Social determinants of health (SDOH) are the environmental conditions that impact peoples’ health, and  they  play a critical role in how, when, and why patients experience illness or injury. They also change the way that healthcare professionals choose to treat these patients. The environments and conditions that people are born and raised in directly influence their health. Healthcare without regard for social determinants leaves little room for personalized treatment or effective, targeted solutions.  

While major organizations like the CDC and various health insurers are investigating SDOH data to advance health equality and uncover new financial models for broad healthcare funds, individual practices and hospital networks have plenty to gain by diving deep into SDOH. The United States spends more on healthcare than any other developed nation, yet, according to the  2017 Commonwealth Fund, we rank last in overall health outcomes. 

Evidence indicates that social determinants of health directly impact various health outcomes. For instance, low-income populations tend to receive less specialized health care due to lack of consideration of social determinants. Data shows that those who suffer from unmet social needs are more likely to: 

• Become frequent emergency department users 
• Have poor cholesterol and glycemic control 
• No-show (even repeatedly) to appointments 

According to the New England Journal of Medicine, 40 percent of premature deaths occur due to individual behaviors. Finding ways to identify the core social determinants that produce these outcomes will improve the quality-of-care, efficiency, equity and equality of healthcare services — especially when it comes to behavioral health. 

Understanding Social Determinants of Health 

As we embrace the big and beautiful world of “big data,” healthcare providers are constantly looking for ways to predict health issues and improve the quality of care. But trying to analyze clinical data doesn’t paint a clear picture. It’s evident that non-clinical factors have a significant impact on people’s well-being, and these factors can help us better understand the healthcare ecosystem at large. 

The CDC promotes a focus on five primary areas of social determinants of health during the coming year. This offers additional insight into some of the social determinants that health experts rely on most to treat patients: 

• Economic stability
  • Employment
  • Food insecurity 
  • Housing instability 
  • Poverty 
• Education
  • Early childhood education and development 
  • Enrollment in higher education 
  • High school graduation 
  • Language and literacy 
• Social and community context
  • Civic participation 
  • Discrimination 
  • Incarceration 
  • Social cohesion 
• Health and health care
  • Access to health care
  • Access to primary care 
  • Health literacy 
• Neighborhood and built environment
  • Access to foods that support healthy eating patterns 
  • Crime and violence 
  • Environmental conditions 
  • Quality of housing 

In other words, social determinants of health are all of the magical metrics that make up peoples’ incredibly complex lives. Where do they live, work, play, eat, sleep, and socialize? What kind of healthcare access have they had in the past? What types of transportation systems do they use? What are their coping mechanisms bred by childhood experiences? These clusters of very real experiences are the so-called “makeup” of peoples’ health DNA.  

How Behavioral Health Institutions Can Begin the Social Determinant Journey 

For most organizations, the social determinants of health journey doesn’t have to begin with a significant monetary investment. But you do have to be committed to holistic healthcare. The initial action starts with information gathering and screening at intake. Of course, it’s valuable to create additional data collection methodologies and each additional data point helps demystify the societal factors that surround each patient. 

To scale analysis of social determinants of health, organizations need to invest in data analysis tools found in inclusive EHR softwares like Procentive and pair these with standard policies and procedures. According to Deloitte, healthcare providers should be looking to accomplish three primary goals with their social determinants of health strategy: 

• Resource consolidation empowered by breaking down silos between healthcare departments 
• Creating value-based models of healthcare that incorporate social needs 
• Improve health tracking, modeling, and cost outcomes 

While the immediate financial impact of societally-geared strategies may not be visible, incorporating these strategies will put you ahead of the curve and well-positioned to provide a greater level of value-based care to all of your patients. After all, the mental health of patients often isn’t cured with drugs — it’s cured with compassion, understanding and deep visibility into that patient’s overall history. 

How to Assess Social Determinants of Health in Your Patient Population 

Assessing social determinants of health in patient populations directly influences health care providers’ ability to effectively diagnose and treat individuals. A greater number of healthcare professionals are beginning to recognize that addressing patients’ social needs is a means of improving health outcomes. Below we will share five steps for addressing social determinants within your practice, and using them to your advantage.  

1. Selecting the Right Assessment Tool 

One of the most important steps in assessing social determinants of health in your patient population is deciding which assessment tool to use. There are a wealth of them available– and each one is best-suited to certain settings and circumstances. The most important step to selecting an adequate assessment tool is introspection. Social determinants of health will allow you as a provider to identify and address a unique subset of patient needs. These strides in health care translate to more timely diagnosis and treatment, more knowledgeable health workers, and improved patient outcomes.  

When selecting a tool, consider: 

• What information do you as the provider want or need to collect 
• What your patients need 
• What the community around your patients has to offer  
• How you will share the information with community organizations and other healthcare providers 

Remember: the best assessment tool effectively captures and highlights patients’ social needs and barriers to care. 

When you select the assessment tool that will work best for your staff and patients, prioritize: 

• The tool’s capacity to address specific needs 
• The availability of a referral network and/or local resources 
• Ease of use in clinical settings 
• The tool’s ability to capture specific and organization-addressable needs 

It’s critical to select the assessment tool that benefits your health community the most. That means that patients’, health care providers’, and the larger communities’ needs and resources should be considered throughout the selection process. 

Remember: You must review any and all relevant privacy and consent laws prior to implementing an assessment tool. Patients’ right to privacy is critical– many health care providers view social determinants of health and instances of data as information that should be protected by HIPAA and similar state laws. You must determine how to share information securely and create policies that govern which information can be exchanged and how the exchange can be completed. 

2. Patient Assessment  

Now that you have selected your tool, you have the means to help your patients and agencies at your fingertips. Patient assessment is the key to understanding patient health and achieving desired health care outcomes.  When care providers fail to recognize how a patient’s social determinants of health impact their well being and treatment, they fail to personalize their approach to health care.  You can start by utilizing the social determinants listed above within your assessment tool to gather information.  

It’s important to combine societal determinants with medical records. This will follow the patient across healthcare settings — providing crucial information to future healthcare providers. A good example of this is the California San Mateo County Health System. They combine societal determinants of health with electronic medical records to  help reduce repetitive healthcare needs among the vulnerable homeless population.   

3. Collect and Utilize Information Concerning Social Determinants of Health 

Collecting patient data is of little use if the data is not collected and analyzed properly. You will need to integrate your assessment tools of choice into your screening processes. Some organizations opt to integrate screening and assessment into their electronic care coordination platforms. This results in patient data that can be easily accessed by health and community systems. 

Behavioral Health Clinics should remember that this step of implementation can be the most demanding– both time- and funds-wise. Procentive offers a customizable patient portal where clinical documents can be stored safely and accessed directly by clients or their designated representatives with a secure, personalized login.  

Some offices need to make significant investments in system and hardware upgrades. This is why some opt for lower-cost (and more traditional “low tech”) solutions. Paper surveys or in-office touch screen stations allow for patient screening without much investment. 

4. Use Workflows to Track and Address Patient Needs 

Once patient data has been collected, it needs to be assessed in a way that allows you to take steps to improve patient outcomes. Implementing workflows and specific processes for analyzing social determinants of health data makes this possible. 

When the patient screening process is standardized, it’s much easier to refer them to the appropriate parties and services. It helps expedite workflow and frees up care providers to focus on additional patients and cases. A standard skeleton for a provider workflow generally includes: 

• A time frame for administering the assessment (i.e. prior to or during intake, after an initial appointment, etc.) 
• Which care team member (or members) is responsible for conducting assessments and making referrals based off of those assessments 
• Community health workers are uniquely well-positioned for this due to their unique understanding of the communities they serve 
• Care team members involved in home visits also have unique knowledge of a patient’s social needs and experiences 
• A means of tracking referrals and follow-ups

5. Identify Community Resources to Close the Referral Loop 

The last step to effectively assessing and addressing social determinants of health in your patient population involves identifying local resources and fully closing the referral loop. Countless health care organizations rely on outdated and informal inventories (at best) of their local communities’ resources. Even more fail to track what happens after a referral is granted. 

Another way organizations can immediately (and without significant investment) begin implementing social determinant strategies is to connect with stakeholders at major community outreach programs. Bridging the gap between medical and non-medical initiatives can help you begin to approach mental health more holistically. These groups oftentimes serve the same clients– and working together with a common goal can help that goal become a reality much more quickly. Providers can select from web- and technology-based applications to ensure that their patients are connected to referred parties. They can also share information with patients about various benefits that they may be entitled to, including: 

• Heating assistance 
• SNAP, WIC, or other food assistance 
• Educational assistance 
• Childcare assistance 

Final Thoughts 

Behavioral healthcare providers that want to work towards value-based care while improving the quality-of-life of their patients should consider incorporating baseline strategies to collect and analyze social determinants of health. Change doesn’t happen overnight, but once the results start to take shape, larger investments in data analysis and EHR solutions can help make the most out of SDOH data. For now, behavioral healthcare clinics have a path forward to understanding these factors and how it impacts care.Prev