Social Determinants

Integrating Social Needs Screening and CHWs in Primary Care: The Community Linkage to Care Program

Clin Pediatr (Phila). 2020 Jun;59(6):547-556. [Pubmed Abstract]

Fiori KP, Rehm CD, Sanderson D, Braganza S, Parsons A, Chodon T, Whiskey R, Bernard P, & Rinke ML

Abstract
Clinic-based social needs screening has been associated with increased access to social services and improved health outcomes. Using a pragmatic study design in an urban pediatric practice, we used logistic regression to identify factors associated with successful social service uptake. From December 2017 to November 2018, 4948 households were screened for social needs, and 20% self-reported at least one. Of the 287 households with unmet needs who were referred and interested in further assistance, 43% reported successful social service uptake. Greater than 4 outreach encounters (adjusted odds ratio = 1.92; 95% confidence interval = 1.06-3.49) and follow-up time >30 days (adjusted odds ratio = 0.43; 95% confidence interval = 0.25-0.73) were significantly associated with successful referrals. These…

Toward an institutional perspective on social capital health interventions: lay CHWs as social capital builders

Sociol Health Illn. 2020 Jan;42(1):95-110. doi: 10.1111/1467-9566.12992. Epub 2019 Nov 1. [Pubmed Abstract]

Adams C

Abstract
This article argues that social capital health research should move beyond a mere focus on social cohesion and network perspectives to integrate an institutional approach into the development of social capital health interventions. An institutional perspective, which is unique in its emphasis on linking social capital in addition to the bonding and bridging forms, contextualises social capital, allowing researchers to confront the complexity of social relationships. This perspective allows for the construction of interventions that draw on the resources of diverse actors, particularly the state. One intervention strategy with the potential to create community linkages involves lay community health workers (LCHWs), individuals who are trained to perform a variety of health-related functions but lack a formal professional health education. This article…

Realizing the Value of CHWs — New Opportunities for Sustainable Financing

N Engl J Med. 2019 May 23;380(21):1990-1992. [Pubmed Abstract]

Lapidos A, Lapedis J, Heisler M

Health care financing in the US, especially since the passage of the Affordable Care Act (ACA) or “Obamacare,” has increased opportunities for financing peer support and community health worker (CHW) programs.  In this week’s Tuesday Tip, our colleague, Michele Heisler, and two of her other colleagues from the University of Michigan, Adrienne Lapidos and Jeremy Lapedis outline the case for routine financing of CHWs and several possible mechanisms and paths to accomplish this.

Opportunities include 2018 Medicare provisions to cover CHW and other nonmedical benefits especially for those with chronic diseases.  This follows earlier Medicaid provisions included in the ACA to cover CHW and other supportive services for those with mental health and chronic conditions.  Medicaid has also updated rules to encourage Medicaid MCOs to cover services including those addressing social…