The welcome packet for families at the health clinic of Dayton (Ohio) Children's Hospital got a little thicker recently, with the addition of a new survey asking simple questions not about allergies and medications but about daily life at home. Do they have access to nutritious food? What about water and electricity?
The questionnaire is part of a new program, the Family Resource Connection, that screens families for basic social needs, then connects them with resources. The leaders who are behind the program regard it as critical, not just for the children and families whose lives—and health—they expect it to improve, but also for the healthcare system at large amid the industrywide drive to wring better health outcomes from fewer dollars.
“First of all, it's the right thing to do for kids,” said Jessica Saunders, director of the Center for Child Health and Wellness at Dayton. From a healthcare standpoint, the program promises many benefits, she added. “It's hard to quantify prevention, but that's ultimately what that program really addresses.”
By detecting patients' social needs, the program could potentially nip future medical problems in the bud. If a child has asthma because she's living in a home with mold, solutions like cleaning up the mold are far more cost-effective than repeated visits to the emergency room or pulmonary clinic, Saunders said.
The program will also allow doctors and social workers to practice at the top of their licenses, by tackling and resolving minor social issues and leaving the most difficult cases to the most highly trained. A major issue like homelessness, for instance, would be referred to the hospital's social work department, as the Family Resource Connection handles minor needs.
“Hopefully we're addressing them further upstream, before a situation might get out of control,” Saunders said. “That'll be cost savings down the road.”
Some research into the impact of social needs on healthcare links up to 40% of health outcomes to these needs. Other estimates suggest 70% of health outcomes can be attributed to social and environmental factors."
Dayton Children's Hospital started considering this program about a year and a half ago, when during strategic planning sessions, leaders realized they needed to address some of the social determinants of health—the environments where kids lived, played, went to school.
To build the program, they collaborated with Health Leads, a Boston-based not-for-profit that works with health systems to address the social needs of patients and which launched a toolkit in July for providers that want to gauge their patients' social needs.
In the screening process, families bringing their kids for wellness visits at the Dayton hospital's Children's Health Clinic fill out the questionnaire with a yes-or-no format before seeing the doctor. During the checkup, the doctor goes through the form, and if the family has an unmet social need, the doctor tells them that they'll be contacted by the Family Resource Connection.
Every day, a student volunteer visits the health clinic to collect screening forms and bring them to the Family Resource Connection. There, students who are overseen by a social worker with a master's degree make follow-up calls based on the forms, asking families more details about what they need and the most feasible way for them to get it.
At the students' fingertips is a database called Reach, a customizable tool developed by Health Leads that contains a host of different resources in the local community. Students can search and relay the information in it to families while also documenting their outreach work so that the team and coordinator can easily keep track of the outreach done with each family.
The students follow up until the family has gotten what it needs, like enrolling a child in an after-school program or resolving a utility bill. The process typically takes a maximum of two months, Saunders said. Currently, five attending doctors in the children's health clinic screen patients, sending four or five referrals daily to the Family Resource Connection.
Of those, about 40% of families report having unmet social needs, Saunders said. Since July 11, when the pilot program launched, about 120 families have been enrolled.
The students are drawn from five local universities; their academic backgrounds are of a mix of fields including social work, pre-med, exercise physiology and public health. That variety was deliberate, Saunders said. “We wanted them to learn what it's like to work on a multidisciplinary team,” she explained.
By working with others from different backgrounds, the students in the program, who receive college credit for their work, will become accustomed to working in a fashion that Saunders considers the future of healthcare. Until healthcare evolves to take social needs seriously, in a multidisciplinary fashion, “We're not going to move the needle on health,” she said. “We really wanted to leverage this program to build the next generation of healthcare workers.”
These services are not reimbursable, and the budget for the program at Dayton Children's Hospital is about $100,000, funded by donations from the community or philanthropies like the Dayton Children's Foundation.
Relying on philanthropic funding in the beginning is common among providers that have adopted social screening programs, said Lea Tompsett, principal of Health Leads' Learning Networks. “As they see results, they seek to move it into their operational budget,” she said.
It can be difficult to determine what health issues such programs have prevented. But their impact can be measured in other ways, as other organizations that have partnered with Health Leads to screen for social needs have begun to do, Tompsett said. Decreases in emergency room visits, patient and provider satisfaction and patient outcome are some of the possibilities, she said.
At Dayton Children's Hospital, the trajectory for its social screenings program is onward and upward. In the next four to six weeks, it'll roll out Spanish and Russian versions of the questionnaire, and it is also expanding the program to more clinics within the hospital.
Nationwide, the drive to improve healthcare quality and value has pushed a steadily expanding number of providers, payers and other institutions, including the U.S. government, to pay more attention to the social determinants of health.
In January, the CMS Innovation Center announced $157 million in funding for a pilot project to test whether screening patients for health-related social needs and connecting them to relevant resources would improve health and cut down on healthcare spending. Last week, it expanded part of that model to make it available to a broader swath of organizations.
“Many of these social issues, such as housing instability, hunger and interpersonal violence, affect individuals' health,” Dr. Patrick Conway, CMS' principal deputy administrator and chief medical officer, wrote in a blog post Thursday. “Yet they are rarely, if ever, detected or addressed during typical health care-related visits.”
