Critical Perspectives: Medical Social Workers' Early Insights on Health-Related Social Needs Screening and Follow-up

As the impact of social determinants of health on patients' health status has received greater focus, and in light of national changes in requirements for hospitals to assess and address health-related social needs (HRSN), healthcare organizations are designing and implementing formal screening and follow-up processes for HRSN. While healthcare organizations are gaining more experience with both HRSN screening and subsequent resource provisions, engaging staff who implement screening and follow-up is key to the development of sustainable and informed processes. This study sought to understand the perspectives of medical social work regarding HRSN screening and follow-up in order to help shape the design and implementation of new screening and follow-up processes. Medical social workers (MedSWs) were identified because of their position as the staff members most likely to address, identify, and follow up on HRSN. Therefore, they have useful insights into the context in which these activities take place.

Interviews were conducted at an urban pediatric hospital in the Midwest. Eighteen MedSWs from various inpatient, outpatient, and mixed-setting departments were interviewed. All of this institution's medical social workers were invited to participate in the interviews, which were held individually or in groups based on participant preference. A semi-structured interview guide was developed, which addressed social worker background, clinic flow, current process for social needs screening and follow-up (formal or informal), and potential barriers to and facilitators of screening implementation. Interviews were recorded with participant consent and transcribed verbatim. The research team utilized a consensus coding approach to identify common themes and interpret results.

Four main themes were identified from these interviews. The first described the benefits of a standardized screening process in reducing bias and more accurately identifying needs. A second theme focused on the importance of coordination and collaboration among other members of the hospital system in addressing these needs. The third theme reflected concerns raised by participants regarding their capacity for immediate follow-up with patient families. Finally, perspectives on follow-up were shared about the tailoring of resources to specific patient needs, the capacity for addressing identified needs in a timely manner, and the trusted resources that MedSWs rely on when addressing needs.

Since these interviews were conducted, their findings have been used to contribute to the process of expanding social needs screening in this hospital. Recent changes, including the option for patients to select the method of follow-up used after a positive screening, were driven by the findings of this study. Future research may expand to other members of the screening and follow-up processes to gain additional insight and revisit the perspectives of the MedSWs after these changes were made and since the rollout of HRSN screening across the institution has further progressed.