Use of and barriers to adopting standardized social risk screening tools in federally qualified health centers during the first year of the COVID‐19 pandemic

Abstract

ObjectiveTo describe the national rate of social risk factor screening adoption among federally qualified health centers (FQHCs), examine organizational factors associated with social risk screening adoption, and identify barriers to utilizing a standardized screening tool in 2020.Data Source2020 Uniform Data System, a 100% sample of all US FQHCs (N = 1375).Study DesignWe used multivariable linear probability models to assess the association between social risk screening adoption and key FQHC characteristics. We used descriptive statistics to describe variations in screening tool types and barriers to utilizing standardized tools. We thematically categorized open‐ended responses about tools and barriers.Data CollectionNone.Principal FindingsIn 2020, 68.9% of FQHCs screened patients for any social risk factors. Characteristics associated with a greater likelihood of screening adoption included having high proportions of patients best served in a language other than English (18.8 percentage point [PP] increase, 95% CI: 6.0, 31.6) and being larger in size (10.3 PP increase, 95% CI: 0.7, 20.0). Having higher proportions of uninsured patients (14.2 PP decrease, 95% CI: −25.5, −0.3) and participating in Medicaid‐managed care contracts (7.3 PP decrease, 95% CI: −14.2, −0.3) were associated with lower screening likelihood. Among screening FQHCs, the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) was the most common tool (47.1%). Among non‐screening FQHCs, common barriers to using a standardized tool included lack of staff training to discuss social issues (25.2%), inability to include screening in patient intake (21.7%), and lack of funding for addressing social needs (19.2%).ConclusionsThough most FQHCs screened for social risk factors in 2020, various barriers have prevented nearly 1 in 3 FQHCs from adopting a screening tool. Policies that provide FQHCs with resources to support training and workflow changes may increase screening uptake and facilitate engagement with other sectors.

The big picture for this special issue: The state of the field, article highlights, and a look into the future

“…Much of a collaborative's value comes from its ability to link services, and several papers here explore the challenges and successes different programs encountered in such efforts. First, the study by Giron and colleagues draws on a survey of Federally Qualified Health Centers to describe nationwide uptake of a standardized screening tool designed to identify patient needs that could be addressed by outside partners 23 . They find that multiple language options stand out as a factor boosting the usage of the screening tool, underscoring the importance of incorporating community voices in the context of data systems.…”

National Prevalence of Social Risk Factors at Federally Qualified Health Centers

“…Federally qualified health centers (FQHCs) deliver comprehensive primary care services to 30 million individuals with low income nationwide, irrespective of ability to pay. While recent studies show that 70% of US FQHCs collect social risk factor data, to our knowledge, there are no national studies of positive social risk factor screening rates at FQHCs. In 2022, for the first time, data were collected from all US FQHCs that captured positive screening rates for 4 important social risk factors: food insecurity, housing insecurity, lack of transportation, and financial strain.…”