Essentials in Population Health—a four-part webinar series for children's hospital leaders and teams—recently hosted the second installment, "Context Counts: How Social Determinants of Health Impact Care Delivery." Here's a glimpse into that session and the move toward this emerging approach to health care.
Christopher's asthma was flaring up again. It wasn't his first time in the emergency room with difficulty breathing. Between his mother's two jobs and Medicaid coverage, the ER was often his only means of receiving treatment. His home sits near a major highway and has ongoing problems with roaches and rodents. That, in addition to his mother's smoking habit, makes it likely this won't be his last visit to the hospital for his asthma.
This was the picture painted by Susan Choi, Ph.D., CPHQ, senior director, Quality Partnerships and Initiatives of the Health Care Improvement Foundation in Philadelphia. And while Choi presented "Christopher" as a hypothetical case to demonstrate the profound impact of social determinants of health (SDOH), the story is commonly seen by health care professionals around the country.
Defining social determinants of health
The CDC defines SDOH as "conditions in the places where people live, learn, work and play that affect a wide range of health risks and outcomes." That goes beyond just their physical environment to encompass factors like education level, socioeconomic status and social support network. Choi likened it to an iceberg, where the information traditionally available to care practitioners is the visible tip of the iceberg, while the vast majority of background information that makes up a person's health—the social determinants of health—is the massive base of ice lying below the surface.
"The opportunity that exists for children's hospitals to improve population health by addressing social determinants really has the potential for far-reaching effects," Choi says. "Early life intervention is important."
But how do children's hospitals go beyond their walls to proactively make a difference in the health of their communities? Choi offers four strategies:
1. Build awareness internally
As simple as it may sound, spreading awareness of SDOH's impact on overall health is vitally important. This means gaining buy-in across the organization and creating champions for the cause to build understanding. The good news: You don't have to face this task alone. There are many tools and resources to aid in this process, such as the CDC Foundation's Health and Well-Being for All meeting-in-a-box, which creates interactive experiences for leaders, providers and staff to gain a better understanding of the impact of SDOH and how they can help address it.
2. Be curious
There's more to patients than when they present at the hospital or office. It's important to systematically assess social circumstances with patients to determine possible areas of need. This should include deliberate planning to determine how to administer the screening—meaning, which patient visits, by which staff and at what frequency. This may likely appear to be a paradigm shift for patients, so ensure the inquiries are made with sensitivity and patients are given context regarding your questions.
Choi says it's also important not to be deterred by the scope of the effort. "The needs that we're trying to address can seem quite overwhelming, and you may not know where to begin," Choi says. "That can be paralyzing, so see what you can do that's small and may not require too much of an initial financial outlay."
3. Build your resource network
A lot of things can be changed in a short amount of time when working with community partners. Once you've identified areas of patient need, it's important to have a network of resources in place to which you can refer patients. For example:
- The Children's Advocacy Project (CAP4Kids): A program for health care providers, social workers, child advocates and parents and teens to find reliable, up-to-date information on community resources to help improve and enhance the lives of children and families
- United Way's 211 service: Community resource specialists connect users with local organizations providing a wide range of critical services, including food and nutrition programs, housing assistance, employment and education resources and health care information
Building partnerships with community enables a more personal touch when it comes to referrals—think warm handoffs and in-person support versus just giving a name and number. They also provide a more thorough system of follow-up and ongoing evaluation of referred patients.
4. Head upstream with preventive approaches
Consider exploring upstream solutions that involve intervening on SDOH—the root cause of many health problems—to reduce unmet social needs at the community level. As an example, Choi cites a study conducted by Nobel Prize-winning economist James Heckman that showed an upstream economic benefit to the community of $8.74 for every dollar invested in early education for disadvantaged children.
For children's hospitals, this can take many forms, such as investing in or partnering with programs that promote early childhood education, affordable housing or safe spaces for outdoor exercise.
To learn more, listen to the replay of the "Context Counts: How Social Determinants of Health
Impact Care Delivery" webinar or view the whitepaper.
These webinars are part of the Essentials in Population Health, an educational series through CHA that explores changes under health care reform and how to operationalize a population health strategy.
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