I7 – Screening, Referral and Linkage for Social Determinants of Health: Health Care and Early Childhood Systems Integration in Practice

Summary

Background. Child health practitioners and managers frequently support recommendations to screen for and provide social determinants of health (SDOH) resources to families. They also report reluctance to implement screening guidelines because they perceive community services to be limited or unavailable. Thus, forging effective partnerships across health care and community service systems is a promising, but still little understood, tool for addressing SDOH. Methods. This paper reports findings from one component of a mixed methods, longitudinal study of nine pediatric health care clinics in five U.S. communities implementing innovations to address SDOH among families of infants. The study reports the results of interviews at two time points with early childhood organizations and health care providers overseeing the innovations. In interviews (n = 60 at t1, n = 18 at t2), participants reported on their partnerships between community service systems and health care; experiences implementing screening, referral, and linkages in pediatric primary care; and key aspects to sustainability. We analyzed qualitative interviews thematically and developed cross-site summaries of emergent findings. Results. Early childhood and health care participants reported that embedding screening in pediatric health care, that includes team-based care, yielded important cross-sector knowledge that did not exist prior to implementing the innovations. Participants also said that the lack of clear financial mandates for the work influenced sustainability, as did a lack of role clarity about which system supported families to support access to community services. Implications. Screening, referral, and linkage for SDOH has promise to increase access to resources for individual families and as well as inform local and state advocacy efforts. However, current funding models, infrastructure, evidence, and will among leadership pose important constraints on scaling innovations to address SDOH.