Social Needs Research Articles

Physical, Social and Emotional Needs of Developing Children: Comparison of Neuroscientific Findings and Bertrand Russell's Ideas

Bu çalışmanın amacı Bertrand Russell’ın eğitim felsefesi görüşleri ile son dönemde giderek önem kazanan nörobilim araştırmalarında ve eğitsel nörobilim alanında ortaya çıkan bulgu ve felsefi görüşleri karşılaştırmaktır. Nörobilim çalışmalarının bulguları ve eğitsel nörobilim tartışmalarına göre öğrenme ve öğrenmenin davranışa dönüşmesini sağlayan en önemli unsurlar biyolojik (fiziksel ve kimyasal), ve sosyal unsurlardır. Bertrand Russell da eğitim hakkındaki görüşlerini bu unsurlara dayandırarak bir eğitim felsefesi geliştirmiştir. Nörobilimsel bulgular öğrenme ve diğer bilişsel faaliyetleri çoklu parametreler üzerinden detaylı şekilde açıklamaktadır. Russell’da özellikle modern toplumların sahip olduğu problemleri bu ayrıntılar ve gündelik dinamikler ile felsefi bir üslüpta tartışmıştır. Yapılan bu karşılaştırmada ortaya çıkan sonuçlara göre; öğrenme ve eylem ilişkisinde, insanın fizyolojik ve duygusal ihtiyaçlarının beraber değerlendirilmesinin önemi, eğitimde özerklik ve serbestinin rolü, cinsel eğitimi, sosyal güç dengeleri ve oyun temaları ön plana çıkan konu başlıkları olmuştur. Ortaya çıkan bu bulgulara göre biyolojik, duygusal ve sosyal unsurların iç içe geçmesi öğrenme ve bilişsel faaliyetler için temel oluşturmaktadır. Bu biyolojik, duygusal ve sosyal unsurların ortaya çıkardığı sosyal ve bireysel ihtiyaçlar da tartışma kapsamında değerlendirilmiştir.

Helping low-income smokers quit: findings from a randomized controlled trial comparing specialized quitline services with and without social needs navigation

Quitting smoking is especially challenging for low-income smokers due to high stress, high smoking prevalence around them, and limited support for quitting. This study aimed to determine whether any of three interventions designed specifically for low-income smokers would be more effective than standard tobacco quitline services: a specialized quitline, the specialized quitline with social needs navigation, or the standard quitline with social needs navigation. Using a randomized 2×2 factorial design, low-income daily cigarette smokers (n=1944) in Missouri, USA who called a helpline seeking assistance with food, rent or other social needs were assigned to receive Standard Quitline alone (n=485), Standard Quitline+Social Needs Navigation (n=484), Specialized Quitline alone (n=485), or Specialized Quitline+Social Needs Navigation (n=490). The target sample size was 2000, 500 per group. The main outcome was 7-day self-reported point prevalence abstinence at 6-month follow-up. Multiple imputation was used to impute outcomes for those missing data at 6-month follow-up. Binary logistic regression analyses were used to assess differences between study groups. Participants were recruited from June 2017 to November 2020; most were African American (1111 [58%]) or White (666 [35%]), female (1396 [72%]), and reported <$10,000 (957 [51%]) or <$20,000 (1529 [82%]) annual pre-tax household income. At 6-month follow-up (58% retention), 101 participants in the Standard Quitline group reported 7-day point prevalence abstinence (20.8% of those assigned at baseline, 38.1% after imputation). Quit rates in the Specialized Quitline (90 quitters, 18.6%, 38.1%) and Specialized Quitline+Social Needs Navigation (103 quitters, 21.0%, 39.8%) were not different from the Standard Quitline. Quit rates for Standard Quitline+Social Needs Navigation (74 quitters, 15.3%, 30.1%) were significantly lower than Standard Quitline (OR=0.70, 95% CI=0.50-0.98). A specialized version of a state tobacco quitline was no more effective than standard quitline services in helping low-income smokers quit. Adding social needs navigation to a standard quitline decreased its effectiveness. ClinicalTrials.gov Identifier: NCT03194958. National Cancer Institute: R01CA201429.

1004-P: Association of Social Needs with 30-Day Readmission and Length of Stay

Introduction: The objective of this study was to investigate if social needs are associated with inpatient quality metrics (30-day readmission [30DR], length of stay [LOS]) and if the relationship differed for individuals with and without diabetes. Methods: We used the data from electronic medical records at a tertiary academic hospital in Southern Wisconsin for patients aged 18 years or older with inpatient encounters during which data on social needs were collected between February 2021 to December 2021. Patient demographics including age, gender, race, and insurance along with comorbidities, social needs, LOS and readmission information were extracted for the index inpatient encounter. The social needs items included financial strain, food insecurity, housing insecurity, and transportation need. Appropriate models were run to assess the association of social needs with the outcomes, overall and with interaction for DM status Results: Overall, 13,010 patients were included in our study. Only 7.2% reported presence of any social needs with financial strain as the most frequently reported need (5.3%) and 24% of the sample had diabetes. Overall, there was no significant association of the presence of any social needs with either 30DR or LOS. In addition, there were no significant interactions for DM status indicating relationship was similar for individuals with and without DM. Conclusion: The overall prevalence of any material needs was much lower than national estimates. Presence of social needs was not associated with 30RR and LOS. Investigation is needed for best practices in collecting social needs in inpatient setting. Disclosure S.Bhandari: None. R.J.Walker: None. A.Z.Dawson: None. J.S.Williams: None. L.E.Egede: None.

Relationship Between Unmet Social Needs and Care Access in a Veteran Cohort

BackgroundThe association between unmet social needs (e.g., food insecurity) and adverse health outcomes is well-established, especially for patients with and at risk for cardiovascular disease (CVD). This has motivated healthcare systems to focus on unmet social needs. Yet, little is known about the mechanisms by which unmet social needs impact health, which limits healthcare-based intervention design and evaluation. One conceptual framework posits that unmet social needs may impact health by limiting care access, but this remains understudied.ObjectiveExamine the relationship between unmet social needs and care access.DesignCross-sectional study design using survey data on unmet needs merged with administrative data from the Veterans Health Administration (VA) Corporate Data Warehouse (September 2019–March 2021) and multivariable models to predict care access outcomes. Pooled and separate rural and urban logistic regression models were utilized with adjustments from sociodemographics, region, and comorbidity.SubjectsA national stratified random sample of VA-enrolled Veterans with and at risk for CVD who responded to the survey.Main MeasuresNo-show appointments were defined dichotomously as patients with one or more missed outpatient visits. Medication non-adherence was measured as proportion of days covered and defined dichotomously as adherence less than 80%.Key ResultsGreater burden of unmet social needs was associated with significantly higher odds of no-show appointments (OR = 3.27, 95% CI = 2.43, 4.39) and medication non-adherence (OR = 1.59, 95% CI = 1.19, 2.13), with similar associations observed for rural and urban Veterans. Social disconnection and legal needs were especially strong predictors of care access measures.ConclusionsFindings suggest that unmet social needs may adversely impact care access. Findings also point to specific unmet social needs that may be especially impactful and thus might be prioritized for interventions, in particular social disconnection and legal needs.

682-P: Intersectionality among Health-Related Social Needs Predicts Poor Mental Health among Youth and Young Adults with Diabetes

Little is known about how multiple health-related social needs may overlap to contribute to increased risk for poor mental health outcomes among youth and young adults (YYA) with diabetes. This study aims to understand how household food insecurity (HFI) intersects with other health-related social needs to influence poor mental health among YYA with type 1 diabetes (T1D). Analyses included a total of 829 YYA with T1D from the SEARCH Food Security Cohort study. Classification tree analysis was used to identify patterns among 11 health-related social needs, demographic, and socioeconomic characteristics that distinguish between moderate-to-severe and minimal-to-mild depressive symptoms. Health-related social needs included HFI, housing insecurity, need for reliable transportation, and experiences of discrimination. HFI was measured using the USDA Household Food Security Survey Module and experiences of discrimination were measured using the Everyday Discrimination Scale. The outcome of depressive symptoms was assessed using the Center for Epidemiological Studies-Depression (CES-D) scale. Overall, 35.6% reported moderate-to-severe depressive symptoms and 27.6% of YYA with T1D had anxiety symptoms; however, in the food insecure group, 73% and 56% were affected, respectively. Discrimination intersected with HFI among YYA with T1D such that 86% of YYA experiencing greater discrimination and HFI reported moderate-to-severe depressive symptoms (compared to 47% among the food secure group). In those reporting less discrimination, this corresponded to 56% and 17%, respectively. Adding discrimination to the model that included HFI, demographic, and socioeconomic measures improved the prediction accuracy (AUC= 0.71 versus AUC= 0.64). Study findings have implications for interventions to address multiple health-related social needs to decrease mental health problems among YYA with T1D. Disclosure A.D.Brown: None. A.Bellatorre: None. F.Malik: None. A.D.Liese: None. E.A.Frongillo: None. K.Flory: None. M.Lohman: None. J.Wei: None. J.A.Mendoza: None. B.A.Reboussin: None. E.T.Jensen: Consultant; Regeneron. L.M.Dolan: None. Funding National Institute of Diabetes and Digestive and Kidney Diseases (1R01DK117461-01, 1UC4DK108173); National Institute of General Medical Sciences (T32GM081740)

1124-P: Outcomes of Health-Related Social Needs Screening in a Midwest Pediatric Diabetes Clinic Network

Background: Screening for health-related social needs (HRSNs) is recommended as part of standard diabetes care given the strong impact of social factors on health outcomes. We implemented a HRSN screen at routine diabetes clinic visits and assessed differences between youth with positive and negative screens. Methods: A 6-item questionnaire was adapted from the Accountable Health Communities Health-related Social Needs Screening Tool to screen for HRSNs in 4 domains: 1) housing, 2) utilities 3) transportation, 4) food. A positive screen was defined as any positive response to a HRSN. Cross-sectional data was analyzed using chi-square or independent t-test. Results: There were 4,119 screens completed over 14 months with 10% (n=438) being positive. The majority of positive screens were positive for a single HRSN (73%), most commonly food insecurity (66%). Table 1 compares youth with positive vs. negative screens. A higher percentage of positive screens was found in minority youth (p&amp;lt;0.001), while a lower percentage was seen in youth with commercial insurance (p&amp;lt;0.001) and diabetes technology use (p&amp;lt;0.001). Most indicators of diabetes control were less optimal in the positive screen group. Summary: Youth with HRSNs are at risk for adverse health outcomes. Screening for HRSNs can be incorporated into routine pediatric diabetes care and may help enhance health equity in delivery of care. Disclosure K.Halpin: None. J.D.Colvin: None. M.A.Clements: Consultant; Glooko, Inc., Research Support; Dexcom, Inc., Abbott Diabetes. E.L.Dewit: None. S.Relan: None. J.Roghair: None. R.Pomerantz: None. K.Evans: None. M.S.Barnes: None. H.Feingold: None. S.N.Jacob: None. C.Winterer: None. Funding The Leona M. and Harry B. Helmsley Charitable Trust

63-OR: The Contribution of Social-Needs Factors to Racial Differences in Type 2 Diabetes

Studies have attributed gaps in type 2 diabetes (T2D) between Black/African-American (BAA) and White adults to socioeconomic factors. We quantified the contribution of social risk factors to racial gaps in T2D in 6 Kaiser Permanente health systems across the U.S. We utilized data collected from the National KP Social Needs Survey conducted in 2020 among 10,226 health system members. We linked survey data to electronic health record data. Exposures included financial strain, food insecurity, and housing instability in the past year. The outcome, prevalent T2D, was defined as either a diagnosis of T2D or medication fills for antidiabetic medications. Self-reported BAA and White race were used to stratify data. Other covariates included demographics, insurance type, clinical measures, and comorbidities. Cross-sectional logistic regression models assessed the odds of T2D by race and the Oaxaca-Blinder decomposition method calculated the percent contribution of all variables to the racial difference in T2D. All statistical analysis were weighted to account for the complex survey design. Our final analysis included 1,223 BAA and 3,372 White survey participants. BAA participants were more likely to be younger, female, report more social risk factors, and have a greater burden of comorbidities. The prevalence of T2D was 22% in BAA patients and 11% in White patients. The covariates in the Oaxaca-Blinder analysis explained 43% of the 11% overall difference in T2D prevalence between BAA and White patients. Of this explained difference, the combined variable of financial strain, food insecurity, or housing instability significantly contributed to the racial gap in T2D by 11%. Our results demonstrated, that if social risk factors of BAA patients were equal to White patients, the racial difference in T2D would be reduced by 11% in our population with access to health care. However, the impact is relatively small and other social factors (e.g. discrimination) will be important to explore using this methodology. Disclosure S. Vupputuri: None. S. Kim: None. M. Clennin: None. L. Cromwell: None. S.L. Daugherty: None. Funding Kaiser Permanente Social Needs Network for Evaluation and Translation

Meeting the Social and Emotional Needs of P–12 Learners: A Descriptive Study of Music Teacher Education Programs

The purpose of this survey study was to describe how teacher preparation programs prepare undergraduate preservice music teachers to consider P–12 learners’ socioemotional development. Music teacher education programs ( N = 665) were identified from the 2019 Title II Report of National Teacher Preparation Data. Program representatives were invited via email to complete an online questionnaire; data from respondents ( n = 133) were analyzed quantitatively and qualitatively. Findings revealed that programs varied greatly in providing opportunities, conceptions, and practices. Relevant, embedded coursework existed in most music teacher education programs. Just under one quarter of respondents reported requiring socioemotional development coursework, and 4.51% indicated at least one music-specific course. Course topics were directed at specific populations and teaching methods; courses were often housed in education, psychology, or sociology departments. Required experiences included fieldwork in general music, practicum, student teaching, or “diverse,” rural, or urban settings. Methods of delivery for optional experiences were similar to required experiences, with the addition of conferences and partnerships with organizations.

How Can Conspicuous Omni-Signaling Fulfil Social Needs and Induce Re-Consumption?

This study investigated consumer behaviors in conspicuous omni-signaling—its internal motivations and its consequences on social needs fulfilment and re-consumption intention in the context of luxury fashion. A phenomenon of conspicuous consumption is identified with the consumption and display of conspicuous goods to signal status, wealth, and prestige. Digital development has made conspicuous signaling radically emerge in social media through the posting of photos, videos, or stories of luxury goods. This drives an emerging phenomenon of conspicuous omni-signaling, the use of both offline and online media to signal conspicuous consumption hybridlike. As a new phenomenon, little is known of consumer behaviors related to conspicuous omni-signaling. To facilitate the investigation, an online survey was conducted to collect data from 474 valid respondents across eight cities representing various conspicuous consumption characteristics of Indonesian consumers. Veblen’s conspicuous consumption and Maslow’s hierarchy of needs theories were employed as the main lens for analysis. PLS-SEM technique was employed as the research model uses mixed reflective and formative constructs. WarpPLS 7.0 was then used for data analysis. The results indicated that luxury values and fashion consciousness positively affect conspicuous omni-signaling. This study also found that conspicuous omni-signaling affects conspicuous re-consumption both directly and indirectly through social needs fulfilment. This study contributes to extend the concept of conspicuous offline consumption and conspicuous online consumption to conspicuous omni-signaling. This study also confirms conflicting results in the effect of conspicuous consumption on social needs fulfilment, and conflicting results in the effect of conspicuous consumption on conspicuous re-consumption.

The effects of social determinants of health on colorectal cancer screening.

6568 Background: Colorectal cancer is the 3rd leading cause of cancer death in the United States yet has consistently lagged in screening rates compared to other cancers. While patient-reported barriers have been previously described, few studies have analyzed how patients’ social needs affect screening rates. Methods: This cross-sectional study includes 3974 Kaiser Permanente (KP) patients ages 50-75 years who completed the 2020 KP National Social Needs Survey. Survey respondents were from the seven KP regions of Southern California, Northern California, Colorado, Washington, Northwest, Georgia, and Hawaii. Five Social Needs categories were assessed: Financial Strain, Housing Instability, Transportation Issues, Social Isolation, and Food Insecurity. Being up to date on CRC screening was determined from patients’ KP electronic health records, defined as meeting HEDIS criteria for screening. Multivariate analyses compared the level of social need to the respondents’ completion of colorectal screening between the years of 2019-2021, adjusting for age, sex, race/ethnicity, diagnostic category group (DxCG), neighborhood deprivation index (NDI), and insurance type. Results: Among the 3974 survey respondents, 92.2% were up to date on their colorectal cancer screening. Not being up to date on CRC screening was significantly associated with having any social need and having severe needs in four of the five social need domains adjusted for sociodemographic and health status (Table). Patients were less likely to be screened if they had severe financial strain (OR 0.54, 95% CI 0.40-0.73), severe social isolation (OR 0.52, 95%CI 0.38-0.71), severe transportation issues (OR 0.33, 95% CI 0.18-0.61), and severe food insecurity (OR 0.41, 95% CI 0.27-0.62). No significant association between screening status and the domain of severe housing instability were found (OR 0.74, 95% CI 0.52-1.06). Conclusions: Respondents with financial strain, social isolation, food insecurity, and transportation issues had lower odds of being up to date with colorectal cancer screening. Future efforts aimed to improve colorectal cancer screening rates should assess patients’ social needs and target ways to address these potential barriers to screening. [Table: see text]

Estimated Costs of Intervening in Health-Related Social Needs Detected in Primary Care

Health-related social needs are increasingly being screened for in primary care practices, but it remains unclear how much additional financing is required to address those needs to improve health outcomes. To estimate the cost of implementing evidence-based interventions to address social needs identified in primary care practices. A decision analytical microsimulation of patients seen in primary care practices, using data on social needs from the National Center for Health Statistics from 2015 through 2018 (N = 19 225) was conducted. Primary care practices were categorized as federally qualified health centers (FQHCs), non-FQHC urban practices in high-poverty areas, non-FQHC rural practices in high-poverty areas, and practices in lower-poverty areas. Data analysis was performed from March 3 to December 16, 2022. Simulated evidence-based interventions of primary care-based screening and referral protocols, food assistance, housing programs, nonemergency medical transportation, and community-based care coordination. The primary outcome was per-person per-month cost of interventions. Intervention costs that have existing federally funded financing mechanisms (eg, the Supplemental Nutrition Assistance Program) and costs without such an existing mechanism were tabulated. Of the population included in the analysis, the mean (SD) age was 34.4 (25.9) years, and 54.3% were female. Among people with food and housing needs, most were program eligible for federally funded programs, but had low enrollment (eg, due to inadequate program capacity), with 78.0% of people with housing needs being program eligible vs 24.0% enrolled, and 95.6% of people with food needs being program eligible vs 70.2% enrolled. Among those with transportation insecurity and care coordination needs, eligibility criteria limited enrollment (26.3% of those in need being program eligible for transportation programs, and 5.7% of those in need being program eligible for care coordination programs). The cost of providing evidence-based interventions for these 4 domains averaged $60 (95% CI, $55-$65) per member per month (including approximately $5 for screening and referral management in clinics), of which $27 (95% CI, $24-$31) (45.8%) was federally funded. While disproportionate funding was available to populations seen at FQHCs, populations seen at non-FQHC practices in high-poverty areas had larger funding gaps (intervention costs not borne by existing federal funding mechanisms). In this decision analytical microsimulation study, food and housing interventions were limited by low enrollment among eligible people, whereas transportation and care coordination interventions were more limited by narrow eligibility criteria. Screening and referral management in primary care was a small expenditure relative to the cost of interventions to address social needs, and just under half of the costs of interventions were covered by existing federal funding mechanisms. These findings suggest that many resources are necessary to address social needs that fall largely outside of existing federal financing mechanisms.

Addressing Health-Related Social Needs—Costs and Optimism

It is well documented that health care contributes about 20% to a person’s health, while social and economic factors contribute twice as much.1 The substantial effect of social needs on health has led to increased interest in screening for and addressing social needs within health care settings.

CHQ- SocioEmo: Identifying Social and Emotional Support Needs in Consumer-Health Questions

General public, often called consumers, are increasingly seeking health information online. To be satisfactory, answers to health-related questions often have to go beyond informational needs. Automated approaches to consumer health question answering should be able to recognize the need for social and emotional support. Recently, large scale datasets have addressed the issue of medical question answering and highlighted the challenges associated with question classification from the standpoint of informational needs. However, there is a lack of annotated datasets for the non-informational needs. We introduce a new dataset for non-informational support needs, called CHQ-SocioEmo. The Dataset of Consumer Health Questions was collected from a community question answering forum and annotated with basic emotions and social support needs. This is the first publicly available resource for understanding non-informational support needs in consumer health-related questions online. We benchmark the corpus against multiple state-of-the-art classification models to demonstrate the dataset’s effectiveness.

A Unique Model and Workforce to Address Health-Related Social Needs and Health Equity: Regional Health Connectors in Colorado.

Unmet health-related social needs contribute to high morbidity and poor population health. Improving social conditions are likely to reduce health disparities and improve the health of the overall U.S. population. The primary objective of this article is to describe an innovative workforce model, called Regional Health Connectors (RHCs), and how they address health-related social needs in Colorado. This is a program evaluation that analyzed field notes and interview data from 2021-2022. We applied our findings to the framework developed by the National Academies of Sciences, Engineering, and Medicine's (NASEM's) report on strengthening social care integration into health care (2019). We found that RHCs address the following health-related social needs most commonly: food insecurity (n = 18 of 21 regions or 85% of all regions), housing (n = 17 or 81% of all regions), transportation (n = 11 or 52% of all regions), employment opportunities (n = 10 or 48% of all regions), and income/financial assistance (n = 11 or 52% of all regions). RHCs interacted across many sectors to address health-related social needs and provided multiple types of support to primary care practices at the organizational level. Examples of emerging impact of RHCs are described and mapped onto the NASEM framework. Findings from this program evaluation add to the growing landscape of knowledge and importance of detecting and addressing health-related social needs. We conclude that RHCs are a unique and emerging workforce that addresses multiple domains needed to integrate social care into health care.

A Physician's Sense of Responsibility to Address Disparities: Does It Relate to Reported Behaviors About Screening for and Addressing Social Needs?

It is widely accepted that negative social determinants of health (e.g., poverty) are underlying drivers of poor health and health disparities. There is overwhelming support among physicians to screen for patient-level social needs, but only a minority of clinicians actually do so. The authors explored potential associations between physician beliefs about health disparities and behaviors to screen and address social needs among patients. The authors used 2016 data from the American Medical Association Physician Masterfile database to identify a purposeful sample of U.S. physicians (n = 1,002); data obtained in 2017 were analyzed. Chi-squared tests of proportions and binomial regression analyses were employed to investigate associations between the belief that it is a physician's responsibility to address health disparities and perceptions of physician behaviors to screen for and address social needs, accounting for physician, clinical practice, and patient characteristics. Of 188 respondents, respondents who felt that physicians have a responsibility to address health disparities were more likely than their peers (who did not feel that physicians have such a responsibility) to report that a physician on their health care team would screen for social needs that were psychosocial (e.g., safety, social support) (45.5% vs 29.6%, P = .03) and material (e.g., food, housing) (33.0% vs 13.6%, P < .0001). They were also more likely to report that a physician on their health care team would address both psychosocial needs (48.1% vs 30.9%, P = .02) and material needs (21.4% vs 9.9%, P = .04). With the exception of screening for psychosocial needs, these associations persisted in adjusted models. Engaging physicians to screen for and address social needs should couple efforts to expand infrastructure with educational efforts about professionalism and health disparities, especially underlying drivers such as structural racism and the social determinants of health.

Health Care Impacts Of Resource Navigation For Health-Related Social Needs In The Accountable Health Communities Model.

Social determinants of health can adversely affect health and therefore lead to poor health care outcomes. When it launched in 2017, the Accountable Health Communities (AHC) Model was at the forefront of US health policy initiatives seeking to address social determinants of health. The AHC Model, sponsored by the Centers for Medicare and Medicaid Services, screened Medicare and Medicaid beneficiaries for health-related social needs and offered eligible beneficiaries assistance in connecting with community services. This study used data from the period 2015-21 to test whether the model had impacts on health care spending and use. Findings show statistically significant reductions in emergency department visits for both Medicaid and fee-for-service Medicare beneficiaries. Impacts on other outcomes were not statistically significant, but low statistical power may have limited our ability to detect model effects. Interviews with AHC Model participants who were offered navigation services to help them find community-based resources suggested that navigation services could have directly affected the way in which beneficiaries engage with the health care system, leading them to be more proactive in seeking appropriate care. Collectively, findings provide mixed evidence that engaging with beneficiaries who have health-related social needs can affect health care outcomes.

Addressing Health-Related Social Needs Via Community Resources: Lessons From Accountable Health Communities.

The Center for Medicare and Medicaid Innovation launched the Accountable Health Communities (AHC) Model in 2017 to assess whether identifying and addressing Medicare and Medicaid beneficiaries' health-related social needs reduced health care use and spending. We surveyed a subset of AHC Model beneficiaries with one or more health-related social needs and two or more emergency department visits in the prior twelve months to assess their use of community services and whether their needs were resolved. Survey findings indicated that navigation-connecting eligible patients with community services-did not significantly increase the rate of community service provider connections or the rate of needs resolution, relative to a randomized control group. Findings from interviews with AHC Model staff, community service providers, and beneficiaries identified challenges connecting beneficiaries to community services. When connections were made, resources often were insufficient to resolve beneficiaries' needs. For navigation to be successful, investments in additional resources to assist beneficiaries in their communities may be required.

Unmet Social Needs are Associated with Lower Adherence to Antiretroviral Therapy (ART) Medication Among a Sample of Black People Living with HIV (PLHIV).

The current study examined the prevalence and typology of unmet needs and the association between unmet needs and HIV antiretroviral therapy (ART) medication adherence among a sample of Black people living with HIV(PLHIV) (N = 304) in Los Angeles, CA. We found a high prevalence of unmet needs, with 32% of participants reporting having two or more unmet needs. The most common unmet needs category was basic benefits needs (35%), followed by subsistence needs (33%), and health needs (27%). Significant correlates of unmet needs included food insecurity, history of homelessness, and history of incarceration. A greater number of unmet needs and any unmet basic benefits needs were each significantly associated with lower odds of HIV ART medication adherence. These findings provide further evidence linking the social determinants of health and social disenfranchisement to ART medication adherence among Black PLHIV.

Supporting the Capture of Social Needs Through Natural Language Processing.

Social factors impact morbidity and mortality among patients. Documenting social needs in the clinical notes is currently widely done by family physicians. The unstructured format of information on social factors in electronic health records limits the ability of providers to address these issues. A proposed solution is using natural language processing to identify social needs from the electronic health record. This could support physicians in capturing structured social needs information that is consistent and reproducible without increasing documentation burden.

Preliminary Pilot-Testing of Social Determinants of Health Screener for Individuals With Intellectual and Developmental Disabilities in Med-Peds.

In the United States, one in six children has an intellectual and/or developmental disability (I/DD), including attention deficit hyperactivity disorder (ADHD), autism, cerebral palsy, learning disabilities, seizures, and developmental delays, with or without intellectual impairment. Individuals with I/DDs experience disproportionate rates of immune, metabolic, cardiovascular, and neurological disorders, as well as anxiety, depression, functional somatic symptoms, and other co-occurring physical and mental health conditions. During the coronavirus disease 2019 (COVID-19) pandemic, having an I/DD emerged as one of the strongest predictors of contracting and dying from COVID-19. These findings spurred increased attention toward the myriad health inequities affecting this population well before the pandemic. While inequities for individuals with I/DD can be traced to many factors, social determinants of health (SDOH) - the underlying social, economic, and environmental conditionsthat lead to poor health outcomes and high healthcare costs - are key contributors. Our interdisciplinary combined internal medicine and pediatrics (Med-Peds) team of physicians, psychologists, and researchers within a large, diverse, academic health system aimed to pilot-test the implementation of a five-item SDOH screener within a Med-Peds specialty clinic focused on the developmental needs of individuals with I/DD and their families (Leadership Education in Neurodevelopmental Disabilities {LEND}) and a general primary care practice (PCP).The SDOH screener tested in this initiative includes five items from the Accountable Health Communities (AHC) Health-Related Social Needs Screening Tool (HRSN) assessing social isolation, food insecurity, transportation, and paying for basic needs, such as housing and medical care. In this study, we describe the process of implementing this screener and collecting initial pilot data from 747 patients between October 2022 and April 2023 across the LEND and the primary care practice. We also highlight the challenges and opportunities identified during the mid-way point of implementation and pilot testing. The results of this pilot study revealed low response rates among SDOH screeners, spurring several measures to increase uptake, including increasing the accessibility of the screener and ensuring the screener results in effective referrals. We call on additional Med-Peds healthcare teams without universal SDOH screening protocols in place - particularly those serving the I/DD population - to consider adopting these practices.