Screening for social determinants of health (SDH) can promote collaboration between clinical and allied health services and the community by identifying unmet health-related social needs, barriers to health, and assisting individuals to access appropriate services. The Concord Hospital Family Health Center (CHFHC) is a selected site for a Medicaid payment transformation project that aims to achieve better outcomes at a lower cost. This project entailed screening for social determinants of health (SDH) in individuals covered by Medicaid and analyzing SDH data to identify patterns between biopsychosocial needs and healthcare utilization. The data collection took place at a family medicine residency-based community health center in a mixed urban-rural city in New Hampshire, which serves primarily under-insured individuals; 36% of whom have Medicaid. All adult English-speaking patients of CHFHC with NH Medicaid coverage who came to a clinic appointment were screened. Analysis looked at correlations between stressors, such as safety, education, transportation, housing, substance use, and depression screening, as well as healthcare utilization. Thus far (n=190), results identify positive correlation between stressors (including safety, education, transportation, housing and substance use) and anhedonia (52%) and depression (57%, r=0.64). This project is continuing in the data entry and analysis phase to continue to examine this correlation. A better understanding of the stressors of our Medicaid population, and their relationship to mental health outcomes can lead to an integrated behavioral health approach that would more adequately address these patterns and decrease barriers to care.
- Identify the stressors of our Medicaid population leading to anhedonia/depression.
- Identify correlations between the stressors and mental health outcomes.
- Adequately address specific stressors and decrease barriers to care in our Medicaid population.