Social determinants of health: Screening in the clinical setting

Given the relevance of social circumstance, many healthcare organizations are developing innovative methods to address SDH within clinical settings as a possible strategy to enhance patient care, improve health outcomes, and prevent avoidable health care utilization. One particular approach endorsed by the American Academy of Pediatrics is SDH screening. This process takes place within clinical care settings and relies on clinical teams to administer a validated and standardized survey which seeks to identify unmet social needs or adverse social circumstances within the patient’s experience. After completion of the survey, providers discuss results with the patients and their families and develop an action plan for their needs to be addressed. This may be done in a variety of ways, with referrals to community resources being the most common.

Overall, screening is a complex process that will require considerable deliberation before implementing. Clinical care settings will need to consider their staffing capabilities, patient needs, and other variables before deciding upon a tool to use. With proper implementation, SDH screening and the associated referral process have been demonstrated to increase detection and discussion of patients’ social needs and to increase families’ receipt of beneficial resources. Despite the numerous benefits associated with pediatric screening, no standardized procedure nor tool exists. This policy brief reviews many of the models which implement screening and the characteristics that individual care settings should consider when selecting a tool for their institution. In addition, this brief discusses general implementation strategies and assesses the merits and evidence base of different comprehensive screening tools currently in use.