Referral Program Research Articles

A Screening and Referral Intervention for Food Insecurity Among Older Emergency Department Patients

Food insecurity is prevalent among older adults, negatively impacts health, and may increase healthcare utilization. Risk factors include poverty, lack of transportation, and social isolation. Community-based services may mitigate food insecurity and other social risk factors. However, identifying those at risk and connecting them to services can be challenging. We implemented a screening and referral program in an Emergency Department (ED) to identify older adults facing food insecurity and connect them to a local Area Agency on Aging (AAA), which arranged and tracked delivery of community-based services. ED nursing assistants used the Hunger Vital Sign screener to assess food insecurity in patients aged 60 years and older. ED Care Managers (CMs) saw all who screened positive and made referrals to the AAA. The AAA conducted an intake assessment and arranged services. Patients were contacted three months after their ED visit to evaluate health, quality of life, and satisfaction with services. Of 423 patients screened over 7 months, 45 (11%) reported food insecurity. Of those, 25 were referred to the AAA. Patients were not referred to the AAA due to CM inability to make a referral (7), declining services (4), or other reasons (11). The AAA reached 21 patients and 9 received at least one service. Of those, 5 were reached for follow-up and reported satisfaction with services. The most frequently requested service was Meals on Wheels (10). Food insecurity is common among older ED patients. An ED-AAA partnership is feasible and connects older adults to beneficial services in their communities.

Successes and challenges of implementing a lung cancer screening program in federally qualified health centers: a qualitative analysis using the Consolidated Framework for Implementation Research.

In recent years, studies have shown that low-dose computed tomography (LDCT) is a safe and effective way to screen high-risk adults for lung cancer. Despite this, uptake remains low, especially in limited-resource settings. The American Cancer Society (ACS) partnered with two federally qualified health centers and accredited screening facilities on a 2 year pilot project to implement an LDCT screening program. Both sites attempted to develop a referral program and care coordination practices to move patients through the screening continuum and identify critical facilitators and barriers to implementation. Evaluators conducted key informant interviews (N = 46) with clinical and administrative staff, as well as regional ACS staff during annual site visits. The Consolidated Framework for Implementation Research guided our analysis of factors associated with effective implementation and improved screening outcomes. One study site established a sustainable lung screening program, while the other struggled to overcome significant implementation barriers. Increased time spent with patients, disruption to normal workflows, and Medicaid reimbursement policies presented challenges at both sites. Supportive, engaged leaders and knowledgeable champions who provided clear implementation guidance improved staff engagement and were able to train, guide, and motivate staff throughout the intervention. A slow, stepwise implementation process allowed one site’s project champions to pilot test new processes and resolve issues before scaling up. This pilot study provides critical insights into the necessary resources and steps for successful lung cancer screening program implementation in underserved settings. Future efforts can build upon these findings and identify and address possible facilitators and barriers to screening program implementation.

Qualitative program evaluation of social determinants of health screening and referral program.

Although the integration of social determinants of health (SDH) screening and referral programs in clinical settings has rapidly grown, the voice and experience of participants within SDH programs has not been well understood in program evaluations. To qualitatively evaluate a comprehensive SDH screening and referral program based in an academic primary care setting, we conducted a qualitative analysis of a semi-structured, focus group interview of 7 caregivers. We performed inductive coding representing emerging ideas from each transcript using focus group transcripts from families who participated in the SDH screening and referral program. A thematic model was created describing caregivers’ experiences with respect to screening, intake, and referral phases of the program. Caregivers reported satisfaction with structural and process-related components of screening, intake, and referral. They expressed a preference for trained patient navigators over physicians for screening and intake for they were perceived to have time to prioritize caregivers’ social needs. Caregivers reported disappointment with legal services screening, intake, and referral, citing lack of timely contact from the legal resource team and prematurity of provided legal resources. Overall, caregivers recommend the program, citing that the program provided social support, an environment where expression is encouraged, motivation to address their own health needs, and a convenient location. Overall, caregivers would recommend the program because they feel socially supported. The use of trained patient navigators appears to be instrumental to the successful implementation of the program in clinics, for navigators can provide caregivers with the appropriate time and personal attention they need to complete the survey and discuss their needs. Streamlining the referral process for evaluation of health-harming needs by the medical legal partnership was highlighted as an area for improvement.

Oncologic colorectal surgery in a general surgery unit of a small region of Italy—a successful “referral Centre Hub & Spoke Learning Program” very important to reduce mobility in the Covid-19 era

Oncologic colorectal surgery in a general surgery unit of a small region of Italy—a successful “referral Centre Hub & Spoke Learning Program” very important to reduce mobility in the Covid-19 era

Implementing hospital-based peer recovery support services for substance use disorder

ABSTRACT Background The rise in drug overdose deaths in the United States necessitates novel approaches to reduce harms. In response, peer recovery support services for substance use disorder have been implemented in clinical and community settings in several states. Objectives This descriptive analysis aimed to describe the implementation of hospital-based peer recovery support services for substance use disorder. Methods We describe the implementation of the Peer Recovery Program, which delivers recovery support services 24 hours a day, seven days a week, for patients with substance use disorder in emergency departments and inpatient settings across 20 hospitals. We report program, patient, and referral characteristics and program process measures. Results From 2016 to 2019, Recovery Specialists received referrals during 30,263 patient visits. In 2019, 65.4% (n = 7,564) of patients were male. Across three subsamples of referrals, patient acceptance of continued recovery support services ranged from 74.8% to 83.0%. At affiliated hospitals in 2019, the median response time from referral to Recovery Specialist arrival at patient bedside was eight minutes (interquartile range = 4–16), and the median duration of initial bedside consultation was 35 minutes (interquartile range = 25–45). In 2019, Recovery Specialists and Patient Navigators attempted 113,442 follow-up contacts, and patients accepted 4,696 referrals provided by Patient Navigators to substance use disorder treatment and other medical, social, and recovery services and supports. Conclusions This study describes peer recovery support services for substance use disorder delivered in emergency departments and inpatient settings. Evidence of improved patient outcomes is needed prior to widespread adoption.

Efficacy of an Online Physical Activity Intervention Coordinated With Routine Clinical Care: Protocol for a Pilot Randomized Controlled Trial.

BackgroundMost adults are not achieving recommended levels of physical activity (150 minutes/week, moderate-to-vigorous intensity). Inadequate activity levels are associated with numerous poor health outcomes, and clinical recommendations endorse physical activity in the front-line treatment of obesity, diabetes, dyslipidemia, and hypertension. A framework for physical activity prescription and referral has been developed, but has not been widely implemented. This may be due, in part, to the lack of feasible and effective physical activity intervention programs designed to coordinate with clinical care delivery.ObjectiveThis manuscript describes the protocol for a pilot randomized controlled trial (RCT) that tests the efficacy of a 13-week online intervention for increasing physical activity in adult primary care patients (aged 21-70 years) reporting inadequate activity levels. The feasibility of implementing specific components of a physical activity clinical referral program, including screening for low activity levels and reporting patient program success to referring physicians, will also be examined. Analyses will include participant perspectives on maintaining physical activity.MethodsThis pilot study includes a 3-month wait-listed control RCT (1:1 ratio within age strata 21-54 and 55-70 years). After the RCT primary end point at 3 months, wait-listed participants are offered the full intervention and all participants are followed to 6 months after starting the intervention program. Primary RCT outcomes include differences across randomized groups in average step count, moderate-to-vigorous physical activity, and sedentary behavior (minutes/day) derived from accelerometers. Maintenance of physical activity changes will be examined for all participants at 6 months after the intervention start.ResultsRecruitment took place between October 2018 and May 2019 (79 participants were randomized). Data collection was completed in February 2020. Primary data analyses are ongoing.ConclusionsThe results of this study will inform the development of a clinical referral program for physical activity improvement that combines an online intervention with clinical screening for low activity levels, support for postintervention behavior maintenance, and feedback to the referring physician.Trial RegistrationClinicalTrials.gov NCT03695016; https://clinicaltrials.gov/ct2/show/NCT03695016.International Registered Report Identifier (IRRID)DERR1-10.2196/18891

Impact of embedded medication assistance program specialists on medication access in outpatient oncology clinics.

Medication prior authorizations (PA) required by insurance payers can be time-consuming to complete and may lead to delays in treatment for cancer patients. The primary objective of this study is to assess the impact of Medication Assistance Program (MAP) specialists embedded in adult hematology and oncology clinics on the PA and financial assistance process. This was a retrospective chart review study performed at a large academic medical center that examined medication referrals completed by MAP specialists in four hematology and oncology clinics. The primary outcome was the median PA turnaround time, defined as time from initial referral creation to final referral completion. Secondary outcomes assessed median turnaround time for financial assistance programs and total patient savings. A total of 176 prior authorization, 92 manufacturer patient assistance program (PAP), and 37 copay assistance referrals were completed. The median turnaround times were 24, 154, and 19 hours for PA, manufacturer PAP, and copay assistance program referrals, respectively. Total cost savings amounted to over $1.8 million for patients approved to receive medications through manufacturer PAPs. Embedding MAP specialists in adult hematology/oncology clinics supports an efficient and timely process for PA approvals while also providing patient cost-savings.

Reliability and Feasibility of the First-Episode Psychosis Services Fidelity Scale-Revised for Remote Assessment.

The authors sought to evaluate the interrater reliability and feasibility of the First-Episode Psychosis Services Fidelity Scale-Revised (FEPS-FS-R) for remote assessment of first-episode psychosis programs according to the coordinated specialty care model. The authors used the FEPS-FS-R to assess the fidelity of 36 first-episode psychosis program sites in the United States with information from three sources: administrative data, health record review, and phone interviews with staff. Four raters independently conducted fidelity assessments of five program sites by listening to each of the staff interviews and independently rating the two other data sources from each site. To calculate interrater reliability, the authors used intraclass correlation coefficients (ICCs) for each of the five sites and across the total scores for each site. Total interrater reliability was in the good to excellent range, with a mean ICC of 0.91 (95% confidence interval = 0.72-0.99, p<0.001). Two first-episode psychosis program sites (6%) achieved excellent fidelity, 25 (69%) good fidelity, and nine (25%) fair fidelity. Of the 32 distinct items on the FEPS-FS-R, 23 (72%) were used with good or excellent fidelity. Most sites achieved high fidelity on most items, but five items received ratings indicating low-fidelity use at most sites. The fidelity assessment proved feasible, and sites required on average 10.5 hours for preparing and conducting the fidelity review. The FEPS-FS-R has high interrater reliability and can differentiate high-, moderate-, and low-fidelity sites. Most sites had good overall fidelity, but the FEPS-FS-R identified some services that were challenging to implement at many sites.

The impact of a personalized, community-based counselling and referral programme on modern contraceptive use in urban Ghana: a retrospective evaluation

Community-based demand-generation family planning programmes have been associated with increased contraceptive use in rural areas of Ghana. However, rigorous evaluations of such programmes in urban contexts are lacking. We used a retrospective, cross-sectional with comparison group design to estimate the immediate and sustained impact of the Willows intervention on modern contraceptive use in Kumasi, Ghana. The Willows intervention is a home-based counselling and referral programme for women in low-income urban settlements. We analysed data from a cross-sectional representative survey of 1205 women of reproductive age in the intervention area and 1108 women in a matched comparison site. The main outcome was women’s reported contraceptive use at: (1) baseline (January 2013); (2) programme close (December 2016); and (3) follow-up (August to October 2018). We estimated the programme effect at the community level and for women who reported receiving a family planning counselling visit. We used coarsened exact matching to assess the impact of the intervention relative to outcomes for matched comparison women. Comparing those who reported a family planning visit in the intervention area with matched comparison area women who reported no visit, we estimated a 10.5 percentage point increase in use of modern contraceptives from baseline to close (95%CI : 6.2, 14.8; P < 0.001) and a 7.6 percentage point increase from baseline to follow-up (95%CI : 3.3, 11.9; P < 0.001). However, only 20.2% of women in the Willows intervention area reported a visit. The Willows intervention, therefore, did not achieve its aim to reach all reproductive-aged women in the community. At the community level, we found no significant effect of the intervention at either programme close or 2 years later. We recommend that similar community-based interventions strive for greater outreach and simultaneously launch robust prospective impact evaluations.

Connecting tobacco users in the primary care setting to comprehensive tobacco treatment: a quality improvement initiative

The goal of the Stanford Tobacco Treatment Initiative was to improve referrals from primary care clinics to a specialty tobacco addiction treatment clinic. Lean A3 problem solving was used to map current state, perform a cause and effect analysis, develop key drivers for program referrals, and ideate tests of change. We discarded ideas that put any additional burden on on-the-ground providers, favouring automated and sustainable processes. After prioritizing for feasibility and impact, plan-do-study-act (PDSA) cycles were performed on the following interventions: education and outreach, referral champions, and automated referrals. Following implementation, referrals to the specialty tobacco treatment clinic increased by 600% and had no impact on clinic provider workflow. The new process spread through all of Stanford Primary Care clinics, has sustained over time, and could serve as a model for other institutions seeking to enhance capacity for tobacco treatment in their health care system using process improvement methodology.

Combining two implementation strategies to increase reach for tobacco treatment with cancer patients: Ask-Advise-Connect and closing care gaps.

242 Background: Tobacco treatment is an important component of cancer care, and pragmatic strategies are needed. The University of California Davis Comprehensive Cancer Center (UCD CCC) was selected to join the National Cancer Institute Cancer Center Cessation Initiative (NCI C3I) to integrate tobacco treatment with cancer care. As a matrix cancer center, UCD had tobacco treatment workflows established in primary care, with Health Management Education group classes and a quitline order, but less so in cancer care. Methods: We use the RE-AIM framework for our study evaluation. During the two-year study period (1/2018-12/2019) patient data were reported in 6-month periods to NCI C3I from core Cancer Center clinics including medical, surgical, and radiation oncology. Three strategies were implemented serially and in convergence. Strategy #1 involved cancer provider and staff education and training, Strategy #2 initiated the Ask-Advise-Connect workflow with medical assistants assessing and referring within the clinic encounter, and Strategy #3 conducted Closing Care Gaps outreach to contact “unassisted” smokers outside of the clinic encounter. Stakeholder perspectives for implementation readiness across units were engaged at least bi-monthly by multidisciplinary members of the Cancer Committee, led by the physician-in-chief. Implementation strategies were developed in partnership with clinic management and Health Management Education staff with monthly rapid feedback reports for referral orders. Results: Our project Reach improved tobacco assessment from 83.6% to 96.4% and tobacco treatment program orders and outreach by 6-fold (from 40 to 254) over the four NCI C3I 6-month reporting periods. For tobacco treatment program Effectiveness, among 118 patients who engaged in treatment (January 2018-June 2019), past-week abstinence at 6 months was 22.9% (missing data assumed to be smoking) Adoption and Implementation of tobacco treatment program referrals were highest in medical (5-10 fold) and surgical oncology (3-fold) annual increases. In contrast, radiation oncology referrals remained low due to a different clinic workflow and electronic health record module. Booster trainings have helped to Maintain referrals in the clinic. Conclusions: A matrix cancer center can rapidly adopt and implement tobacco treatment strategies that are internal and external to the clinic visit, with the goal of offering tobacco treatment and maximizing reach to all cancer patients who smoke.

3 - Patient and Paramedic Experiences With a Direct Electronic Referral Program for Hypoglycemia Education Following Paramedic Service Assist-Requiring Hypoglycemia: A Qualitative Study

3 - Patient and Paramedic Experiences With a Direct Electronic Referral Program for Hypoglycemia Education Following Paramedic Service Assist-Requiring Hypoglycemia: A Qualitative Study

Young adult cancer survivors\u2019 experience of taking part in a 12-week exercise referral programme: a qualitative study of the Trekstock RENEW initiative

PurposeThere is emerging evidence that physical activity interventions have the potential to improve the physical function and psychosocial well-being of young adult cancer survivors. However, most existing interventions for young adult cancer survivors have been delivered in an in-patient hospital setting. The purpose of this study is to explore young adult cancer survivors’ (YACS) experiences of the RENEW programme, a 12-week community-based exercise referral scheme delivered by Trekstock, a UK-based cancer charity.MethodsSixteen semi-structured interviews were conducted with YACS (mean age, 33 years; 87.5% female) who participated in the RENEW exercise referral programme. Each interview followed the same semi-structured interview guide which asked participants about their experiences of the RENEW programme and their ideas for the future development of the scheme. Data was audio-recorded, transcribed full verbatim and analysed using framework analysis.ResultsYACs predominantly chose to take part in the RENEW programme as a means to improve their health and overcome cancer related impairments (e.g. fatigue, loss of strength, low body confidence). The offer of one-to-one tailored support and unlimited gym access was often cited as a factor which motivated enrolment. Overall, YACS experience of the programme was positive with many describing improvements in physical function and general well-being. Barriers to participating in the programme included sign-off from clinicians prior to enrolment, travelling to the gym and fear of exercising alone.ConclusionsExercise referral schemes are acceptable to YACS and provide a promising opportunity for young people with cancer to improve their physical and psychosocial health through physical activity.

Suicide prevention in Slovenia in the context of public health

Abstract Background Suicide mortality in Slovenia has decreased with 30% in the last two decades, from 28,25 per 100,000 in 2003 to 17,08 per 100,000 in 2018. Nevertheless, the country's suicide rate remains markedly above the EU average. Only from March 2018, Slovenia has a National Strategy for Mental Health 2018-2028, with one of the priority areas being suicide prevention and a strategic goal of decreasing suicide mortality by 15% in the next 10 years. Methods Specific objectives are aimed at (i) raising of mental health awareness and literacy, particularly in relation to suicide, (ii) early identification of people at risk, (iii) access to help and mental health provision for people at risk of suicide, (iv) reduction in alcohol use, (v) restriction of access to the means of suicide. Results Many of suicide prevention initiatives in Slovenia are being implemented on the local, regional, and national level. They include universal and targeted approaches such as collaboration with different gatekeepers (e.g. general practitioners, first responders, school workers, media), screening programs for at risk individuals at the primary health care level (e.g. PHQ-9), network of psychological counselling services, etc. Two interventions will be presented in more detail, namely (i) collaboration with media representatives on responsible reporting on suicide (a 'pre-post' comparison of reporting revealed statistically significant improvement in 6 out of 10 guidelines) and (ii) a population screening for depression and referral program for individuals aged &amp;gt; 35. Conclusions The aforementioned decrease in suicide mortality, timely coincides with the launch of multiple preventative activities. Even though further sound research is necessary to confirm a statistically significant relationship between the observed decrease and these preventive initiatives, it is probable that these actions contribute to the stagnation (and even decline) in the suicide rate in our country.

Impact of home-based family planning counselling and referral on modern contraceptive use in Karachi, Pakistan: a retrospective, cross-sectional matched control study

ObjectivesTo assess: (1) the impact of a reproductive health program on modern contraceptive use from baseline to program close; (2) the sustained impact from baseline to follow-up 36 months later;...

Strategies for Referring Cancer Patients in a Smoking Cessation Program.

Most people who smoke and develop cancer are unable to quit smoking. To address this, many cancer centers have now opened smoking cessation programs specifically designed to help cancer patients to quit. An important question has now emerged—what is the most effective approach for engaging smokers within a cancer center in these smoking cessation programs? We report outcomes from a retrospective observational study comparing three referral methods—traditional referral, best practice advisory (BPA), and direct outreach—on utilization of the Duke Cancer Center Smoking Cessation Program. We found that program utilization rate was higher for direct outreach (5.4%) than traditional referral (0.8%), p < 0.001, and BPA (0.2%); p < 0.001. Program utilization was 6.4% for all methods combined. Inferring a causal relationship between referral method and program utilization was not possible because the study did not use a randomized design. Innovation is needed to generate higher utilization rates for cancer center smoking cessation programs.

Use prices as sales agents

We use a monopoly model with consumer heterogeneity to study the profitability of group buying, in which the discounted price is offered to consumers if more than a certain number of them agree to make purchases. We find that group buying generally outperforms intertemporal pricing but is outperformed by a referral reward program. The optimal minimum requirement depends on parameters. If a consumer and her invitee have homogeneous preference and there is no discount of future utility, a pricing strategy characterized by the low (medium) minimum requirement is always dominated by high minimum requirement, whose profit coincides with one‐person group buying.

The Healthy Meal Program: A food insecurity screening and referral program for urban dwelling older adults.

To describe the Healthy Meal Program (HMP), a community-academic partnership that aims to address the food insecurity and social isolation in older adults living in an urban setting. Low-income older adults were screened for food insecurity and social isolation. A partnership with the food bank and a farm-based organization helped provide a weekly congregate or home-delivered meal, pilot a cooking class, and offer a mobile market selling fresh vegetables at discounted prices. Overall, 339 individuals agreed to participate in the screening process. Sixty-eight percent (n=230) screened positive for food insecurity and 41% (n=139) screened positive for social isolation. Among individuals who were food insecure, 159 were referred to a food commodity program, 31 to meals on wheels, 23 to Supplemental Nutrition Assistance Program benefits, and 28 to emergency food pantries. The mobile market served 75 participants weekly and 15 individuals took part in cooking classes. Screening for food insecurity and social isolation in the HMP helped to assess the prevalence of these social determinants of health in low-income older adults. Weekly congregate meals, home visits, and group cooking classes were initiatives taken to decrease the impact of food insecurity and social isolation in this vulnerable population.

U.S. Navy Bolsters Mental Health Services During Pandemic

Back to table of contents Previous article Next article Clinical & ResearchFull AccessU.S. Navy Bolsters Mental Health Services During PandemicNick ZagorskiNick ZagorskiSearch for more papers by this authorPublished Online:16 Jul 2020https://doi.org/10.1176/appi.pn.2020.6b28AbstractWith services ranging from peer counseling groups to psychiatrists embedded within deployed personnel, the Navy’s No Wrong Door program is striving to provide mental health services to all personnel.iStock/Avigator PhotographerAs highlighted by the large-scale outbreak of COVID-19 on the USS Theodore Roosevelt aircraft carrier that started in late March, the U.S. Navy is not immune to the virus. Given the existing stresses of military service and the close quarters many naval personnel operate in, the COVID-19 pandemic might be a recipe for significant psychological burden.“[S]o far, we have not seen a spike in demand for our mental health services,” said physician Capt. James Reeves, director for primary care and mental health at the Navy Bureau of Medicine and Surgery, during a virtual roundtable event in late May discussing how the COVID-19 crisis has impacted the Navy. “Inpatient hospital admissions have even diminished during this time.”While it may still be some time before the mental health effects of COVID-19 emerge, Reeves said he is encouraged by these early trends.The lack of a significant mental health spike is due in part to some broad protective factors, according to Reeves. “As a group, our personnel are all still employed and have access to health care,” he said. As many personnel are accustomed to long periods on vessels, they may also be more resilient to the effects of self-isolation. “Some individuals might even appreciate the necessity of spending more time at home with family,” he said.Reeves also said he believes that the comprehensive mental health program developed by Navy Medicine known as No Wrong Door may be contributing to the positive early data. If Navy personnel experience mental health problems, they have a range of service options—from peer support to psychiatry specialists, Reeves said.In addition to having psychiatrists available at the large Navy hospitals and medical centers, the Navy provides behavioral services (generally psychologists and/or social workers) at many of their smaller on-base primary care clinics. In the last decade, the Navy and other military branches have also started embedding mental health professionals with specific units such as submarine crews, aviators, or special forces. “Each of our units is unique in what it does and has its own culture,” Reeves said, noting that currently about one-third of mental health professionals in the Navy are embedded. “These embedded staff know how the units operate, they deploy with them, and can provide concierge-level care.”Due in part to a multifaceted strategy of peer and professional behavioral services, Navy personnel have not experienced significant mental distress during the COVID-19 outbreak, says Capt. James Reeves.Additionally, a referral program known as Military OneSource can help U.S. servicemembers to connect with non-military counselors if they feel more comfortable going to someone outside their base.Supporting the long-term mental health of Navy personnel requires tending to stressors that were likely around before and will extend beyond the pandemic.“This is especially concerning now since the extra time needed to manage a crisis situation prevents personnel from caring for their personal health,” said Joshua Morganstein, M.D., an associate professor of psychiatry at the Uniformed Services University of the Health Sciences (USUHS) and chair of APA’s Committee on the Psychiatric Dimensions of Disasters.Fleet and Family Support Centers on bases and deployment resiliency counselors on ships offer counseling for issues including family illness, marriage problems, or sexual harassment. Additionally, Navy chaplains play a key role in supporting personnel, Reeves said. “People may think of chaplains purely as spiritual help, but they are trained in counseling on issues like grief and loss,” he said.In response to COVID-19, the Navy has been quick to increase virtual mental health services. Reeves noted that most services being offered are telephone-based, though they are ramping up their video-conferencing abilities. Several Navy hospitals have also developed virtual programs to help both patients and caregivers during this crisis.“We know that this pandemic is straining the health care system and creating excess operational stress on caregivers,” Reeves said. “We want our staff to be able to recognize stress symptoms early and ensure they can get the support needed.”Morganstein added that the Center for the Study of Traumatic Stress at USUHS has created numerous resource sheets on how caregivers, patients, and families can mitigate the impact of the COVID-19 crisis. ■The Center for the Study of Traumatic Stress pandemic resources are posted here. ISSUES NewArchived

Social Needs Screening and Referral Program at a Large US Public Hospital System, 2017

Many health care providers and systems are developing and implementing processes to screen patients for social determinants of health and to refer patients to appropriate nonclinical and community-based resources. The largest public health care system in the United States, New York City Health + Hospitals, piloted such a program in 2017. A qualitative evaluation yielded insights into the implementation and feasibility of such screening and referral programs in health care systems serving low-income, minority, immigrant, and underserved populations.