Implementation of health-related social needs screening at michigan health centers: A qualitative study

Abstract

PURPOSE Federally qualified health centers (FQHCs) are leaders in screening for and addressing patient’s health-related social needs but variation exists in screening practices. This variation is relatively unexplored, particularly the influences of organizational and state policies. We employed a qualitative descriptive approach to study social needs screening practices at Michigan FQHCs to characterize screening processes and identify drivers of variation in screening implementation. METHODS Site visits and semistructured interviews were conducted from October 2016 through March 2017, to explore implementation of social needs screening in clinical practice. Five FQHCs were selected through maximum variation sam-pling. Within each site, snowball sampling identified care team members highly knowledgeable about social needs screening. We conducted 4 to 5 interviews per site. Transcripts were analyzed using a thematic approach. RESULTS We interviewed 23 participants from 5 sites; these sites varied by geogra-phy, age distribution, and race/ethnicity. We identified 4 themes: (1) statewide ini-tiatives and local leadership drove variation in screening practices; (2) as community health workers (CHWs) played an integral role in identifying patients’ needs, their roles often shifted from that of screener to implementer; (3) social needs screening data was variably integrated into electronic health records and infre-quently used for population health management; and (4) sites experienced barriers to social needs screening that limited the perceived impact and sustainability. CONCLUSIONS FQHCs placed value on the role of CHWs, on sustainable initia-tives, and on funding to support continued social needs screening in primary care settings.