Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric Patients

Byhoff, Elena; Garg, Arvin; Pellicer, Michelle; Diaz, Yareliz; Yoon, Grace; Charns, Martin P.; Drainoni, Mari-Lynn

doi:10.3122/jabfm.2019.03.180276

Cited by 50 publications

(66 citation statements)

References 30 publications

(26 reference statements)

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“…Three of the clinics were randomized to implement the WE CARE model, while the remaining three continued with their standard of care (i.e., no WE CARE or SDOH screening). 8 The study and methods were approved by the Boston University Medical Campus Institutional Review Board.…”

Section: Methods and Settingmentioning

confidence: 99%

“…Our team had previously implemented the WE CARE model, a SDOH screening and referral intervention, in community health centers (CHCs) and pediatric clinics. 4,8 For this study, we explored how CHC staff responded to the WE CARE model and how they implemented WE CARE activities into daily practice. Using key informant qualitative interviews, we asked pediatric, CHC staff and clinicians about their experiences with the WE CARE model, the challenges they faced with the model, and how it affected their clinical practice.…”

Section: Background and Significancementioning

confidence: 99%

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Implementing Social Determinants of Health Screening at Community Health Centers: Clinician and Staff Perspectives

Herrera

Brochier

Pellicer

et al. 2019

J Prim Care Community Health

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Purpose: Screening for social determinants of health (SDOH) during primary care office visits is recommended by pediatric and internal medicine professional guidelines. Less is known about how SDOH screening and service referral can be successfully integrated into clinical practice. Methods: Key informant interviews with 11 community health center (CHC) clinicians and staff members (medical assistants and case managers) were analyzed to identify themes related to integrating a SDOH screening and referral process (augmented WE CARE model) into their workflow. Results: CHC clinicians and staff believed the augmented WE CARE model benefited their patients and the CHC’s mission. Most clinicians found the model was easy to implement. Some staff members had difficulty prioritizing the nonclinical intervention and were confused about their roles and the role of the patient navigator. The eligibility requirements and time needed to access local SDOH resources frustrated clinicians. Discussion: SDOH screening and referral care models can help support the mission of CHCs by identifying unmet material needs. However, CHCs have organizational and administrative challenges that successful interventions must address. CHCs need clinical champions for SDOH models because the screening and follow-up processes involve clinical staff. Additional support for SDOH models might include piloting the SDOH screening model workflow and formalizing the workflow before implementation, including the specific roles for clinicians, staff, and patient navigators.

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Section: Methods and Settingmentioning

confidence: 99%

Section: Background and Significancementioning

confidence: 99%

Implementing Social Determinants of Health Screening at Community Health Centers: Clinician and Staff Perspectives

Herrera

Brochier

Pellicer

et al. 2019

J Prim Care Community Health

Self Cite

View full text Add to dashboard Cite

show abstract

“…Three studies described using both selfadministered and clinician-administered screening. 55,58,70 For example, in 1 model, front desk staff provided paper 31 Safety-net urgent care clinic 27 Adults with depression 31 Community health center 30,31 Women with depression 32 Women's health clinic 32 Multi-setting 26,28 Difference-indifference/quasiexperimental Urban 34 Academic primary care clinic 34 Adults 34 Not mentioned 33 Integrated health system 33 Adults with predicted high utilization 33 Pre-post with control Urban [35][36][37] Academic primary care clinic 35- 60 Elderly Hispanic adults 57 Community health center/ federally qualified health center 40,45,46,61,68,69 Pregnant women 40 Black women 49,50 Women with depression 71 Academic-federally qualified health center 39,57,62,66 Multiple populations 45,55 Unspecified primary care clinic 64,67 Not mentioned 41,60,63 Multi-primary care setting 49,50,55,58 Quality improvem...…”

Section: Screening and Responding To Unmet Needsmentioning

confidence: 99%

Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review

Sandhu

Eisenson

et al. 2021

J Prim Care Community Health

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Objectives While healthcare organizations increasingly aim to address the social determinants of health (SDOH) in the clinic setting, there is little guidance on which staff are best equipped to assume this role. The present study is a scoping review of the peer-reviewed literature to characterize workforce models used to screen for and respond to patients’ unmet social needs in ambulatory settings. Methods Four online databases were used to identify papers published until February 2021. Eligible articles were original research studies or systematic reviews that described the implementation of a standardized assessment for multiple SDOH domains and resulting activities to respond to individual patient needs (eg, referral to community resources) in ambulatory care settings. Results Of the 1569 articles identified, 65 met study eligibility criteria. Majority of studies had observational study designs (11% were randomized control trials). For screening-related activities, more articles reported using traditional healthcare staff (51%), such as medical providers, medical assistants, and front-desk staff, than social care staff (32%), such as social workers and student volunteers. In contrast, for response-related activities, more articles reported using social care staff (88%) than traditional healthcare staff (60%). While we found wide variations in specific team configurations and training for the roles, social care staff generally provided more intensive forms of assistance than traditional healthcare staff. Conclusion While this review demonstrates the breadth of models for building or deploying a workforce to integrate health and social care, it also identifies the need for rigorous research on workforce development, implementation, and effectiveness.

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“…In one of the few studies to ask patients about their expectations regarding social risk screening, we find evidence that more than half of patients (64.5%) do not want help addressing their social risk from clinical staff. 20 We additionally see this viewpoint supported in work by Byhoff et al, 21 which reveals that although patients believe social risk screening is necessary and acceptable, they do not expect their health care teams to address the reallife social challenges they face. These findings underscore the importance of health care systems identifying solutions for needs that patients want, will accept and are in practical reach.…”

Section: Discussionmentioning

confidence: 76%

Eliciting the Social Determinants of Cancer Prevention and Control in the Catchment of an Urban Cancer Center

et al. 2021

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Objective: The objectives of this study were two-fold: 1) to engage community stakeholders in identifying the top three social determinant of health (SDOH) barriers to the early detection and treatment of cancer in their respective communities; and 2) to develop a tailored plan responsive to the potential social risks identified within the catchment of an urban academic cancer center.Methods: Stakeholders from four neighborhoods in Brooklyn, New York with disproportionate cancer burden were recruited; the nominal group technique, a semi-quantitative research method, was used to elicit the SDOH barriers. Responses were consolidated into categories and ranked by points received.Results: 112 stakeholders participated in four community-based meetings. The SDOH categories of economic stability, education, and community and social context were identified as the top barriers. The themes of lost wages/employment, competing priorities, and the inability to afford care embodied the responses about economic stability. The domain of education was best described by the themes of low health literacy, targeted health topics to fill gaps in knowledge, and recommendations on the best modalities for improving health knowledge. Lastly, within the category of community and social context, the themes of stigma, bias, and discrimination, eroding support systems, and cultural misconceptions were described.Conclusion: The implications of our study are three-fold. First, they highlight the strengths of the nominal group technique as a methodology for engaging community stakeholders. Second, our analysis led to identifying a smaller set of social priorities for which tailored screening and practical solutions could be implemented within our health care system. Third, the results provide insight into the actual types of interventions and resources that communities expect from the health care sector.Ethn Dis. 2021;31(1):23-30; doi:10.18865/ ed.31.1.23

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Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric Patients

Cited by 50 publications

References 30 publications

Implementing Social Determinants of Health Screening at Community Health Centers: Clinician and Staff Perspectives

Implementing Social Determinants of Health Screening at Community Health Centers: Clinician and Staff Perspectives

Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review

Eliciting the Social Determinants of Cancer Prevention and Control in the Catchment of an Urban Cancer Center

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