SDOH screening differs widely among community health centers

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While capturing social determinants of health data is increasingly recommended in clinical guidelines, there is a lack of standard screening and referral practices among Boston community health centers.

A study of SDOH screening and referral in 13 of Boston’s community health centers finds a wide variation in practice. Researchers identified 16 domains and 78 dimensions of SDOH, but housing was the only domain screened in all participating CHCs.

“Our findings highlight a range of SDOH domains and dimensions that are being screened for, without clear consensus for a single screening tool or agreement on particular screening questions,” according to the authors, who reported that the most frequently screened domains included housing, followed by material hardship and mental health—all of which are in alignment with national recommendations.

However, they contend that “despite this broad agreement between Boston CHCs and national policy makers, few validated screening questions exist, and therefore SDOH domain alignment does not necessarily correlate to comparable screening items.”

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In addition, the study revealed a lot of variation in provider and staff opinions about what helps or hinders the process for SDOH screening and referral.

“There was little agreement about whether provider perspectives, workflow, prior experience, site resources and staffing, and sustainability were barriers or facilitators for implementing the screening, because they were all seen as barriers and facilitators depending on the respondent,” says senior author Mari-Lynn Drainoni, research professor of health law, policy and management at Boston University School of Public Health.

“This suggests that tailoring processes and including staff and providers in implementation decisions may overcome issues with time, work flow, and knowledge,” adds Drainoni.

Further, the authors make the case that “as national guidelines and professional organizations recommend adoption of SDOH screening and referral in routine clinical practice, it will be important to enable tailoring for clinical sites to implement SDOH screening and referral practices to their strengths or perceived patient needs.”

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