Social Needs Research Articles

The Association of Preoperative Food Insecurity With Early Postoperative Outcomes After Bariatric Surgery

IntroductionTo assess the rate of food insecurity in patients undergoing bariatric surgery. To compare the rates of 30-d postoperative complications based on food security status. MethodsPatients undergoing primary Roux-en-Y gastric bypass or sleeve gastrectomy between 7/2020 - 3/2022 were screened for food insecurity via telephone using questions from the Accountable Health Communities Health-Related Social Needs Screening Tool. Screens were matched to patient data and 30-d outcomes from the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program database. ResultsIn total, 213 (59%) of the 359 bariatric surgery patients were screened with 81 (38%) screening positive for food insecurity. Evaluation of preoperative variables based on food security status showed comparable age, body mass index, and comorbidity status. Food insecure patients were found to have an increased length of stay following surgery compared to food secure patients (P = 0.003). Food insecurity was not associated with higher rates of Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program reported 30-d postoperative complications including emergency department/urgent care visits (P = 0.34) and hospital readmissions (P = 0.94). ConclusionsFood insecurity was prevalent at 38% of the bariatric surgical population. Food insecure patients had a statistically longer length of stay after primary bariatric surgery but were not associated with an increased risk of 30-d complications. Future studies are needed to determine the mid-term and long-term effects of food insecurity status on bariatric surgical outcomes and the potential impact of food insecurity on length of stay.

Identification of Social Needs among Students with Disabilities from the View Point of Their Teachers: UAE Perspective

The goal of this research endeavor was to discern the social requirements of children with disabilities within the educational context of schools situated in the emirate of Abu Dhabi. Additionally, the study sought to explore potential differentials in the extent of these needs predicated upon variables such as gender and age. To this end, the researchers used a questionnaire consisting of 17 distinct items was methodically constructed and subsequently administered to a demographically diverse cohort of 83 educators, encompassing both male and female participants. The empirical findings of this investigation underscored the considerable significance of addressing the social needs encountered by children with disabilities in the Emirates of Abu Dhabi's educational institutions. Furthermore, the research focused on disparities in social needs were not significantly contingent upon gender-based distinctions. However, the analysis shows that age emerged as a substantively influential variable. Specifically, the researchers found that children within the age range of 7 to 10 exhibited a greater degree of social needs in comparison to their counterparts belonging to other age brackets.

Assessing the Feasibility of an Empathic Inquiry Approach to Social Needs Screening in 10 Federally Qualified Health Centers.

Despite an increasing emphasis from health care organizations on patients' social health, there is debate about how best to screen patients for social health needs in practice. Empathic Inquiry is a patient-centered approach to asking about patients' social needs that incorporates motivational interviewing and trauma-informed care techniques to increase patient experience of trustworthiness and safety with their care teams. The purpose of this brief report is to describe the feasibility and acceptability of implementing an Empathic Inquiry-informed approach to social needs screening in 10 federally qualified health centers. Clinical staff at community health centers implemented Empathic Inquiry as part of an 8-month learning collaborative. Patients completed surveys about their experience with Empathic Inquiry after screening conversations took place. Qualitative data on organizational implementation experience were collected monthly during 2018. Eight of 10 organizations completed the learning collaborative and implemented Empathic Inquiry in practice. Of 132 patient surveys received, patients agreed (64% strongly agree, 28% somewhat agree) that being screened for social needs strengthened their relationship with their care team and 83% strongly agreed the conversation was a good use of time. Most patients (54%) indicated social health screening was appropriate at every visit, and 27% answered once every 6 months. The Empathic Inquiry approach to understanding patients' social needs was feasible for implementation in community settings. Patients said the conversations were worthwhile, built trust with their care teams, and should be conducted every 6 months or more frequently.

Social Needs in the Prehospital Setting (SNIPS): EMS Attitudes Toward Addressing Patient Social Needs.

There has been interest in utilizing EMS to address patients' social determinants of health, which are thought to be the cause of many unnecessary transports, particularly for "super-utilizing" patients. However, existing research is limited regarding EMS clinicians' understanding of social determinants of health and attitudes toward potential interventions. This cross-sectional study was conducted using an internet-based survey of EMS clinicians across the United States with multiple methods of recruitment. Descriptive statistics and Chi Square Tests analyzed the data. A total of 1,112 EMTs and paramedics completed the survey with 43.4% reporting familiarity with the term, "social determinants of health," and 87.7% screening positive for burnout. Greater than 60% reported willingness to use proposed interventions to address patient social needs. Those who reported familiarity with the term, "social determinants of health," were more likely to indicate willingness to utilize interventions and to believe they were responsible for addressing their patients' social needs. Burnout had no effect on clinicians' willingness to use resources. Respondents showed substantial interest in using the proposed resources to address patient social needs, suggesting that EMS clinicians may be receptive to expanding their scope of responsibility to include socioeconomic interventions. EMS clinicians familiar with the term "social determinants of health" were more likely to believe they were responsible for addressing patient social needs and more willing to use interventions, suggesting a potential benefit to more education on the topic. Burnout among EMS clinicians may not be a barrier to implementing such interventions. Our survey suggests that EMS clinicians may be interested in helping to address their patients' social needs. EMS clinicians should be offered education on social determinants of health in their initial training and through continuing education. Partnerships with human services agencies will be important to ensure the effectiveness of prehospital interventions.

Addressing Veteran Health-Related Social Needs: How Joint Commission Standards Accelerated Integration and Expansion of Tools and Services in the Veterans Health Administration

The Joint Commission recently named reduction of health care disparities and improvement of health care equity as quality and safety priorities (Leadership [LD] Standard LD.04.03.08 and National Patient Safety Goal [NPSG] Standard NPSG.16.01.01). As the largest integrated health system, the Veterans Health Administration (VHA) sought to leverage these new accreditation standards to further integrate and expand existing tools and initiatives to reduce health care disparities and address health-related social needs (HRSNs). A combination of existing data tools (for example, Primary Care Equity Dashboard), resource tools (for example, Assessing Circumstances and Offering Resources for Needs tool), and a care delivery approach (for example, Whole Health) are discussed as quality improvement opportunities to further integrate and expand how VHA addresses health care disparities and HRSNs. The authors detail the development timeline, building, limitations, and future plans for these tools and initiatives. Responding to new health care equity Joint Commission standards led to new implementation strategies and deeper partnerships across VHA that facilitated expanded dissemination, technical assistance activities, and additional resources for VHA facilities to meet new standards and improve health care equity for veterans. Health care systems may learn from VHA's experiences, which include building actionable data platforms, employing user-centered design for initiative development and iteration, designing wide-reaching dissemination strategies for tools, and recognizing the importance of providing technical assistance for stakeholders. VHA continues to expand implementation of a diverse set of tools and resources to reduce health care disparities and identify and address unmet individual veteran HRSNs more widely and effectively.

“With me and for me”: Perspectives of Service Users with Complex Health and Social Needs on Mental Health Care

“With me and for me”: Perspectives of Service Users with Complex Health and Social Needs on Mental Health Care

A Case Study Implementing a Social Needs Screening Process and a Family Navigation Hub at Holland Bloorview Kids Rehabilitation Hospital.

Identifying and addressing clients' and families' most pressing social determinants of health needs are integral to quality healthcare. Healthcare leaders and front-line clinicians have long recognized the connection between unmet essential resource needs, such as food, housing and transportation and health outcomes. As a component of broader organizational efforts to improve equitable access to services, a social needs screening (SNS) initiative was introduced, along with a Family Navigation Hub providing navigation interventions. This paper describes the systematic approach taken to support the SNS initiative implementation and highlights evaluation results of the first year of activity.

Addressing Social Needs in Clinical Settings: Early Lessons from Accountable Health Communities.

The Centers for Medicare and Medicaid Services recently adopted quality metrics that require hospitals to screen for health-related social risks. The hope is that these requirements will encourage health care organizations to refer patients with social needs to community resources and, as possible, offer navigation services. This approach-screening, referrals, and navigation-is based, in part, on the Accountable Health Communities (AHC) model. Twenty-two of 31 participants in the AHC model in 2019 were interviewed to generate guidance for health care organizations as they implement screening, referral, and navigation activities to improve patients' health-related social risks. From these interviews, the team identified 4 key program design elements that facilitated AHC implementation: (1) centralized management office, (2) accountability milestones, (3) prescriptive requirements, and (4) technology support. The structure and requirements of the AHC model spurred participating organizations to rapidly implement social care activities, but the model did not allow for the flexibility necessary to ensure sustained adoption of AHC activities. The AHC model required a designated centralized management office, which was instrumental in ensuring AHC activities were implemented effectively. The centralized management office was typically external from participating clinical sites that impacted the AHC model's integration within clinical workflows. The reliance on the centralized management office to implement AHC activities limited the sustainability of the model. As payers, policymakers, and delivery system leaders aim to develop sustainable and effective social care programs, insights from these interviews can help guide and shape policy and program design elements.

S887 Health-Related Social Needs & Disease Activity Are Independently Associated With Moderate-to-Severe IBD-Related Disability

S887 Health-Related Social Needs & Disease Activity Are Independently Associated With Moderate-to-Severe IBD-Related Disability

410EMF Speaking the Same Language: Adapting Multilingual Approaches to a Clinical Social Needs Intervention

410EMF Speaking the Same Language: Adapting Multilingual Approaches to a Clinical Social Needs Intervention

Social Support Assets and Needs of Underrepresented Students Participating in Health Sciences Pathways Programs in Birmingham, Alabama.

Using the Asset Bundle Model, we sought to understand the social support assets and needs of underrepresented minority (URM) high school, undergraduate, and graduate students. Study participants were or had participated in health sciences pathway programs at Birmingham City Schools and/or the University of Alabama at Birmingham. We took a concurrent mixed methods approach to conduct an environmental scan of health science pathway programs in the Birmingham, AL area. Four focus groups were conducted between November 2022 and January 2023, and a 225-item online survey was administered between November 4, 2022, and February 4, 2023. Both tools collected data from high school, undergraduate, and graduate students to examine key components of existing health care pathways programs for URMs and identify barriers and facilitators to successful implementation of such programs. Twenty-two students participated in the focus groups, and 168 individuals responded to the survey. Both focus group participants and interview respondents were primarily URMs (eg, 68.2% and 65.7% identified as Black or African American, respectively). Survey responses and focus group discussions showed that, overall, undergraduate and graduate students programs develop more robust identities as future health care professionals through friendships and institutional supports, expand their networks more broadly through mentorship, and feel more supported by family members in their academic endeavors than high school students. Health science pathway programs for URMs should facilitate and bolster social supports for students, especially those in high school, to enhance persistence through education and into the workforce.

"We Don't Want to Screen for the Sake of Screening": A Qualitative Evaluation of a Social Needs Screening and Referral Intervention in the NICU.

Low uptake of social determinants of health (SDH) screening and referral interventions within neonatal intensive care units (NICUs) is partly due to limited understanding of the best procedures to integrate this practice into routine clinical workflows. To examine the feasibility and acceptability of an SDH screening and referral intervention in the NICU from the perspective of neonatal nurses; and to identify factors affecting implementation outcomes. We conducted 25 semistructured interviews with NICU nurses. We used the Promoting Action on Research Implementation in Health Services (PARiHS) framework to guide interview questions and codebook development for directed content analysis. Themes were mapped onto the 3 PARiHS domains of context, evidence, and facilitation. Analysis yielded 8 themes. Context : Nurses felt that stressors experienced by NICU families are magnified in a safety net environment. Nurses shared varying viewpoints of the roles and responsibilities for social care in the NICU, and feared that scarcity of community resources would make it difficult to address families' needs. Evidence : The intervention was perceived to increase identification of adverse SDH and provision of resources; and to potentially jump-start better caregiver and infant health trajectories. Facilitation : Procedures that improved acceptability included dynamic training and champion support, regular feedback on intervention outcomes, and strategies to reduce stigma and bias. We identified contextual factors, concrete messaging, and training procedures that may inform implementation of SDH screening and referral in NICU settings.

Engaging Stakeholder Advisors Around Health-Related Social Needs Research, Policy, and Practice Priorities.

As health care systems invest significant resources to address social needs associated with poor health such as food, financial, and housing insecurity, many eligible patients are still not obtaining the resources they need. The recently initiated PURPLE Project (Promoting Understanding in Social Needs Research Projects by Listening and Engaging) engages stakeholder advisors to help address 2 challenges: (1) many patients do not accept offered assistance, and (2) of patients who accept assistance, less than half have their needs addressed. This article presents the team's engagement with local advisors, garnering real-life insights from patients with social needs, staff and leadership in public health, health care, and community service organizations. The team shares these organizations' priorities and recommendations and how these can be applied to these major challenges. This article can assist others in the social care arena who seeks to involve local partners as advisors to improve practices and policies in addressing social needs.

Does the Urban Park Provision Fit the Social Needs of the Community? Evidence for Semarang City, Indonesia

Urban Park is a green open space in the form of social facilities that play an essential role in improving the quality of life of urban communities. This study aims to determine the categories of urban park services that can fit the community needs in Semarang City, Indonesia, covering locations of observation: Simpang Lima Park, Indonesia Kaya Park, Pandanaran Park, Banjir Kanal Barat Park, and Sri Gunting Park. Data were obtained by using a semi-open questionnaire from 100 park users. The analysis process used a scoring technique and hypothetical score category. The results showed that urban park services were in the “medium’ category. It can be seen from the assessment of 17 ideal urban park variables, dominated by the “medium” category (335<=X<397). They are completeness of the facilities, quality of facilities, types and the number of trees, suitability of the distance between spaces, park cleanliness conditions, clean air quality, wind, and sun direction orientation, parks’ use for social interaction, and users’ interest to promote the parks. These results indicated that urban park services were not yet maximum in fitting the community needs. This study is expected to be used for evaluation and input for future urban park planning.

Clinician Champions' Influence on Social Needs Screening Volumes in Pediatric Practices.

Health systems face barriers implementing routine screening for social needs. We assessed the impact of "clinician champions" on social needs screening. Screening data were assessed at 11 pediatric primary care practices in Bronx, NY, between April 2018 and August 2021. Three intervention practices had clinician champions; 8 control practices did not. The Wald chi-square tests and Poisson regressions evaluated the relationship between screening and introduction of clinician champions. The introduction of a clinician champion was a significant predictor of screening (P < .001). Within a practice, screening after the introduction of a clinician champion was higher than before the introduction (P < .001). The rate of screening for practices with a clinician champion was 2.8 times higher per month than for practices without a clinician champion. Furthermore, practices with clinician champions had higher rates of screening during the pandemic. In summary, the presence of clinician champions increased social needs screening rates in pediatric primary care practices.

Implementing and Enhancing Social and Economic Needs Screening at a Federally Qualified Health Center.

Programs to screen for social and economic needs (SENs) are challenging to implement. To describe implementation of an SEN screening program for patients obtaining care at a federally qualified health center (FQHC). Large Chicago-area FQHC where many patients are Hispanic/Latino and insured through Medicaid. In the program's phase 1 (beginning April 2020), a prescreening question asked about patients' interest in receiving community resources; staff then called interested patients. After several refinements (e.g., increased staffing, tailored reductions in screening frequency) to address challenges such as a large screening backlog, program phase 2 began in February 2021. In phase 2, a second prescreening question asked about patients' preferred modality to learn about community resources (text/email versus phone calls). During phase 1, 8925 of 29,861 patients (30%) expressed interest in community resources. Only 40% of interested patients were successfully contacted and screened. In phase 2, 5781 of 21,737 patients (27%) expressed interest in resources; 84% of interested patients were successfully contacted by either text/email (43%) or phone (41%). Under one-third of patients obtaining care at an FQHC expressed interest in community resources for SENs. After program refinements, rates of follow-up with interested patients substantially increased.

Utilizing a Tailored Approach to Standardized Screening of Health-Related Social Needs.

Despite the increased awareness of social determinants of health (SDoH), integrating social needs screening into health care practice has not consistently occurred. No social needs screening using recommended standardized questions was available at an outpatient hemodialysis clinic. Plan-Do-Study-Act cycles, based on the Model for Improvement, were used to implement the Core 5 SDoH screening tool, a staff referral process, and an evaluation of the implementation process. A standardized social needs screening tool and a staff referral process were implemented. An evaluation of the implementation process also occurred. Of 73 patients screened, 21 reported 32 unmet social needs; all received referrals to community resources. Nurses demonstrated high acceptance and usability of the tool and the referral process. Implementing a standardized screening and referral process customized to clinical workflow enhanced the identification of social needs in patients undergoing hemodialysis.

Health-Related Social Needs in Patients With Gastroparesis: Relationships to Symptom Severity and Quality of Life

Patients with health-related social needs (HRSNs) experience barriers to health care services. To identify areas of intervention, we need to understand the impact of HRSN in patients with gastroparesis. This study aimed to 1) determine types of HRSN present in patients with gastroparesis; 2) analyze relationship between HRSN and gastroparesis symptom severity and health-related quality of life (HRQL); and 3) evaluate which HRSN domains most significantly affect symptom severity and HRQL. Patients with gastroparesis were enrolled and completed questionnaires to assess the following: 1) severity of gastroparetic symptoms using Gastroparesis Cardinal Symptom Index (GCSI); 2) HRSN using screening questionnaire; and 3) HRQL using the Patient Assessment of Upper Gastrointestinal Disorders-Quality of Life (PAGI-QOL). Three hundred twenty-one patients with gastroparesis participated in this study. Two hundred twelve patients completed GCSI and HRSN questionnaires, and 109 additional patients completed PAGI-QOL questionnaire. Of the 321 total patients, the most common HRSN were mental health, financial strain, and food insecurity. Overall, 43% had at least one HRSN and 22% had at least 2 HRSN. The number of HRSN was directly correlated to the GCSI total symptom score (r= 0.284, P < .05) while inversely correlated to the PAGI-QOL score (r=-0.650, P < .05). Of the 7 HRSN domains studied, patients with mental health HRSN, in particular, reported more severe gastroparesis symptoms and lower quality of life. A large number (43%) of patients with gastroparesis had at least 1 HRSN. Patients with HRSN reported more severe gastroparesis symptoms and lower quality of life than patients without HRSN.

Higher Art Education at Civilisational Crossroads: Creative, Personal, and Social Needs

The purpose of the article is to consider current issues of national higher art education in the context of meeting creative, personal, and social needs. Research methodology. To achieve the goal, general scientific (analysis and synthesis, generalisation) and special research methods were used. The systematic-analytical method made it possible to determine the features of modern art education, and the axiological method helped to identify the value priorities of art education, taking into account the needs of society and the artist. The method of theoretical generalisation was used to establish the specifics of the functioning of art education in modern conditions. The scientific novelty of the obtained results lies in the theoretical understanding of modern processes in art education, taking into account its personal, creative, and social potential. Conclusions. In general, the organisation of higher education in Ukraine provides a comprehensive approach to the training of an artist. The level of higher art education largely reflects the state of national education in general, the ability of students to act as producers of material and spiritual values, which characterises them as the spiritual potential of Ukraine. In order to address the issue of artistic education's relevance to contemporary civilisational challenges, its structure should be systematically modernised, taking into account the national educational experience gained. Traditional art education should be aimed at educating not only a producer of material values, but also a specialist capable of passing on his experience to a new generation, promoting spiritual values and interest in artistic activity among society by his own example. On the other hand, art education should enable artists to fulfil their creative and professional needs, which, in turn, should coincide with the development goals and needs of society.&#x0D; Key words: art education, artist, art, professional realisation, creativity, hermeneutics.

Social Needs as a Risk Factor for Positive Postpartum Depression Screens in Pediatric Primary Care.

The goal of this study was to examine the association between self-reported social needs and postpartum depression (PPD) symptoms of mothers screened in pediatric primary care clinics. This retrospective cohort study used electronic health record data from 3,616 pediatric patients (age 0 to 6 months), whose mothers completed the Edinburg Postpartum Depression Scale (EPDS) and a social needs screening in a large pediatric primary care network between April 2021 and February 2022. Mothers were screened for four self-reported social needs (food, housing, transportation, and utilities). Logistic regression evaluated the association between report of any social need and a positive EPDS screen (≥10), adjusting for demographic and clinical characteristics and ZIP code-level poverty. Overall, 8.6% of mothers screened positive for PPD and 10.0% reported any social needs. The odds of a positive depression screen were significantly higher among mothers who reported any social need compared to those not reporting a social need (OR 4.18, 95% CI 3.11-5.61). The prevalence of all depressive symptoms on the EPDS was significantly higher among those who reported any social need, relative to those reporting no needs. Mothers reporting any social needs were significantly more likely to report thoughts of self-harm (6.9% vs. 1.5%, p<0.005). Self-report of social need was significantly associated with positive PPD screens during infant well-child visits. Social needs may be a target of future interventions addressing PPD in pediatric settings. Improving care for social needs may have added benefit of alleviating risk for PPD.