Under pressure and underrecognized: The role of social workers and case managers in screening for social determinants of health in the United States

Social determinants of health (SDOH) screening is increasingly embedded in clinical care, yet the work of asking, documenting, and responding to social needs often falls to social workers and nurses or professional case managers who operate under significant time, staffing, and system constraints. We conducted a narrative review to examine how SDOH influence outcomes, identify systemic and emotional barriers to effective screening, and synthesize evidence-informed strategies that support implementation. Across included sources, findings clustered into three domains: challenges in integrating screening (policy and accreditation pressure, staffing and resource constraints, EHR documentation and interoperability limits, closed-loop referral and cross-sector partnership gaps, and training and role ambiguity), the emotional and professional toll (burnout, moral distress, and compassion fatigue, amplified by repeated identification of needs without reliable pathways to act), and trust and data accuracy (relational conditions for disclosure and how privacy, stigma, and documentation concerns shape data quality and downstream action). Promising practices emphasized clear communication about the purpose of screening, nonjudgmental and culturally responsive approaches, team-based workflows with role clarity, usable documentation processes, and referral infrastructure capable of follow-through. Overall, SDOH screening is advancing faster than workforce capacity and systems can respond, underscoring the need for investments that align expectations with actionable care pathways.