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

Abstract

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.

Social care practices and perspectives among U.S. pediatric emergency medicine fellowship programs

“…and general pediatric faculty and trainee physicians alike. 7,14,15,[25][26][27][28][29][36][37][38][39][40] Institution name was not collected to protect respondent pri-…”

“…Generalizability of our geographically and demographically diverse national sample (Table 1) to the larger population is supported by a consistency across numerous contemporary studies demonstrating similar findings of a perceived high value, low preparedness in social care among emergency medicine. and general pediatric faculty and trainee physicians alike 7,14,15,25‐29,36‐40 …”

“…Increased social needs screening in emergency departments (ED) is supported by recent literature reporting high rates of unmet social needs, their health and wellness impact, and numerous policy statements on poverty by the American Academy of Pediatrics (AAP) 1‐13 . Pediatric emergency physicians report a high perceived value of social needs screening and intervention, yet few feel prepared to address this need largely due to lack of time and training 11,14,15 .…”

“…Increased social needs screening in emergency departments (ED) is supported by recent literature reporting high rates of unmet social needs, their health and wellness impact, and numerous policy statements on poverty by the American Academy of Pediatrics (AAP). [1][2][3][4][5][6][7][8][9][10][11][12][13] Pediatric emergency physicians report a high perceived value of social needs screening and intervention, yet few feel prepared to address this need largely due to lack of time and training. 11,14,15 Rather than looking to advocacy efforts provided by individual health care workers, there is now a call for the integration of social care-services that address health-related social risk factors and social needs-into clinical practice and training at the health care system level.…”

Integrated Health and Social Care in the United States: A Decade of Policy Progress

“…The US policy efforts have not outlined a comprehensive workforce strategy for integrating health and social care, including for the Medicaid population. The workforce used for social prescribing activities in the US has been heterogenous and include both the traditional health care workforce (e.g., doctors and nurses) and the social care workforce (e.g., case managers, social workers, and volunteers) [ 71 ]. Although research of workforce models suggest interprofessional care teams in clinical settings and community health workers in community and home-based settings could be possible in the US [ 14 ], barriers to reimbursement remain a challenge.…”