Three things to consider before you start screening for social determinants of health

Family physicians see firsthand how social needs (or “social determinants of health”) can complicate a patient’s health issues. For example, a patient who lacks safe housing, reliable transportation, or adequate food resources may be more likely to struggle with medication adherence or showing up for visits.

Screening for social determinants of health can be an effective way to help these patients, but before you implement this change in your practice, think through the following issues.

1. Do you have an effective screening tool? There is no single preferred screening tool recommended for social determinants of health, but several good options exist:

• The Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE), which is used by organizations such as the National Association of Community Health Centers,
• The Social Needs Screening Tool (short form) from the EveryONE Project of the American Academy of Family Physicians,
• The Accountable Health Communities Health-Related Social Needs Screening Tool (AHC-HRSN) from the Centers for Medicare Medicaid Services.

2. Who will do the screening, how often, and at what point in the workflow? Physicians can become overwhelmed when asked to incorporate “just one more thing” to their daily workflow, so social determinants screening must not be the sole responsibility of the physician. Instead, it should be a team-based effort. For example, the medical assistant could be responsible for administering an annual screening after rooming the patient and entering the results in real-time as social history in the electronic health record (EHR), which the physician will then review with the patient. If a patient is currently experiencing multiple social issues, the physician would decide which issue to address first, document the care plan and follow-up plan in the EHR, and instruct the medical assistant to handle the referral details with the patient. Other workflow options would be to use nonclinical staff to conduct the screening either before or after the visit, or have patients complete a self-assessment while they wait.

3. What will you do with the results? For screening to be effective, the practice must be equipped to address any identified needs. Consider developing a list of referral resources to connect patients to needed services in the community, such as meal programs or utility assistance programs, and partner with local agencies who can help address the needs most prevalent in your patient population.

Read the full FPM article: “A Practical Approach to Screening for Social Determinants of Health.”