As more healthcare systems consider implementing a social determinants of health (SDoH) screening program to care for patients’ non-medical needs, we at Salud America! at UT Health San Antonio are sharing important tips in developing such a program.
Today, we’re highlighting how often patients should be screened for social needs.
While there is no evidence-based gold standard for how often screening should be conducted, lived experiences from clinics that have successfully implemented a SDoH screening program can help healthcare facilities make critical decisions in designing their own screening program.
Let’s explore the lived experiences of several of these clinics today!
Considerations in Determining Screening Frequency
Initially, it may seem most effective to screen patients for social needs at every visit.
However, screening for social needs this often may become burdensome to both staff and patients. It may even result in a backed-up appointment schedule since screening, data collection, and connecting patients to community resources takes time.
Additionally, screening for social needs at every patient visit isn’t always appropriate.
If a patient is sick, chances are they won’t appreciate being asked about their social needs when their main concern is feeling better, said Dr. Andrea Caracostis, leader of the HOPE Clinic in Houston.
“If a patient is really sick, then you probably don’t want to ask them if they’re hungry,” Caracostis explained. “Our nurses are really good about using their judgment to avoid overwhelming patients with questions when their real concern is the bumping headache they have.”
Caracostis said HOPE Clinic screen patients for SDoH issues once a year through a verbal questionnaire administered at the nurse’s station.
Nemours Children’s Health also screens patients once per year via the Nemours app, but this questionnaire is self-completed before the patient’s appointment.
No matter the details of how you screen, you may be thinking that social needs can change a lot in a year’s time.
If you’re considering screening more than once per year, the Health Information Technology, Evaluation, and Quality Center (HITEQ) offers some solutions.
One clinic HITEQ talked to screens at key appointments that take longer than 30 minutes, such as new patient visits, annual physicals, and hospital follow-ups.
Another clinic shares the workload of screening for social needs among several healthcare workers that interact with the patient throughout their visit.
Each healthcare worker asks a different set of screening questions at various points in the patient encounter and documents this data in the electronic health record. Touch points where patients are screened include the check-in counter and the patient’s room (before seeing the provider).
If the patient screens positive for certain questions, a social work staff member will fully screen the patient for social needs. Overall, this technique requires a lot of teamwork, organization, and careful consideration of who should be screeners.
Another option may include administering a short questionnaire at certain checkpoints throughout the year to confirm if patients are still struggling with social needs of which they previously screened positive.
This questionnaire could be self-administered electronically or on pen and paper. With this method, the patient doesn’t necessarily have to be in the clinic to complete the screening. Patients can use an electronic device they own or mail in their screening answers.
Alternatively, the screening could be completed through a verbal conversation with a dedicated screener either at the clinic or via a phone call.
If new social needs have developed, a follow up phone call or an appointment may be scheduled to address such needs.
Ultimately, how often you screen is up to your patient population’s needs and your clinic’s capacity for screening.
Developing and implementing a SDoH screening program takes time, patience, and a lot of resources – don’t be discouraged if you don’t have all the answers right away.
An Essential Tool in Healthcare
SDoH screening has the power to address a variety of health-related social needs for Latinos and all people.
“Health is far more than what can be provided in a doctor’s office,” said Dr. Amelie Ramirez, director of Salud America! and its home base, the Institute for Health Promotion Research at UT Health San Antonio. “In the same way that a team of doctors develops a patient treatment plan to treat cancer, a team of doctors and community services should develop a patient treatment plan that includes addressing social needs and their root causes.”
You can help address SDoH and health equity in your neighborhood, too.
Select your county and get a Health Equity Report Card by Salud America! at UT Health San Antonio.
In your report card, you will see maps, data, and gauges to compare public health issues to the rest of your state and nation.
You can email your Health Equity Report Card to local leaders to stimulate community change.
Use the data in your materials or share on social media to raise awareness about the importance of SDoH issues and SDoH screening in local healthcare facilities.
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