Considering the impact of social risk screening and referral interventions on adults in the safety-net: a mixed methods approach to health system perspectives

Abstract

The United States’ healthcare system has focused on identifying determinants of negative health outcomes through the standardized assessment of unmet social needs, termed as ‘social risk screenings.’ Prior research has established different health sector stakeholders’ perceptions regarding the acceptability and utility of these screenings, but there is limited evidence regarding the impact of social risk screening on patient health outcomes. Evidence is especially limited on the impact of social risk screening on persons with mental health or cancer diagnoses, despite high levels of reported unmet social needs in these populations. Additionally, an important consideration in the development and use of social risk screens lies in the potential disconnect between the conceptualization of social needs from the provider versus patient perspectives – a disconnect that may be driven by the ‘medicalization’ of the complex contextual factors that shape one’s social determinants of health. The goal of this dissertation is to generate evidence on the experience of clinical providers charged with administering and responding to social risk screenings, how screenings are associated with service use for patients with mental health needs, and patients’ own experiences of and reactions to being asked about social needs and the resultant impacts on the patient-provider interactive relationship. This dissertation contains three chapters that explore the impact of social risk screening on the adult safety net from multiple health sector perspectives. The first study, Patient Navigator and Clinical Team Perceptions on Addressing Unmet Social Needs: Results from a Breast Cancer Patient Navigation Intervention Study, utilizes primary data collection to characterize how patient navigators and clinical teams seek to screen and address unmet social needs for their patients via a social risk screening and referral intervention embedded in breast cancer care sites across Boston, MA. The second study, The Association between Social Needs Screening and Health Care Utilization Among Adults with Mental Health Needs in the Safety-Net, utilizes secondary data analysis of patient electronic health record data to examine the association of social risk screening on healthcare utilization for patients with mental health needs. The third study, Patient Perceptions and Consideration of Unmet Social Needs whilst Accessing Medical Services: A Qualitative Study utilizes primary data collection to understand the ambulatory care patient experience of responding to social risk screens, how patients prioritize different unmet social needs in light of seeking care, and the impact of social risk screening on the patient-provider relationship