Development and validation of a performance-based assessment for communication about social needs with patients

Background: 
Unmet social needs impact morbidity, mortality and healthcare engagement and utilization. Screening patients for social needs and referring to services that can address those needs improves patient-level outcomes and are part of regulatory guidelines. Clinicians report a key barrier to addressing social needs is discomfort having conversations with patients and concern about negative impacts on patient relationships. Conversations are susceptible to bias and microaggressions and can result in patient and provider frustration. 

Objective: 
Assess the reliability and validity of a stakeholder-informed, multi-disciplinary communications checklist for social needs conversations between clinicians and patients using standardized patients and workplace-based assessment. 

Methods: 
An interdisciplinary team of internal medicine, pediatric, family medicine, and population health faculty conducted a literature review and met over an extended period. Using principles of relationship-centered communication, we drafted an initial version of a communications skills checklist for use by faculty and standardized patients to assess conversations around social needs. To guide checklist items, we utilized principles of trauma-informed care and strengths-based approach. We are establishing content validity through patient, community health worker and clinician focus groups, and a national expert Delphi survey. We will then assess reliability and dimensionality, set competency standards, and explore criterion validity. 

Results:
 We developed the “Go-DEEP” communication skills checklist. Components of the checklist include explaining social needs screening, asking permission, delving into social needs, exhibiting empathy, exploring patients’ perspectives, and partnering to develop a plan. 

Conclusion: 
This project will fill a critical gap in performance-based assessment of addressing social needs in the clinical setting through the development of an innovative and transferable stakeholder-informed social needs communication assessment checklist with reliability and validity evidence. Ultimately, this project will enhance communication between clinicians and patients about health-related social needs, fostering greater trust and improving health outcomes.)

Presentation slides