Social Determinants of Health Screening in a Pediatric Medical Home: Social Workers’ Roles and Perspectives

Background. Social determinants of health (SDOH) screening in healthcare seeks to promote health equity by identifying and meeting health and social needs (Kreuter, 2021). Social workers play a key role given understanding of systems’ impacts on health, unique qualifications to address barriers uncovered by screenings, and ability to identify how to integrate screenings with resource linkage to improve health (Rine, 2016). Despite their central role in interprofessional teams, social workers’ views on SDOH screening are not often solicited; doing so can improve screening processes (Sokol, 2023). We sought to characterize social worker’s perspectives on SDOH screening.

Methods. We conducted qualitative interviews (N=11) about social needs screening, referral, and connection to resources in a university medical center. We interviewed clinic-based providers/social workers including: 1) BSW-level social workers focused on macro issues (“Guest Assistance Program”; GAP); 2) MSW-level, clinical social workers. Using thematic analysis (Braun, 2006) we identified themes regarding social workers’ roles in these processes.

Results. 4 themes emerged:
1. Technology access challenges regarding inequities in patient capacity to complete screening and provider capacity to address screening results: “We're only capturing folks that have a portal that they use [to complete screening questionnaires]. And people with the highest needs probably don't have that technology.”
2. Inefficiencies in internal processes when moving from screening to referral and connection to care: “Some doctors I think get confused and... send what should go to GAP to MSW... then I see MSW sending it to GAP. I think some people don't know about financial counselors, so the doctors will send anything financial related to GAP. And then GAP then sends it to financial counselors.”
3. Social workers are valued, but overburdened so can’t creatively problem-solve. Focus on productivity metrics hampers social workers’ autonomy to manage workload, leading to burnout and reduced capacity: “[Providers] send to where they think they can get resources, which is always social work. 'Cause social workers are creative, and they are problem solvers.” and “Unfortunately...I have to have a packed schedule to meet productivity requirements which means I'm not available for warm handoffs.”
4. Difficulties connecting families to resources and prioritizing needs. Prioritization isn’t based directly on need but on community resources available and/or family engagement; sometimes families report needs but decline referrals due to mandated reporting: “I've had families decline... services because they don't have transportation to the centers, and they don't want anyone coming to their home because they're worried that it's dirty and they're gonna get reported and... their kids are gonna get taken away.”

Conclusions. Social workers are often the connector between SDOH screening and referrals to care. Yet systems are not set up to support their efforts in an efficient manner, impacting social workers as they triage, problem-solve, and connect across units and to communities. Collaborating to improve within-system processes is critical for achieving positive social impact. Identifying systemic inefficiencies can reduce social worker burden so that they can work to their credentials to support clients and ultimately address inequities for families.