Evaluating Community Health Center Social Care Activities

Context: Despite the expansion of social risk data collection, little research has examined how the increased availability of social risk information influences care delivery.

Objective: To explore the collection and use of social risk data in community health centers (CHC) in Texas, and the facilitators/barriers to these social care activities in pre/peri-COVID-19 pandemic periods.

Study Design & Analysis: Mixed methods: 1) interviews and thematic analysis; 2) surveys and electronic health record (EHR) review and descriptive statistics.

Setting: Four urban/suburban CHCs.

Population Studied: Providers, staff and patients.

Instrument: Semi-structured interview guide, online survey.

Outcome Measures: Perspectives on integrating a range of social care activities; reach of social screening.

Results: We conducted 27 interviews (15 providers; 12 staff), 97 provider surveys, and reviewed EHR data from two CHCs. There was broad support for integrating social care; support increased peri-pandemic. 90% of survey respondents reported incorporating social screening into patient conversations; 46% of those screening used standardized screening tools. 29% of all survey respondents were unaware their clinic had a standardized tool. EHR data showed that both numbers of screens per month and rates of screens per encounters increased (4% of patient encounters in 8/2019 to 44% in 2/2021). There were significant differences in whether patients were screened by race/ethnicity and language (p<0.001). Provider and staff reported barriers to social care included: lack of time and staffing, language and cultural barriers, limited community resources, and poor coordination and communication about implementation efforts. Beyond making referrals to social services, providers used social data in medical care decision-making to improve medication affordability and change follow-up care planning.

Conclusions: CHCs were in the early phases of social care delivery, primarily focused on awareness and assistance with little dedicated attention to adjustment or population health-level evaluations. Differences in screening reach by patient demographics raise concern that social care might exacerbate disparities. Future research should explore equity in implementation and effectiveness. Overcoming barriers to reach, sustainability and equity will require supports targeted to program design and development, workforce capacity, quality improvement, and community investments in social services.