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.

Background and Objectives Despite high comorbidity between substance use disorders and other mental health diagnoses, there is a paucity of literature on buprenorphine treatment outcomes in outpatient mental health settings. This study aimed to identify rates and predictors of outpatient buprenorphine treatment retention in a Behavioral Health Clinic (BHC). Methods This retrospective cohort study of adults on buprenorphine used multiple logistic regression to identify clinical and demographic factors associated with 1‐ and 2‐year treatment retention and buprenorphine adherence. Results Of 321 subjects, 169 (52.6%) were retained in treatment for at least 1 year; 114 (35.5%) were retained for 2 years or more. Buprenorphine adherence was 95.8% and 97.3% for 1‐ and 2‐year retention groups, respectively. Predictors of 1‐year retention included benzodiazepine co‐prescription (adjusted odds ratio [AOR] = 2.4; 95% CI [1.30, 4.55]), having a diagnosis of other mood disorder (AOR = 3.4; [1.95, 5.98]), or nicotine use disorder (AOR = 2.4; [1.35, 4.27]). Predictors of 2‐year retention included female gender (AOR = 2.1; [1.16, 3.73]), having a diagnosis of depressive disorder (AOR = 4.6; [1.49, 14.29]), other mood disorder (AOR = 3.6; [1.88, 6.88]), or nicotine use disorder (AOR = 2.0; [1.13, 3.52]). Discussion and Conclusion During the study period, 52.7% and 35.5% of BHC patients treated with buprenorphine were retained for 1 and 2 years, respectively, comparable to the studies performed within primary care. Providing buprenorphine treatment within mental health clinics may serve patients who are already engaged with mental health providers but are reluctant to start new treatment within another treatment setting. Scientific Significance Identifying common predictors of retention can help determine which patients require additional substance use treatment support. (Am J Addict 2019;28:339–346)

Background: Patient navigation is increasingly being used by pediatric health care delivery systems to address patients’ unmet social needs. However, it is not known whether navigators working remotely can be as effective at linking families to community resources as on-site navigators. The aim of this study was to assess whether a patient navigator located on-site versus remotely is more likely to receive referrals from clinicians, successfully follow-up with patients, and assist families with enrollment in social needs resources. Methods: A patient navigator worked on-site and remotely as she divided her time between 4 federally qualified health centers (FQHCs) from May 2015 to June 2019. We conducted a 1-sample test of proportion comparing the proportion of on-site referrals made with the proportion of the week spent in each FQHC. To assess the impact of on-site versus remote referrals on number of contacts with a family, we conducted a 2-sample t test. We used chi-square testing to assess the effect of on-site versus remote status on resource enrollment. Results: Of the referrals (N = 414) made to the patient navigator, the majority were made through the electronic health record (83%) versus in person (17%) ( P < .0001). When the navigator was on-site, significantly more referrals were made than expected (45% vs 29%, P < .0001). Between remote and on-site referral groups, there was no significant difference in number of contact points (1.0 vs 1.1 points, P = .32) or in the proportion of families who received a resource (4.6% vs 5.1%, P = .31). Conclusion: Our results indicate that clinicians were significantly more likely to refer families to patient navigation if the navigator was on-site. The likelihood of having contact with the navigator and enrolling in a resource, however, did not differ between families referred when the patient navigator was on-site compared with remote.

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