Health-Related Social Needs Research Articles

Patient engagement in a community-partnered hybrid health-related social needs navigation intervention for adolescents and young adults with cancer (AYA-NAV).

173 Background: Adolescent and young adult (AYAs) cancer survivors experience high rates of financial toxicity (FT), which is associated with poorer health outcomes. FT may disproportionately affect AYAs with unmet health-related social needs (HRSN), such as food or housing insecurity. Needs navigation may be an effective intervention to reduce financial distress, however, engagement has been a challenge in prior adult-directed interventions. We hypothesize that a hybrid navigation delivery model with community organization support and digital delivery will reduce financial distress and improve health outcomes. In a pilot study of AYA-NAV, an AYA-directed needs navigation intervention, we report patient engagement among participants. Methods: Eligible AYAs were 15-39 years old, Spanish- or English-speaking, receiving curative-intent treatment for cancer, and screened positive for FT (Comprehensive Score of Financial Toxicity < 22) or unmet HRSN (food, housing, transportation, or utilities insecurity). Participants were referred for a consultation with the Patient Advocate Foundation (PAF), a national organization that provides case management and navigation support for people facing life limiting illness. At month 1, participants were referred to findhelp.org, a digital platform of comprehensive resources to facilitate resolution of unmet HRSN. Monthly check-ins were conducted by the study team to assess acceptability, intervention fidelity, and provide additional navigation support. We plan to enroll 30 participants on this study. Results: Of 19 AYAs that completed screening to date, 13 met criteria for FT or unmet HRSN; 13 (100%) agreed to AYA-NAV participation. To date, of 46 check-ins initiated by the study team, 33 (72%) were completed. All AYAs connected with the study team at least once during the 6-month duration of the study by text, phone, and/or in-clinic. Ten out of 13 (77%) participants reported that they spoke with a PAF case manager, and 7 (70%) of those said it was helpful. If the patient was unable to connect with PAF, more than half (55%) requested to be reconnected during a monthly check-in. Eight of the 13 (62%) participants visited findhelp.org; 6 (75%) of those found the digital platform to be helpful. Most patients referenced the high usability of findhelp.org, and 55% stated they connected to community resources via findhelp.org. Patients qualitatively reported challenges to intervention participation including medical complications, scheduling conflicts, and work commitments. Conclusions: Preliminary data demonstrate high patient engagement and intervention fidelity during a pilot feasibility study of AYA-NAV. Flexible modes for data collection and intervention delivery are important to inclusion of and retention of AYAs in hybrid navigation delivery models. Clinical trial information: NCT06072833 .

A Proactive Telephonic Outreach Program to Address Unmet Social Needs of Children in Immigrant and Refugee Families at a Federally Qualified Health Center.

We developed a telephonic outreach and care coordination program for children in immigrant and refugee families (CIRF) at a federally qualified health center (FQHC) in North Carolina to address unmet health-related social needs (HRSN). Participants were recruited between December 2020 and October 2021. Eligible children were ages 0-5, non-English speaking, and were seen at the FQHC in the 2years prior. A bicultural/bilingual case manager completed telephonic outreach to caregivers of participants with HRSN screening. Bilingual patient navigators made follow-up calls to assess connection to resources and to develop strategies for addressing unmet needs. Three hundred forty-two families received outreach; 212 (62.0%) completed the baseline questionnaire. The majority (N = 160, 75.5%) completed at least one follow-up. The majority (N = 186, 88.1%) were Spanish-speaking, and over two-thirds (N = 149, 70.3%) were uninsured. Most participants had between 3-5 HRSNs identified (N = 121, 57.1%); "employment" (n = 158, 74.5%) and "food" (n = 138, 65.1%) were the most common. Despite repeated assistance, the majority of participants struggled to link to a community resource for their highest priority need (N = 123, 78.3%). Proactive phone-based HRSN screening may be a feasible and effective intervention to facilitate the identification of social needs for CIRF. The delivery of the intervention in languages other than English may have further contributed to program acceptability. Despite program feasibility and acceptability, community-level barriers to the resolution of HRSNs persist. While similar care coordination models can be considered to identify the high burden of unmet HRSN among CIRF, addressing the limited capacity of community-based resources for this population will be a critical component to ensuring the sustainability of such programs.

Program Implementation Strategies Associated With Reduced Acute Care Utilization for Medicaid Beneficiaries in California's Whole Person Care Pilot Program.

Public health care policymakers and payers are increasingly investing in efforts to address patients' health-related social needs (HRSNs) as a strategy for improving health while controlling or reducing costs. However, evidence regarding the implementation and impact of HRSN interventions remains limited. California's Whole Person Care Pilot program (WPC) was a Medicaid Section 1115 waiver demonstration program focused on the provision of care coordination and other services to address eligible beneficiaries' HRSN. In this study, we examine pilot-level variation in impact on acute care utilization and identify factors associated with differential outcomes. The majority of pilots reduced emergency department (ED) visits for enrollees relative to matched controls; however, only four pilots reduced both ED visits and hospitalizations. Coincidence analysis results highlight the importance of cross-sector partnerships, field-based outreach and engagement, and adequate program investment in differentiating pilots that reduced acute care utilization from those that did not.

Sharing Social Needs Data Across Sectors: Lessons From the Centers for Medicare and Medicaid Services Innovation Center's Accountable Health Communities Model.

Health-related social needs (HRSNs), like unstable housing, inability to afford utilities, food insecurity, unreliable transportation, and lack of personal safety, profoundly affect people's health and well-being. Between 2017 and 2022, awardees of the Accountable Health Communities Model (AHC) addressed the health-related social needs of Medicare and Medicaid beneficiaries through screening, referral, and community navigation services. Using and sharing HRSN data between clinical and community partners was a critical component of these efforts. This article shares findings from focus groups and interviews with 19 AHC awardees and seven of their partners. It explores the following:1. Whether sharing HRSN data with clinical partners informed clinical care2. Successes and challenges related to sharing data with community-based organizations (CBOs) and clinical partners3. How awardees collected and used HRSN data to advance health equityHalf of awardees interviewed documented HRSNs in electronic health records and shared aggregated HRSN data with CBOs. HRSN data enabled some clinicians to adjust patient care, although most were uncertain about how to do so. Participants described how sharing HRSN data with communities informs program and funding priorities to improve equity. However, CBOs noted that they had limited incentive to participate in data-sharing platforms. Our work highlights opportunities to provide guidance to clinicians on how to use HRSN screening results in care, standardize HRSN screening results in electronic health records, and co-create data-sharing initiatives with CBOs and patients to ensure meaningful participation.

Beyond the Stroke Center Certification Standards: Focusing on Patient Health-related Social Needs (HRSN) in Stroke

Introduction/Background: Medical care and rehabilitation are critical components of stroke recovery. However, recent attention to social determinants of health (SDOH) and more recently, health-related social needs (HRSN) highlight numerous non-health related needs that play a pivotal role in a survivor’s well-being, quality of life and reintegration into the community following a critical illness like stroke. These needs, often overlooked, are essential to optimal recovery, hospital readmission avoidance, and long-term well-being. This article differentiates HRSNs from SDOH and discusses how governmental and regulatory agencies are taking steps to compel hospital providers to address these needs. HRSNs may offer a pathway for individual providers and program-level interventions that could impact patient outcomes. Stroke programs are uniquely positioned to work with their hospital system to address HRSNs in their patient population to improve outcomes.

Social Needs Screening Via Electronic Tablet in Pediatric Primary Care.

(1) Assess whether health-related social needs (HRSN)/caregiver mental health concerns (CMHC) disclosure rates differ when screening questions are administered on paper versus electronic tablet. (2) Evaluate whether changes in need identification alters referral rates to social work and our medical-legal partnership (MLP). We conducted a retrospective review of HRSN/CMHC screening in publicly insured patients 0-18 years presenting for well-child visits in three primary care practices. Our primary outcome was HRSN/CMHC disclosure rate, comparing the proportion of positive HRSN/CMHC screens during the 11 months before and after screening modality change. Generalized estimating equations and interrupted time series (ITS) were used to assess changes over time. Mediation analyses assessed the indirect effect of HRSN/CMHC disclosure during the electronic screening period on changes in referrals to social work/MLP. A total of 16,151 patients had paper-based HRSN/CMHC screens; 13,019 patients had electronic screens. Overall, 11% of paper-based screens identified ≥1 need, compared to 26% of electronic screens (p<0.001). All three practices saw an increase in disclosure rate after transition from paper to electronic screening (odds ratio [OR] range 1.54 to 4.24). Using ITS, two of three practices had significantly increased odds of need disclosure with electronic screens compared to paper (OR 3.0, 95% confidence interval [CI] 2.5, 3.6; and OR 1.7, 95%CI 1.2, 2.4). Increased HRSN/CMHC disclosure rates from transitioning to electronic screening mediated increased referrals to social work/MLP. Electronic screening was associated with an increased HRSN/CMHC disclosure rate compared to paper, which led to increased referrals to social work/MLP.

Community-Specific Video Training for Primary Care Settings: Increasing Capacity and Motivation to Address Food Insecurity.

Food insecurity (FI) is the most common health-related social need (HRSN) and is frequently identified in primary care through screening and referral. However, health care workers often do not have the knowledge, motivation, capability, or opportunity necessary to discuss FI with patients in patient-centered ways. An educational module for health care workers on FI was created using user-centered design and tested with health care workers, using the COM-B model as an evaluation framework. Watching the module's video increased participant knowledge, capability, and motivation to address FI with patients. This preliminary pilot study suggests that simple training modules could help with the effectiveness of efforts to address HRSNs, such as FI, by increasing health care workers' capacity to discuss, screen, and refer patients. Findings warrant expanded studies to assess the effectiveness of such modules on patient-level outcomes. This type of educational module on FI or other HRSNs holds promise as a time- and cost-efficient strategy for improving screening and referral processes, ultimately alleviating FI for more patients and improving health outcomes.

COVID-19 Disruptions to Social Care Delivery: A Qualitative Study in Two Large, Safety-Net Primary Care Clinics

BackgroundSocial care integration refers to the incorporation of activities into health systems that assist patients with health-related social needs (HRSNs) that negatively impact the health outcomes of their patients, such as food insecurity or homelessness. Social care integration initiatives are becoming more common. The COVID-19 pandemic strained health systems while simultaneously increasing levels of unmet social needs.ObjectiveTo describe the effects of the COVID-19 pandemic on established social care delivery in a primary care setting.DesignWe used qualitative semi-structured interviews of stakeholders to assess barriers and facilitators to social care delivery in the primary care setting during the COVID-19 health emergency. Data was analyzed using a hybrid inductive/deductive thematic analysis approach with both the Consolidated Framework for Implementation Research (CFIR) and the Screen-Navigate-Connect-Address-Evaluate model of social care integration.SettingTwo safety-net, hospital-based primary care clinics with established screening for food insecurity, homelessness, and legal needs.ParticipantsSix physicians, six nurses, six members of the social work team (clinical social workers and medical case workers), six community health workers, and six patients (total N = 30) completed interviews.ResultsFour major themes were identified. (1) A strained workforce experienced challenges confronting increased levels of HRSNs. (2) Vulnerable populations experienced a disproportionate negative impact in coping with effects of the COVID-19 pandemic on HRSNs. (3) COVID-19 protections compounded social isolation but did not extinguish the sense of community. (4) Fluctuations in the social service landscape led to variable experiences.ConclusionsThe COVID-19 pandemic disrupted established social care delivery in a primary care setting. Many of the lessons learned about challenges to social care delivery when health systems are strained are important considerations that can inform efforts to expand social care delivery.

Patient-Portal Compared with Supplemental In-Office Tablet Screening for Health-Related Social Needs in Primary Care

BackgroundScreening for health-related social needs (HRSN) has become more widespread but the best method of delivering the screening tool is not yet known.ObjectiveDescribe HRSN screening completion rate, specifically portal-based and in-person tablet-based screening.DesignCross-sectional retrospective observational study.ParticipantsAdults age 18 or older who had a non-acute primary care visit at one of three internal medicine primary care clinics at a large, urban, academic medical center between July 2022 and July 2023.Main MeasuresWe identified the proportion of individuals who were screened using the HRSN questionnaire, whether screening was completed by patient-portal or tablet, as well as the degree of burden of HRSN. Using the electronic health record, we explored associations between sociodemographic characteristics and HRSN attributes.Key ResultsOur study included 24,597 patients, of whom 37% completed the HRSN questionnaire. A smaller proportion of Black/African American patients and those with Medicaid insurance completed the questionnaire, yet they comprised a greater percentage of those who screened positive for unmet HRSN (p ≤ 0.001). Most patients completed the questionnaire by patient-portal (86.1%) compared with in-office tablets (14.0%). A larger proportion of those who completed screening by tablet screened positive for HRSN. Of all patients screened, 21.8% were positive for an unmet HRSN and 11.5% had more than one unmet HRSN.ConclusionsA majority of patients are not being screened for HRSN and results illustrate disparities when screening patients for HRSN through portal-based compared with supplemental in-office tablet-based screening. Prevalence of unmet HRSN varied by demographics such as race and insurance status.

Screening for Health-Related Social Needs and Financial Toxicity Among Patients With Cancer Treated With Radiation Therapy: Findings From a Quality Improvement Project

IntroductionFinancial toxicity is common among patients with cancer, as are co-occurring health-related social risks (HRSRs). There is limited evidence to support best practices in screening for HRSRs and financial toxicity in the cancer context. This analysis sought to understand variations of identified needs based on treatment course using data from a large screening program. MethodsThis 2022 to 2023 screening quality improvement program included four services (breast, gastrointestinal, gynecologic, thoracic) at an urban comprehensive cancer center. The Comprehensive Score for Financial Toxicity measured financial toxicity. Patients completed an HRSR checklist documenting food, housing, medication, or transportation insecurity and financial borrowing practices. Differences were evaluated by treatment course (radiation therapy [RT] versus other treatment and RT plus chemotherapy versus other treatment). ResultsScreening surveys were sent to 70,983 unique patients; 38,249 completed a screening survey (54% response rate). Of responders, 4% (n = 1,686) underwent RT in the 120 days before their survey, and 3% (n = 1,033) received RT in combination with chemotherapy. Overall, patients receiving RT had lower unadjusted Comprehensive Score for Financial Toxicity scores, indicating worse financial toxicity. The proportion of patients receiving RT reporting unmet transportation (15% versus 12%, P < .001) and food (13% versus 11%, P = .02) needs was significantly higher than for patients not receiving RT. More patients receiving RT borrowed money than did patients not receiving RT (17% versus 15%, P = .02). In multivariable models, RT (alone or in combination) was associated with worse financial toxicity and transportation difficulties. ConclusionsScreening for financial toxicity and HRSR is possible at a large cancer center. Patients receiving RT have higher transportation insecurity and worse financial toxicity compared with those receiving other treatments. Tailored intervention throughout the treatment trajectory is essential.

Hospitals' collection and use of data to address social needs and social determinants of health.

To assess differences in hospitals' collection and use of data on patients' health-related social needs (HRSN) by availability of programs or strategies in place to address patients' HRSN and social determinants of health (SDOH) of communities. The 2021 American Hospital Association Annual Survey and 2022 Information Technology (IT) Supplement. This cross-sectional study described hospitals' engagement in screening and the availability of programs or strategies to address nine different HRSN. We assessed differences in screening rates and uses of data collected through screening among hospitals with and without programs or strategies in place to address HRSN or SDOH using Chi-squared tests of independence. Analyses were restricted to IT Supplement respondents with complete data for social needs questions asked in the Annual Survey (N = 1997). In 2022, hospitals used social needs data collected through screening for various purposes including discharge planning and clinical decision-making at their hospital as well as to refer patients to needed resources and assess community-level needs. Hospitals with a program or strategy in place had higher rates of screening across all domains and higher rates of using of data collected through screening for uses involving exchange or coordination with external entities. Collection of social needs data may help inform the development of programs or strategies to address HRSN and SDOH, which in turn can enable providers to screen for these needs and use the data in the near term for care delivery and in the long term to address community and population needs.

Benefits of using both the Hunger Vital Sign and brief nutrition security screener in health-related social needs screening.

Food security is a commonly screened for health-related social need at hospitals and community settings, and until recently, there were no tools to additionally screen for nutrition security. The purpose of this study was to assess the potential advantage of including a one-item brief nutrition security screener (BNSS) alongside the commonly used two-item Hunger Vital Sign (HVS) food security screener for identifying individuals with diet-related health risks. Cross-sectional survey data were collected from April to June 2021. Generalized linear mixed models were used to assess associations between screening status and dietary and health variables. Recruitment was done across five states (California, Florida, Maryland, North Carolina, and Washington) from community-based organizations. Participants (n = 435) were, on average, 44.7 years old (SD = 14.5), predominantly women (77%), and racially/ethnically diverse. In adjusted analyses, being in the food insecure and nutrition insecure group (but not the food insecure and nutrition secure or food secure and nutrition insecure groups) was associated with significantly increased odds for self-reported "fair" or "poor" general health [OR = 2.914 (95% CI = 1.521-5.581)], reporting at least one chronic condition [2.028 (1.024-4.018)], and "low" fruit and vegetable intake [2.421 (1.258-4.660)], compared with the food secure and nutrition secure group. These findings support using both the HVS and BNSS simultaneously in health-related social needs screening to identify participants at the highest risk for poor dietary and health outcomes and warrant further investigation into applying these screeners to clinical and community settings.

Prevalence of financial hardship and health-related social needs among patients with missed radiology appointments

PurposeWe aimed to evaluate the prevalence of financial hardship and Health-Related Social Needs (HRSN) among patients who missed their radiology appointment. MethodsEnglish-speaking adult patients, with a missed outpatient imaging appointment at any of a tertiary care imaging centers between 11/2022 and 05/2023 were eligible. We measured self-reported general financial worry using Comprehensive Score for Financial Toxicity (COST), imaging hardship (worry that the current imaging is a financial hardship to patient and their family), material hardship (e.g., medical debt), cost-related care nonadherence, and HRSNs including housing instability, food insecurity, transportation problems, and utility help needs. Results282 patients were included (mean age 54.7 ± 15.0 years; 70.7 % female). Majority were non-Hispanic White (52.4 %), followed by Asian (23.0 %) and Hispanic (16.0 %) racial/ethnic background. Most missed appointments were patient-initiated (74.8 %); 13.5 % due to cost or insurance coverage and 6.4 % due to transportation and parking. Mean COST score was 26.8 with 44.4 % and 28.8 % reporting their illness and imaging as a source of financial hardship. 18.3 % and 35.2 % endorsed cost-related care nonadherence and material hardship. 32.7 % had at least one HRSNs with food insecurity the most common (25.4 %). Only 12.5 % were previously screened for financial hardship or HRSNs. Having comorbidity and living in more disadvantaged neighborhoods was associated with higher report of financial hardship and HRSNs. ConclusionFinancial hardship and HRSNs are common among those who miss radiology appointments. There needs to be more rigorous screening for financial hardship and HRSNs at every health encounter and interventions should be implemented to address these.

Pharmacist-community-based organization collaboration to address health-related social needs

BackgroundCommunity-based organizations (CBOs) help address community issues, including health-related social needs (HRSNs). Community pharmacies are positioned to collaborate with CBOs to help their patients identify and address HRSNs to optimize medication use. ObjectivesTo develop and evaluate 2 models of community pharmacy-CBO collaboration to address HRSNs facing patients taking medications. MethodsTwo different pharmacy-CBO models were studied. The CBO-initiated model had 2 CBOs assess and refer clients to a community pharmacy to address HRSN-related medication concerns. In the pharmacy-initiated model, pharmacists screened patients for HRSNs, addressed those related to medication costs and referred patients to a CBO for other HRSNs. Documented HRSNs were extracted and analyzed. Participating pharmacy and CBO staff were interviewed. The interview recordings were transcribed and coded, using rapid qualitative analyses. ResultsThe CBO-initiated model screened 23 clients with 17 receiving a comprehensive medication review. In the pharmacy-initiated model, 39 patients were screened for HRSNs with 6 patients having medication costs issues addressed at the pharmacy and 23 patients being referred to the CBO. The most common HRSNs were high stress levels (43%), lack of confidence filling out forms (36%), feeling overwhelmed (34%), and inability to get food (27%). Patient-related themes from interviews were patient willingness to participate in the service, obstacles patients faced in obtaining medication therapy, and establishing patient trust. Pharmacy-related and CBO-related themes included fitting new activities into workflow, importance of time management and good communication, and establishing relationships between pharmacy and CBO personnel. ConclusionBoth pharmacy-CBO models effectively identified clients in need of medication management services or patients with HRSNs affecting medication optimization. Limited trust between the patient and the party to which they were referred was an obstacle to successful referral. Developing pharmacy and CBO personal relationships is a vital key in planning and coordinating these pharmacy-CBO collaboration models.

Beyond ‘‘Screen & Refer’’: Understanding Families’ Use of Resources for Health-Related Social Needs Identified via Primary Care

ObjectiveAs health-related social needs (HRSN) screening increases, attention to families’ resource preferences lags. This study of a pediatric primary care intervention (DULCE) with reliable HRSN screening and resource connection explored whether resources adequately addressed families’ needs and, when HRSN persisted, families' reasons for declining resources. MethodsThis retrospective cohort, mixed-methods study analyzed data from 989 families that received care at seven pediatric clinics implementing DULCE in three states. DULCE screens for seven HRSN around the 1-month and 4-month well-child visits; we calculated the percent of initial and ongoing positive screens. For positive rescreens, we calculated the percent that had all eligible or wanted resources and that were interested in further resources. We also analyzed case notes, which elicited families’ resource preferences, and explored demographic characteristics associated with ongoing HRSN. ResultsHalf of enrolled families (508 of 989) initially screened positive for HRSN; 124 families had positive rescreens; 26 expressed interest in further assistance. Most families with ongoing concrete supports needs accessed all eligible resources (60–100%); 20–58% had everything they wanted. Fewer families with ongoing maternal depression and intimate partner violence accessed all eligible resources (48% and 18%, respectively); most reported having all wanted resources (76% and 90%, respectively). Families declined resources due to lack of perceived need, the HRSN resolving, or families addressed HRSN themselves. White families were more likely to rescreen positive. ConclusionsPediatric medical homes must honor family-centered decision-making while empowering families to accept beneficial resources. Health care systems should advocate for resources that families need and want.

Engaging student volunteers in non-clinical navigation: ACS community access to resources, education, and support (ACS CARES).

e13577 Background: Despite known benefits of oncology patient navigation in improving patient outcomes, implementation is variable and many programs are understaffed. The American Cancer Society (ACS) developed the ACS CARES (Community Access to Resources, Education, and Support) program to expand navigation capacity through the standardized training of students from local universities as volunteers providing non-clinical navigation support. Methods: This pragmatic, real-world hybrid type 2 study utilizes the Consolidated Framework for Implementation Research (CFIR) to evaluate the implementation of student volunteer navigation for patients receiving cancer care at 3 pilot sites. Volunteers meet with patients in clinic, administer a modified NCCN distress thermometer health-related social needs (HRSNs) screen, and administer non-clinical navigation support. Initial process measures from the first 3 months of the pilot data include number and demographics of patients served, distress scores and HRSNs, and time spent by volunteers. Results: Pilot sites spanned diverse geographic regions (rural mid-West, rural-suburban Southeast, urban West) and included clinics with multiple cancer types. From 10/23/23-12/23/23, 22 volunteers navigated 73 patients who were 53% female, 22% Black, and an average age of 57. Of all patients, 46% had a moderate (score 3-6) and 37% had a severe (score 7-10) distress score. ACS CARES volunteers identified 116 HRSNs (56% practical, 18% physical, 17% emotional, 7% social, 2% spiritual). The most common practical HRSNs were finances and transportation. Volunteers spent an average of 78.6 min per patient per in-person meeting, 14 min per patient per follow-up call, 25 min per patient coordinating care and sending encrypted messages, and 90 min per patient identifying and providing resources to address barriers to care. Total time providing non-clinical navigation was over 250 hours. Conclusions: Student volunteers embedded in oncology clinics provided non-clinical navigation support to 73 patients in the first 3 months of the ACS CARES program, further extending the reach and depth of support provided by pilot site care teams. Future analyses will include survey and EMR data to examine program impact on clinical and patient reported outcomes and healthcare utilization. Clinical trial information: 2013209-1.

Acceptance of Automated Social Risk Scoring in the Emergency Department: Clinician, Staff, and Patient Perspectives.

Healthcare organizations are under increasing pressure from policymakers, payers, and advocates to screen for and address patients' health-related social needs (HRSN). The emergency department (ED) presents several challenges to HRSN screening, and patients are frequently not screened for HRSNs. Predictive modeling using machine learning and artificial intelligence, approaches may address some pragmatic HRSN screening challenges in the ED. Because predictive modeling represents a substantial change from current approaches, in this study we explored the acceptability of HRSN predictive modeling in the ED. Emergency clinicians, ED staff, and patient perspectives on the acceptability and usage of predictive modeling for HRSNs in the ED were obtained through in-depth semi-structured interviews (eight per group, total 24). All participants practiced at or had received care from an urban, Midwest, safety-net hospital system. We analyzed interview transcripts using a modified thematic analysis approach with consensus coding. Emergency clinicians, ED staff, and patients agreed that HRSN predictive modeling must lead to actionable responses and positive patient outcomes. Opinions about using predictive modeling results to initiate automatic referrals to HRSN services were mixed. Emergency clinicians and staff wanted transparency on data inputs and usage, demanded high performance, and expressed concern for unforeseen consequences. While accepting, patients were concerned that prediction models can miss individuals who required services and might perpetuate biases. Emergency clinicians, ED staff, and patients expressed mostly positive views about using predictive modeling for HRSNs. Yet, clinicians, staff, and patients listed several contingent factors impacting the acceptance and implementation of HRSN prediction models in the ED.

Effects of the COVID-19 Pandemic on Patient Navigation for Health-Related Social Needs: Reflections From the Accountable Health Communities Model.

This paper uses data from the Center for Medicare & Medicaid Innovation's Accountable Health Communities (AHC) Model to assess the effects of the COVID-19 pandemic on patient navigation (PN) for health-related social needs. We analyzed evaluation data from 28 organizations implementing the Center for Medicare & Medicaid Innovation's AHC Model. We first distilled themes from 81 stakeholder interviews conducted in 2021. We then analyzed quantitative beneficiary-level data on acceptance of navigation among 133,173 unique Medicare and Medicaid beneficiaries who were eligible for navigation between January 2019 and March 2021. During the pandemic, interview participants described greater complexity of patients' cases and uncertainty regarding community service availability. Changes to navigation staffing and mode led to improvements in navigation quality and efficiency, but also challenges such as reduced rapport with patients. The pandemic increased navigator stress and burnout but also deepened appreciation for navigation among navigators and their patients. Beneficiaries were more likely to accept navigation during the pandemic than before the pandemic ( P <.05). Changes in PN during the pandemic were perceived as both good and bad. Future work is needed to assess the long-term implications of pandemic-related changes to navigation for patients and navigators.

Exploring Health-Related Social Needs and Components of Social Competence Following Childhood Traumatic Brain Injury.

Health-related social needs (HRSNs) impact general health care and educational outcomes for children with traumatic brain injury (TBI) and their families. Furthermore, children with TBI of all severities experience negative social competence outcomes chronically postinjury. However, studies have not investigated the relationship between HRSNs and social competence outcomes for children after TBI. The aim of this study was to identify the relationship between HRSNs and components of social competence (i.e., social skills, social communication, family functioning, and behavioral domains per the biopsychosocial framework for social competence) for children with TBI, per parent report. This study used a prospective, cross-sectional study design with a convenience sample. Online surveys were completed by parents of children with TBI (N = 22). On average, children with TBI were 4.84 years old at the time of their TBI and 9.24 years old at the time of study participation. Having a parent identify an HRSN in the domain of mental health was associated with social communication and family functioning difficulties for children with TBI. Statistically significant relationships were found between social communication and family functioning, externalizing behavior, and total behavior; family functioning and social relations; and family functioning and externalizing behavior. The findings of this study support that children with TBI experience chronic deficits in components of social competence, and HRSNs are associated with these outcomes. Further research needs to consider HRSNs to improve equitable prevention, supports, and services for children with TBI.

Abstract SS03-06: Screening for Health Related Social Needs, and now what?

Abstract Screening cancer patients for health related social needs (HRSN) presents benefits and challenges for the patients as well as for the health care facilities. Who gets screened? How often? What are the results used for? What services can be provided? These are some of the issues that institutions face. At the same time patients can feel singled out, afraid to be honest thinking they would receive sub-optimal treatment, and have wrong expectations, among others. In this session we will address the importance of screening for HRSN such as transportation, housing, food security, and financial strain. Strategies to approach the patient and possible ways to address the needs will also be discussed. Citation Format: B. Segarra-Vazquez. Screening for Health Related Social Needs, and now what? [abstract]. In: Proceedings of the 2023 San Antonio Breast Cancer Symposium; 2023 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2024;84(9 Suppl):Abstract nr SS03-06.