Avoiding the unintended consequences of screening for social determinants of health

Screening for social determinants of health, which are the health-related social circumstances (e.g., food insecurity and inadequate or unstable housing) in which people live and work, has gained momentum as evidenced by the recent Centers for Medicare & Medicaid Services innovation initiative of $157 million toward creation of accountable health communities. Funding will allow grantees to test a novel model of health care that includes identifying and addressing social determinants of health for Centers for Medicare & Medicaid Services beneficiaries. The initiative promotes collaboration between the clinical realm and the community through screening of beneficiaries to (1) identify unmet health-related social needs and (2) assist high-risk beneficiaries (i.e., >2 emergency department visits and a health-related social need) with accessing available community services. However, screening for social determinants of health is fundamentally different than more traditional medical screening. As a result, application of key principles could help ensure the benefits of such screening and minimize unintended consequences. Social determinants screening should (1) be patient- and family-centered and involve shared decision making; (2) be conducted within a comprehensive process and system that supports early detection, referral, and linkage to a wide array of community-based services; (3) engage the entire practice population rather than targeted subgroups; and (4) acknowledge and build on the strengths of patients, families, and communities. With attention to these key tenets, screening for social determinants of health has the potential to significantly improve the health and well-being of all patients.