eleanor
AU - White-Davis, Tanya
AU - Wigod, Neal
AU - Chodon, Tashi
AU - Rich, Andrea
AU - Braganza, Sandra
N1 - Funding Information:
Our initial experience translating policy recommendations into practice resulted in a novel and feasible program that incorporated clinical provider feedback, and this case example contributes to addressing the gap in knowledge regarding optimizing and applying guidelines to screen for social needs in a real-world setting. 15 , 16 We attribute observed progress of the CLC program pilot to be a result of identifying and being explicit about key program components, as we found that these components helped sustain the screening process through multiple clinic environmental changes (ie, staff turnover). These elements included utilizing an established social needs screen, having clear referral protocols, defining the role and scope of work, designating provider champions, engaging administrative liaison(s), and making program changes based on provider feedback. To ensure a screening process that would be successful in our individual clinic center, we went through an iterative process using an established forum, our PCMH meetings, to develop and improve workflows. The workflow design included all members of our clinic team (front desk staff, nursing staff, providers, CHWs) and avoided automatically referring patients to our social worker or CHW. Rather, the design emphasized the importance of family-centered screening and shared decision making. 5 Over an 11-month period, we screened more than 4000 patients and encountered almost 800 positive screens, about 20% of the screened population. Most of our providers were actively engaged in the screening process during any given month of the study period. There were several limitations regarding the generalizability of our experience. With regard to context, we were operating at a clinic site that had previous experience with social medicine principles, with a majority of physicians acknowledging the impact of social needs and being open to addressing these needs in a well-child visit. Therefore, there was likely a high level of provider buy-in prior to program implementation initially and may limit generalizability. Next, our workflow included grant-funded CHWs, which may not be financially feasible at other health centers. As mentioned in multiple monthly meetings, it is likely that the integration of CHWs to assist families motivated clinic team members to screen patients. Although CHWs, who are themselves members of the community, may be more effective in communicating and coordinating referrals, we did not assess this in our study. Furthermore, there may be alternative team members who could play this role, as other programs have successfully screened for social needs utilizing other positions with different titles but similar roles such as patient navigators, resource handouts, or in-depth physician training with success. 9 , 12 In regard to our metrics, data was solely extracted from an EMR system, which is not ideal as there may have been missing screening data and/or mistakes in data entry. Finally, we used ICD-10 (International Classification of Diseases–10th Revision) codes to determine the “number of eligible visits” for both Reach and Adoption metrics, which can be inaccurate. There clearly remain additional opportunities for improvement with multiple quality improvement projects underway. We are working in collaboration with multiple actors and health system leadership regarding the sustainability of the model, including funding for CHWs, implementing neighborhood- or place-based interventions targeting SDH, optimizing outreach for social needs categories such as food insecurity, and studying the impact of the CLC program on healthcare utilization, outcomes, and costs. Our experience suggests that screening for social needs at well-child visits is both feasible and practical even in a busy ambulatory pediatric clinic. This case description and these findings will inform scale strategies planned for other ambulatory sites within our health system. We attribute our initial progress to leveraging health center resources, including provider buy-in, and having structural components in place to sustain screening, including a practical workflow, resource availability, provider champions, and meaningful metrics. Declaration of Conflicting Interests The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article. Funding The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: The authors received funding support from the Doris Duke Charitable Foundation (grant #2018169) to support the publication of this article. ORCID iD Kevin Fiori https://orcid.org/0000-0003-1370-7366
PY - 2019
Y1 - 2019
N2 - Purpose: Social and economic factors have been shown to affect health outcomes. In particular, social determinants of health (SDH) are linked to poor health outcomes in children. Research and some professional academies support routine social needs screening during primary care visits. Translating this recommendation into practice remains challenging due to the resources required and dearth of evidence-based research to guide health center level implementation. We describe our experience implementing a novel social needs screening program at an academic pediatric clinic. Methods: The Community Linkage to Care (CLC) pilot program integrates social needs screening and referral support using community health workers (CHWs) as part of routine primary care visits. Our multidisciplinary team performed process mapping, developed workflows, and led ongoing performance improvement activities. We established key elements of the CLC program through an iterative process We conducted social needs screens at 65% of eligible well-child visits from May 2017 to April 2018; 19.7% of screens had one or more positive responses. Childcare (48.8%), housing quality and/or availability (39.9%), and food insecurity (22.8%) were the most frequently reported needs. On average, 76% of providers had their patients screened on more than half of eligible well-child visits. Discussion: Our experience suggests that screening for social needs at well-child visits is feasible as part of routine primary care. We attribute progress to leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.
AB - Purpose: Social and economic factors have been shown to affect health outcomes. In particular, social determinants of health (SDH) are linked to poor health outcomes in children. Research and some professional academies support routine social needs screening during primary care visits. Translating this recommendation into practice remains challenging due to the resources required and dearth of evidence-based research to guide health center level implementation. We describe our experience implementing a novel social needs screening program at an academic pediatric clinic. Methods: The Community Linkage to Care (CLC) pilot program integrates social needs screening and referral support using community health workers (CHWs) as part of routine primary care visits. Our multidisciplinary team performed process mapping, developed workflows, and led ongoing performance improvement activities. We established key elements of the CLC program through an iterative process We conducted social needs screens at 65% of eligible well-child visits from May 2017 to April 2018; 19.7% of screens had one or more positive responses. Childcare (48.8%), housing quality and/or availability (39.9%), and food insecurity (22.8%) were the most frequently reported needs. On average, 76% of providers had their patients screened on more than half of eligible well-child visits. Discussion: Our experience suggests that screening for social needs at well-child visits is feasible as part of routine primary care. We attribute progress to leveraging resources, obtaining provider buy-in, and defining program components to sustain activities.
KW - community health workers
KW - implementation
KW - improvement
KW - pediatrics
KW - quality
KW - social determinants of health
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U2 - 10.1177/2150132719899207
DO - 10.1177/2150132719899207
M3 - Article
C2 - 31894711
AN - SCOPUS:85077340482
VL - 10
JO - Journal of primary care & community health
JF - Journal of primary care & community health
SN - 2150-1319
ER -