How High-Performing Community Health Clinics Accomplish Social Risk Screening

Recent national policies encourage health care delivery systems to document patients' social risks (SR), for example, food, housing, and transportation insecurity, and provide referrals to community services. Under-resourced community health centers (CHCs) face challenges integrating SR screening into care delivery. We sought out CHCs with consistently higher-than-average SR screening rates to understand what drives sustained integration.

This qualitative study used semistructured interviews to collect data about strategies for implementing and sustaining SR screening, staff and patient experiences, and external influences. We recruited 5 CHCs in 3 states with SR screening rates in the top 20% of a large national CHC network. Clinic staff in a variety of roles were invited to participate. Thematic analysis was used for interpretation of interview transcripts.

Interviews were conducted with 27 clinicians and other clinic staff. Responses highlighted both internal and external influences on SR screening. Internally, organization-wide investments in team-based care, longitudinal commitments to quality improvement activities, and capacity to coordinate social services were all cited as key drivers of staff commitment to screening. External influences included Accountable Care Organization incentives, Primary Care Medical Home certification requirements, and support from CHC consortia and external grants. Across interviews, SR screening was framed as a collective endeavor aligned with CHCs' collective mission to serve the whole patient.

CHCs with a sustained culture of team-based care, quality improvement, and care coordination may be more likely to integrate SR screening. Alongside enhanced external supports, investments in these well-characterized and mutually reinforcing building blocks of primary care are likely to translate to sustained SR screening in primary care clinical settings.