| Description |
Background: Pregnant and postpartum women with substance use disorder have an increased need for social work services. Existing recommendations include universal screening for health-related social needs and access to social workers to address identified needs. This paper details a quality improvement project that implemented a social needs screening and social work consultation protocol in a substanceuse in pregnancy clinic. Methods: This project used three phases of the PDSA (Plan-Do-Study-Act) cycle in collaboration with clinic staff to create, implement, analyze, and improve a social needs screening and consultation protocol. Patient chart review was used to evaluate protocol fidelity, which was measured bywhether the social needs screening was completed and added to the patient's medical record as well as the social work visit documented in the patient's medical record. A chi square test of independence was used to determine if outcomes changed significantly. Results:Protocol fidelityimprovedwith statistical significancebetween cycle 1 and cycle 2 and did notchange with statistical significancebetween cycle 2 and cycle 3. Between cycle 1 and cycle 2, there was asignificant increasebetween screenings completed per protocol (32.5% and 61.9%) respectively) and social work visit documentation (0% and 69% respectively). Overall, 88 patients were protocol eligible, 64 were screened, and 61 were offered social work consultations. Changes that improved protocol fidelity included using multiple iterationsof the PDSA cycle,collaboration with clinic team,providing protocol relevant training and continuous support to social workers, and complete integration of protocol into existing workflow. Patient characteristics that decreased protocol fidelity were fewer clinical visitsduring projectand establishment of care postpartum. The social needs screening assessed the following: housing IDENTIFYING AND ADDRESSING HEALTH-RELATED SOCIAL NEEDS 3insecurity, food insecurity, inability to pay for utilities, transportation limitations, interpersonal violence, impaired recovery environment (presence of an active user in the home), and social isolation. The most commonly identified needs via screening were food insecurity, housing insecurity, isolation, and transportation limitation. Social workers had patients prioritize needs and most commonly addressed impaired recovery environment, interpersonal safety, housing insecurity, and patient-identified needs which were not assessed in the screening. During social work visits, patients frequently prioritized needs that they were screened for but did not identify in their questionnaire, like social isolation, interpersonal violence, and recovery environment. Additionally, many patients prioritized needs during social work visits that they were not screened for at all. On the other hand, patients frequently did not prioritize items they did identified on the screening such as transportation and food security.Conclusions: The PDSA cycle was a useful and effective strategy in implementing the social needs screening and consultation protocol. Social needs and priorities were most thoroughly identified using both screening and social work consultation. Recommendations for clinical implementation include universal screening for social needs, universal social work consultation, and universal interventions provided for social needs that are highly prevalent but not frequently prioritized by patients. Areas for further research and improvement of this protocol include efforts to increase protocol fidelity for postpartum patients and patients with fewer clinical visits. |
