Understanding Social Determinants of Health by Increasing Social Needs Screening and Referral at an Outpatient Mental Health Clinic

Background: Unmet social needs are widespread and greatly influence health and well-being. Local Problem: Despite the prevalence of unmet social needs, clinics often fail to screen for and assess the impact of social needs on health. This project aimed to increase social needs screening at an outpatient mental health clinic by implementing an electronic social needs screening tool with an automated referral to community resource information specialists from United Way 211. Methods: In this quality improvement initiative, we administered a pre-survey to assess knowledge, skills, attitudes, and current practices of social needs screening. We also developed and presented an educational module to discuss the importance of screening for social needs and trained participants on using the SINCERE screener. A post-survey administered to participants measured screener effectiveness. In addition, participants and facilitators explored perceived barriers in a final in-person meeting. Intervention: The SINCERE screener was implemented over three months, primarily among new clients. Results: During the 3-month implementation of the screener, six participants completed 13 screeners on their clients. Changes between the pre- and post-survey indicated minor increases in screening for healthcare access, transportation, unemployment, and access to child or elder care. Most participants (n = 5, 83%) felt the screener was helpful; however, two participants (33%) indicated they had never used it. Only two participants (33%) felt the automated referral was helpful. Five participants (83%) intend to continue using the screener post-implementation. Conclusion: Despite satisfaction with the screener, the actuality of participants using the screener was significantly less than anticipated. Several barriers contributed to the low screening rate, including low enrollment of new patients to the clinic and reluctance to ask questions on the screener they felt were already asked in their client interviews. Further efforts to increase social needs screening in a mental health setting should be conducted with a greater emphasis on barriers and facilitators to screening.