How Community Health Workers Are Key to Screening for Social Determinants of Health

Social Determinants of Health (SDOH) are structural conditions (i.e. where people are born, grow, live, work, and age) that influence people’s health and well-being. It is important to identify the SDOH that impact communities that are marginalized because they are often most burdened by their negative effects. Providers serving complex and underserved populations need tools and strategies to identify patients experiencing social, institutional, and environmental factors that may drive poor outcomes and higher costs, as well as develop patient-, organizational-, systemic- and policy-level solutions to address these factors and ultimately improve population health.

Screening for SDOH helps health centers identify key barriers to care and create opportunities to facilitate better service delivery. The Protocol for Responding to and Assessing Patients Assets, Risks and Experiences (PRAPARE) is a national effort to help health centers and other providers collect and apply the data they need to better understand their patients’ social determinants, transform care to meet patient and population needs, and demonstrate the value they bring to patients, communities, and payers. Community Health Workers (CHWs) serve key populations that are vulnerable to adverse health outcomes due to socioeconomic factors, including poverty, unsafe work conditions, food insecurity, lack of transportation, and substandard housing. CHWs can engage in a wide array of activities to screen for and identify SDOH among their patients, including collecting SDOH information, using the PRAPARE tool, documenting SDOH data in electronic health records, and training staff to use data to address patients’ social needs.

This presentation will provide an overview of the importance of screening for SDOH, how CHW programs can be incorporated to improve screening among CHW populations, and promising practices for CHW programs addressing SDOH. Participants will obtain a better understanding of how CHW programs can positively impact screening efforts for SDOH in health care settings and how SDOH data can help health centers.