As the health care industry evolves, there's greater awareness of what factors contribute to health. Social determinants impact 20% of health, and children’s hospitals are tasked to identify and address social needs to improve patient health outcomes.
Responding to member inquiry, Children’s Hospital Association set out to define tactics implementing social needs screening, the community linkages needed and the inherent challenges they present. A representative sample of children’s hospitals contributed to this snapshot of where screening for social needs stands, and what questions must be answered to bring the practice to scale throughout children's hospitals.
The following are key excerpts from the paper.
Screenings: find a tool to understand the whole patient
It’s been well over a decade since literature on the importance of addressing social determinants of health (SDOH) began to rise in prevalence. Defined by the Centers for Disease Control (CDC) as “conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes,” SDOH can include things like food scarcity/insecurity, homelessness or unsafe housing conditions, unemployment, and lack of access to care.
Recognizing the profound impact of these factors, health care providers realize that they can no longer solely focus on the medical needs of their patients. While some children's hospitals work within their community to address these issues on a population level, others are working to address the social needs of individual patients and families.
Children’s hospitals have an added level of complexity when trying to address a patient's social needs, as the needs and context extend beyond the patient to include the family. Children with unmet social needs are familiar to those in the hospital, presenting as non-compliant, with frequent visits to the emergency department for inability to control chronic conditions or issues like failure to thrive.
Additional signs often seen are stressed parents and/or children, an apparent lack of engagement in care or prolonged illness from persistent minor health problems. The consequences of these issues limits the impact of the medical care being provided, affecting the family’s engagement and the child’s overall health.
A starting point: build community connections
One reason many hospitals don’t currently screen for social needs is the uncertainty of how to address them when they are found. To overcome this, respondents suggest a good starting point for building a successful screening process inside the hospital is to establish community relationships outside the hospital. These relationships need to go beyond typical coalition building.
It’s important to understand, and assess, the depth and breadth of resources provided by community and social service organizations in their catchment area, as well as their capacity for referrals.
Tools: Select the right questions
For many, the issue of what comes first—the screener or the resource—is a tough one. While hospitals have taken different approaches, most report they don’t want to ask social needs questions until they have a way to do something with that information. That’s why the topic of building community connections appeared first in this paper. Once those are in place, hospitals can then move to determining which screening tool to use.
The following list provides a sampling of the screeners and referral platforms member hospitals are referencing. Screeners typically just refer to the set of questions being asked, while referral platforms help identify community resources and may involve care management
Implementation: Starting small to make big changes
Building community connections takes time, effort and strategy. Selecting the best tool for your environment requires the same approach, followed by implementation of the new process. Questions quickly arise when the discussion shifts to implementation:
- How do you institute another process without disrupting clinic flow?
- How does social need screening interact with the other screenings already taking place?
- Do you automate the process on tablets or computers or use pen and paper?
- Have it done person-to-person?
- Who talks to the family about resources for a positive screen?
- Do you institute a process that is referral only, or do you want to close the loop and know services were received?
Moving past the why to improve health outcomes
Collaboration between clinicians and community to improve care for children can be found in the origin story of children's hospitals. That collaboration remains active today, and in many instances, is growing as evidence demonstrates the importance of addressing social needs to achieve positive medical outcomes.
Hospitals are large, complex institutions focused on providing high-quality medical care. But without addressing the other risk factors impacting a patient’s life, medical care can only go so far. Initially, the conversations were focused on why changing the care delivery model from sick care to holistic health was important.
The questions throughout the paper can support your organization’s efforts to develop strategies that effectively address social needs. The hospital examples can connect you with colleagues who found ways to integrate screening tools and uncover factors contributing to poor health outcomes.
"Social Determinants of Health: Know What Affects Health," Centers for Disease Control and Prevention, accessed March 20, 2018.
“Context Counts: How Social Determinants of Health Impact Care Delivery,” Children's Hospital Association, published October 27, 2016.