A Community Resource Navigator Model: Utilizing Student Volunteers to Integrate Health and Social Care in a Community Health Center Setting.

Sahil Sandhu,Howard Eisenson,Janet Prvu Bettger,Carolyn Crowder,Veronica Sotelo Munoz,Connor Drake,Lillian Blanchard,Jacqueline Xu

doi:10.5334/ijic.5501

Abstract

Introduction:While unmet social needs are major drivers of health outcomes, most health systems are not fully integrated with the social care sector to address them. In this case study, we describe the development and implementation of a model utilizing student volunteer community resource navigators to help patients connect with community-based organizations (CBOs). We then detail initial implementation outcomes and practical considerations for future work.Methods:We used the Ten Essential Public Health Services Framework to guide program planning of a student “Help Desk” model for a community health center. Planning included a literature review, observation of exemplar programs, development of a CBO directory, and evaluation of the center’s patient population, clinical workflows, and data infrastructure. We piloted the model for two months. After pilot completion, we reviewed patient data to understand the feasibility of the student “Help Desk” model. We utilized planning and pilot execution materials, as well as pilot data, to develop and discuss practical considerations.Results:Design and implementation complemented ongoing social needs screening and referral to CBOs by center case managers. Patients were asked if they would accept telephone follow-up by volunteers two and four weeks after the clinic visit. Of 61 patients screened, 29 patients were referred for follow-up. Ninety percent were reached at least once during the follow-up period, and 48% of patients referred reported connecting to at least one CBO. Only 27% of patients required escalation back to case managers, and no emergency escalation was needed for any patients. Students, faculty advisors, and community health center frontline staff and leadership supported the scale up and continuation of the “Help Desk” model at the community health center.Discussion:Successful implementation required multi-sectoral collaboration, well-defined scope of practice, and data interoperability. Student volunteers are untapped resources to support integrated health and social care.

Highlights

While unmet social needs are major drivers of health outcomes, most health systems are not fully integrated with the social care sector to address them
We closely studied the original “Help Desk” program that trained college volunteers to screen patients for unmet social needs, refer patients to community resources, and follow-up via phone to ensure that connections were made [28]
Of the 61 patients screened for unmet social needs by the behavioral health case managers, 29 patients were referred to four Help Desk student volunteers for follow-up (Figure 3)

Summary

Introduction

Addressing the social determinants of health (SDOH) is a critical step in reducing health disparities. While health care alone is a relatively modest contributor to health, the United States spends nearly 20% of its gross domestic product on medical care compared with only 16% on social care, and achieves poorer health outcomes than peer countries [4]. This allocation of resources persists despite recent evidence that addressing individual social needs can improve health outcomes and expenditures [5,6,7,8,9]

Methods

Results

Discussion

Conclusion