Implementing a Social Determinants Screening and Referral Infrastructure During Routine Emergency Department Visits, Utah, 2017–2018

Abstract

What is already known on this topic? Self-management of health conditions does not occur in isolation but in the context of patients' physical, social, and family environment. What is added by this report? Implementation efforts should emphasize universal social screening during routine emergency department visits, with careful evaluation for potential bias and stigma among staff, providers, and patients. What are the implications for public health practice? Universal screening, referral, and aggregation of clinical and social resource data are possible by using existing resources, but training and the views of those engaged in screening and referrals need to be carefully considered in efforts to implement universal social needs screening.

Integrating social determinants of health screening and referral during routine emergency department care: Evaluation of reach and implementation challenges

“…Themes from registration staff included 1) using professional intuition to decide whether, when, and who to screen; 2) determining the appropriateness of staff being the "right" group to own this work ow; and 3) determining if the chosen screener is the "right" tool for the ED system. There is also strong evidence to supporting our hypothesis from our early pilot work that motivation (self-determination) plays a central role in adoption practices among front-line staff (Wallace et al, 2020). Staff who communicated that they felt like important members of the healthcare team, agents of change, or their role served a bigger purpose in the lives of patients -or intrinsic motivation -were more likely to integrate social needs screenings.…”

“…In a recent study, Tong (2018) studied 123 patients, 85% of whom screened positive for social needs, but only 3% wanted help with those needs. Similarly, in a preliminary study conducted by this research team (Wallace et al, 2020) 52% with needs wished referral after screening. Collectively, these nding suggest that a key issue for research is to understand the limited reach of SDOH interventions, and whether and how social needs screening impacts therapeutic relationships (Hsu et al, 2019;Wallace et al, 2020).…”

“…The process used to develop and integrate the early iterations of the social needs screener addressed key pragmatic measures for implementation research. (Glasgow, 2013;Stanick et al, 2018, Wallace et al, 2020 Methods…”

“…Previous work established that, on average, patients are able to complete the 10 dichotomous yes-no social needs questions in less than 80 seconds (Wallace et al, 2020). Immediately following the screening questions, patients were asked to share their preferred contact information if they wished to be contacted by a Utah 211 information specialist within 48 hours of ED discharge.…”

“…Staff Perspectives. In iterative pilots (Wallace et al, 2020), staff communicated some resistance and skepticism whether the scope of their role should be expanded to incorporate the social needs screener. In order to better understand the context and perspective of staff, in-depth, iterative interviews and observations were conducted with 8 registration team members, representing approximately one-third of staff engaged in screening.…”