Comparison of Social Needs Identified Through Structured Screeners and Clinical Assessments

Health-related social needs, such as food, transportation, and housing insecurity, influence health outcomes. Although standardized social determinants of health screeners are increasingly used in clinical settings, it remains unclear how well these tools capture patient needs compared with conversational assessments conducted by trained staff, such as community health workers.

This observational study was conducted using deidentified electronic health record data from NYC Health + Hospitals between January 1 and December 31, 2023. Adult primary care patients (aged ≥21 years) completed both the system's standardized social determinants of health screener and a community health worker-led semistructured assessment. Assessments covered 10 domains: housing insecurity, housing quality, food insecurity, transportation, childcare, education, financial assistance, insurance or medical cost help, legal assistance, and employment. The proportions of patients with ≥1 identified need and concordance across instruments were calculated.

Among 2,077 patients who completed both instruments, 58.3% were female, 42.5% were Hispanic/Latinx, and 41.1% were Black or African American, with a mean (SD) age of 58 (14.5) years; 33% were uninsured, and 26.9% had Medicaid. Overall, 51.4% reported ≥1 social need on both instruments, 43.3% reported ≥1 need only to a community health worker, and 1.8% reported ≥1 need only on the screener. Community health workers identified higher rates of food insecurity (35.4% vs 10.7%), transportation needs (28.2% vs 11%), and legal assistance needs (23.8% vs 6.8%) than the screener.

Patients disclosed social needs to community health workers at substantially higher rates than on structured screeners, suggesting that conversational, relationship-based assessments reveal unmet needs not captured through standardized tools. Policies relying solely on structured social determinants of health screening may underestimate social needs. Allowing clinical assessments to complement or substitute for screeners could improve the identification of and linkage to resources.