The growing recognition that social risk factors influence individual and population health has generated stakeholder support in the promotion of health equity, bridging partnerships across health care, public health, and social service sectors. The integration of social care into health care delivery requires routine screening to identify and address health-related social needs (HRSN). Screening tools must be short, accessible, and inclusive and accurately reflect potential risks to prioritize tailored interventions. However, HRSNs are also sensitive and can prompt additional ethical concerns when integrated with clinical practice in medical care. This paper examines the psychometric properties of three stakeholder-driven HRSN screening tools to identify adverse, unmet risks among oncology patients. Further research is needed to ensure social needs initiatives protect sensitive social data in electronic health records and that patients with complex medical and social needs receive comprehensive resources through targeted service connections.
The Accountable Health Communities Health-Related Social Needs Screening Tool. (2017). CMS. file:///C:/Users/joshu/Desktop/Healthy%20Planet/AHCM-HealthSocialNeedsScreeningTool-rev-8_10_2021.pdf.
2.
AdlerN. E.SteadW. W. (2015). Patients in context—EHR capture of social and behavioral determinants of health. New England Journal of Medicine, 372(8), 698–701. https://doi.org/10.1056/NEJMp1413945
3.
AlleyD. E.AsomughaC. N.ConwayP. H.SanghaviD. M. (2016). Accountable health communities—addressing social needs through Medicare and Medicaid. New England Journal of Medicine, 374(1), 8–11. https://doi.org/10.1056/NEJMp1512532
4.
BerkowitzS. A.HulbergA. C.HongC.StowellB. J.TirozziK. J.TraoreC. Y.AtlasS. J. (2016). Addressing basic resource needs to improve primary care quality: A community collaboration programme. BMJ Quality & Safety, 25(3), 164–172. https://doi.org/10.1136/bmjqs-2015-004521
5.
BerkowitzS. A.HulbergA. C.StandishS.ReznorG.AtlasS. J. (2017). Addressing unmet basic resource needs as part of chronic cardiometabolic disease management. JAMA Internal Medicine, 177(2), 244. https://doi.org/10.1001/jamainternmed.2016.7691
Centers for Disease Control and Prevention (n.d.). Social determinants of health: Know what affects health. Department of Health and Human Services. Retrieved September 23, 2022, from https://www.cdc.gov/socialdeterminants/.
8.
Centers for Medicare and Medicaid Services, Billioux, A., Verlander, K., Centers for Medicare and Medicaid Services, Anthony, S., Centers for Medicare and Medicaid Services, Alley, D., & Centers for Medicare and Medicaid Services (2017). Standardized screening for health-related social needs in clinical settings: The accountable health communities screening tool. NAM Perspectives, 7(5), 1–40. https://doi.org/10.31478/201705b
9.
ChenP.-H.RoviS.VegaM.JacobsA.JohnsonM. S. (2005). Screening for domestic violence in a predominantly hispanic clinical setting. Family Practice, 22(6), 617–623. https://doi.org/10.1093/fampra/cmi075
10.
Commission on Social Determinants of Health (2008). Closing the gap in a generation: Health equity through action on the social determinants of health : Final report of the commission on social determinants of health. Combler Le Fossé En Une Génération : Instaurer L’équité En Santé En Agissant Sur Les Déterminants Sociaux de La Santé : Rapport Final de La Commission Des Déterminants Sociaux de La Santé, 247.
11.
CookJ. T.FrankD. A.CaseyP. H.Rose-JacobsR.BlackM. M.ChiltonM.deCubaS. E.AppuglieseD.ColemanS.HeerenT.BerkowitzC.CuttsD. B. (2008). A brief indicator of household energy security: Associations with food security, child health, and child development in US infants and toddlers. Pediatrics, 122(4), e867–e875. https://doi.org/10.1542/peds.2008-0286
12.
CunninghamW. E.AndersenR. M.KatzM. H.SteinM. D.TurnerB. J.CrystalS.ZierlerS.KuromiyaK.MortonS. C.St ClairP.BozzetteS. A.ShapiroM. F. (1999). The impact of competing subsistence needs and barriers on access to medical care for persons with human immunodeficiency virus receiving care in the United States. Medical Care, 37(12), 1270–1281. https://doi.org/10.1097/00005650-199912000-00010
13.
DeCampM.DeSalvoK.DzengE. (2020). Ethics and spheres of influence in addressing social determinants of health. Journal of General Internal Medicine, 35(9), 2743–2745. https://doi.org/10.1007/s11606-020-05973-1
14.
FerrellB. R.TwaddleM. L.MelnickA.MeierD. E. (2018). National consensus project clinical practice guidelines for quality palliative care guidelines, 4th edition. Journal of Palliative Medicine, 21(12), 1684–1689. https://doi.org/10.1089/jpm.2018.0431
15.
GargA.Boynton-JarrettR.DworkinP. H. (2016). Avoiding the unintended consequences of screening for social determinants of health. JAMA, 316(8), 813. https://doi.org/10.1001/jama.2016.9282
16.
GargA.MarinoM.VikaniA. R.SolomonB. S. (2012). Addressing families’ unmet social needs within pediatric primary care: The health leads model. Clinical Pediatrics, 51(12), 1191–1193. https://doi.org/10.1177/0009922812437930
17.
GottliebL.TobeyR.CantorJ.HesslerD.AdlerN. E. (2016). Integrating social and medical data to improve population health: Opportunities and barriers. Health Affairs, 35(11), 2116–2123. https://doi.org/10.1377/hlthaff.2016.0723
18.
HagerE. R.QuiggA. M.BlackM. M.ColemanS. M.HeerenT.Rose-JacobsR.CookJ. T.De CubaS. A. E.CaseyP. H.ChiltonM.CuttsD. B.MeyersA. F.FrankD. A. (2010). Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics, 126(1), e26–e32. https://doi.org/10.1542/peds.2009-3146
19.
Health Leads, Inc (2018). Health Leads Social Needs Screening Toolkit.
HenriksonN. B.BlasiP. R.DorseyC. N.MettertK. D.NguyenM. B.Walsh-BaileyC.MacuibaJ.GottliebL. M.LewisC. C. (2019). Psychometric and pragmatic properties of social risk screening tools: A systematic review. American Journal of Preventive Medicine, 57(6), S13–S24. https://doi.org/10.1016/j.amepre.2019.07.012
22.
HillS.TopelK.LiX.SolomonB. S. (2022). Engagement in a social needs navigation program and health care utilization in pediatric primary care. Academic Pediatrics, 22(7), 1221–1227. https://doi.org/10.1016/j.acap.2022.05.012
23.
Institute of Medicine (U.S.) (2014). Capturing social and behavioral domains and measures in electronic health records: Phase 2 (p. 18951). National Academies Press.
24.
KornA. R.Walsh-BaileyC.Correa-MendezM.DelNeroP.PilarM.SandlerB.BrownsonR. C.EmmonsK. M.OhA. Y. (2023). Social determinants of health and US cancer screening interventions: A systematic review. CA: A Cancer Journal for Clinicians, 73, 461–479. https://doi.org/10.3322/caac.21801
25.
KreuterM. W.ThompsonT.McQueenA.GargR. (2021). Addressing social needs in health care settings: Evidence, challenges, and opportunities for public health. Annual Review of Public Health, 42(1), 329–344. https://doi.org/10.1146/annurev-publhealth-090419-102204
26.
LeeJ.KorbaC. (2017). Social determinants of health: How are hospitals and health systems investing in and addressing social needs?Deloitte Center for Health Solutions.
27.
MoenM.StorrC.GermanD.FriedmannE.JohantgenM. (2020). A review of tools to screen for social determinants of health in the United States: A practice brief. Population Health Management, 23(6), 422–429. https://doi.org/10.1089/pop.2019.0158
28.
MontgomeryA. E.FargoJ. D.KaneV.CulhaneD. P. (2014). Development and validation of an instrument to assess imminent risk of homelessness among veterans. Public Health Reports, 129(5), 428–436. https://doi.org/10.1177/003335491412900506
National Association of Community Health Centers, Inc., Association of Asian Pacific Community Health Organizations, & Oregon Primary Care Association (2016). PRAPARE Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences. https://prapare.org/wp-content/uploads/2023/01/PRAPARE-English.pdf.
31.
NuruzzamanN.BroadwinM.KouroumaK.OlsonD. P. (2015). Making the social determinants of health a routine part of medical care. Journal of Health Care for the Poor and Underserved, 26(2), 321–327. https://doi.org/10.1353/hpu.2015.0036
32.
O’GurekD.HenkeC. (2018). A practical approach to screening for social determinants of health. Family Practice Management, 25(3), 7–12.
RabinR. F.JenningsJ. M.CampbellJ. C.Bair-MerrittM. H. (2009). Intimate partner violence screening tools. American Journal of Preventive Medicine, 36(5), 439–445.e4. https://doi.org/10.1016/j.amepre.2009.01.024
37.
ShakilA.DonaldS.SinacoreJ. M.KrepchoM. (2005). Validation of the HITS domestic violence screening tool with males. Family Medicine, 37(3), 193–198.
38.
SherinK. M.SinacoreJ. M.LiX.-Q.ZitterR. E.ShakilA. (1998). HITS: A short domestic violence screening tool for use in a family practice setting. Family Medicine.
39.
TsuiJ.YangA.AnuforoB.ChouJ.BrogdenR.XuB.CantorJ. C.WangS. (2021). Health related social needs among Chinese American primary care patients during the COVID-19 pandemic: Implications for cancer screening and primary care. Frontiers in Public Health, 9, 674035. https://doi.org/10.3389/fpubh.2021.674035
40.
WeirR. C.ProserM.JesterM.LiV.Hood-RonickC. M.GurewichD. (2020). Collecting social determinants of health data in the clinical setting: Findings from national PRAPARE implementation. Journal of Health Care for the Poor and Underserved, 31(2), 1018–1035. https://doi.org/10.1353/hpu.2020.0075
