Defining the social needs service cascade: Evidence from a multistakeholder qualitative study

A service cascade refers conceptually to a multi-step process that occurs during the delivery of care as individuals proceed from one part of care to the next. Health care systems increasingly screen patients for unmet social needs and refer them to community-based organizations to address them, requiring a multi-step interaction between the health and social care systems, which we refer to as the social needs service cascade. This cascade is poorly understood beyond screening and referral. As part of an ongoing trial, we interviewed clinicians (n = 38), representatives from community-based organizations (n = 14), and patients with both uncontrolled type 2 diabetes and food insecurity (n = 39), to improve our understanding of the cascade. Qualitative data were analyzed thematically, and highlight key cascade steps including: (a) screening, (b) referral, (c) lag time, (d) linkage and engagement experience, and (e) resolution. These findings can inform future studies and policy approaches supporting integration between health and social care.Trial