Defining the Social Needs Service Cascade: Evidence From A Multistakeholder Qualitative Study

Area of Science:

• Health Services Research
• Social Determinants of Health
• Health Equity

Background:

• Healthcare systems increasingly screen for social needs, creating a "social needs service cascade" between health and community organizations.
• This multi-step process, involving patient referrals for unmet social needs, is not well understood beyond initial screening and referral.
• Integrating health and social care delivery is essential for addressing complex patient needs.

Purpose of the Study:

• To explore and understand the "social needs service cascade" in detail.
• To identify critical steps and challenges within the social needs service cascade.
• To inform future research and policy for better health and social care integration.

Main Methods:

• Qualitative study involving interviews with clinicians (n=38), community organization representatives (n=14), and patients with type 2 diabetes and food insecurity (n=39).
• Thematic analysis of qualitative data to identify key components of the social needs service cascade.
• Conducted as part of an ongoing clinical trial (ClinicalTrials.gov NCT05472441).

Main Results:

• Identified key steps in the social needs service cascade: screening, referral, lag time, linkage and engagement experience, and resolution.
• Highlighted the complexities and experiences of patients and providers within this multi-step care process.
• Revealed areas for improvement in the transition from healthcare screening to community-based social support.

Conclusions:

• The social needs service cascade involves distinct, critical stages that require further investigation.
• Findings provide insights for optimizing the integration of health and social care services.
• Recommendations can guide future policy and interventions to improve patient outcomes by addressing social determinants of health.