Integrating Social Needs Screening and Community Health Workers in Primary Care: The Community Linkage to Care Program

Kevin P. Fiori, Colin D. Rehm, Dana Sanderson, Sandra Braganza, Amanda Parsons, Tashi Chodon, Renee Whiskey, Patrizia Bernard, Michael L. Rinke

Research output: Contribution to journalArticle

Abstract

Clinic-based social needs screening has been associated with increased access to social services and improved health outcomes. Using a pragmatic study design in an urban pediatric practice, we used logistic regression to identify factors associated with successful social service uptake. From December 2017 to November 2018, 4948 households were screened for social needs, and 20% self-reported at least one. Of the 287 households with unmet needs who were referred and interested in further assistance, 43% reported successful social service uptake. Greater than 4 outreach encounters (adjusted odds ratio = 1.92; 95% confidence interval = 1.06-3.49) and follow-up time >30 days (adjusted odds ratio = 0.43; 95% confidence interval = 0.25-0.73) were significantly associated with successful referrals. These findings have implementation implications for programs aiming to address social needs in practice. Less than half of households reported successful referrals, which suggests the need for additional research and an opportunity for further program optimization.

Original languageEnglish (US)
Pages (from-to)547-556
Number of pages10
JournalClinical Pediatrics
Volume59
Issue number6
DOIs
StatePublished - Jun 1 2020

Keywords

  • community health workers
  • implementation science
  • primary care
  • social determinants of health
  • social needs

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

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