In January, I wrote a Medscape commentary about the mixed evidence that routinely screening patients for social needs improves health outcomes. Although many patients could benefit from assistance with necessities like food, housing, or transportation, screening for social needs only works if patients are prepared to accept help and realistic options exist to provide it:
There are also downsides to screening, which takes time and can distract from the purpose of the visit. ... Many of my patients decline social work referrals, leading me to wonder why we screened them in the first place if they knew that they would not want assistance. For others, referrals may be wasting their time and giving them false hope. Social workers can’t magically produce affordable housing in the midst of a national housing shortage or provide regular access to healthy meals — especially after Supplemental Nutrition Assistance Program benefits were cut by hundreds of millions of dollars.In his 2020 Presidential campaign, entrepreneur Andrew Yang famously endorsed a different strategy. Rather than spending millions on inefficient bureaucracies whose sole purpose is to ensure that only the neediest qualify for government assistance, Yang advocated providing universal basic income, a "Freedom Dividend," to every citizen to spend or save as they saw fit. This strategy would eliminate the stigma of being identified as having social needs.
Could an analogous approach to social risk work in health care - offering every patient a menu of resources to select from rather than screening first and only assessing the needs of persons who screen positive? Dr. Danielle Cullen and colleagues at the Children's Hospital of Philadelphia studied this question in the Socially Equitable Care by Understanding Resource Engagement (SECURE) randomized trial. In this study, 3949 caregivers of children and young adults in the emergency department were randomized to one of 3 groups: 1) completing a social risk screener; 2) receiving a resource menu to indicate desired assistance; and 3) no social assessment. All caregivers were provided with an electronic "resource map" after the initial intervention. The primary outcome was reported desire for resources in any of 5 domains (housing, transportation, childcare, food security, household heat and electricity). Caregivers assigned to the resource menu group were significantly more likely to meet the primary outcome than the screening group (38.4% vs 29%).
Although this study's findings need to be replicated in primary care and patients of all ages, it contributes an important piece to the puzzle of how health care institutions can best elicit and assist with health-related social needs.
