The role of threat vigilance in screening and addressing unmet social care in the ED

Background

 Screening for unmet social needs (such as food or housing insecurity) in healthcare settings has the potential to promote patient health by connecting them with needed resources, but many patients decline to complete screening instruments. 

Objective

The purpose of this paper was to identify the barriers and facilitators of patient participation in social needs screening. 

Methods

Between December 2022 and March 2023, we conducted four focus groups with 32 community-dwelling adults (10 English-Speaking and 22 Spanish-speaking) and asked participants why or why not they might answer screening questions. Based on current theoretical models of human threat vigilance, we coded participant speech into two broad categories: social threat (such as vulnerability, exclusion, and aggression) and social safety (such as helpfulness, inclusivity, and predictability). Analysis was conducted between May and December 2023 

Results

Participants discussed social threats 7 times more often than they discussed social safety, and all of these social threats were expectations (rather than experiences). In contrast, discussions of social safety centered on previous positive experiences, rather than expectations. 

Conclusion

These results align with the notion that human brains maintain a default state of threat vigilance until cues of safety and inclusion are detected. Accordingly, the only way to increase rates of screening is to “head off” patients’ automatic threat vigilance with clear and concrete evidence of social safety, before they are even given the screening instrument. These findings can assist healthcare organizations in developing “safety first” screening protocols that can enhance screening and rates of successful follow-up. 

Presentation slides