PT  - JOURNAL ARTICLE
AU  - Elena Byhoff
AU  - Arvin Garg
AU  - Michelle Pellicer
AU  - Yareliz Diaz
AU  - Grace H. Yoon
AU  - Martin P. Charns
AU  - Mari-Lynn Drainoni
TI  - Provider and Staff Feedback on Screening for Social and Behavioral Determinants of Health for Pediatric Patients
AID  - 10.3122/jabfm.2019.03.180276
DP  - 2019 May 01
TA  - The Journal of the American Board of Family
                Medicine
PG  - 297--306
VI  - 32
IP  - 3
4099  - http://www.jabfm.org/content/32/3/297.short
4100  - http://www.jabfm.org/content/32/3/297.full
SO  - J Am Board Fam Med2019 May 01; 32
AB  - Introduction: Screening and referral for Social and Behavioral Determinants of Health (SDOH) are increasingly recommended in clinical guidelines and consensus statements. It is important to understand barriers and facilitators to implementation of standardized SDOH screening and referral practices, as well as the scope of current existing SDOH screening.Methods: We conducted a mixed-methods study to understand the current state of SDOH screening and to assess the barriers and facilitators to implementing a standardized SDOH screening and referral practice in Boston community health centers (CHCs) for pediatric patients. We requested all SDOH screening documents from 15 Boston CHCs and conducted provider and staff focus groups at intervention sites of an SDOH implementation pilot in Boston.Results: All CHCs screened in some form for SDOH, but there was no agreement on which domains to screen. Participating CHCs screened for a mean of 8 SDOH domains (range, 5 to 16). Overall, 16 SDOH domains emerged. From the focus groups, 5 themes emerged: 1) provider perspectives, 2) work flow, 3) prior experience, 4) site resources and staffing, and 5) sustainability. There was little agreement among participants within each theme, as all were seen as barriers and facilitators depending on the respondent.Discussion: This study highlights the various SDOH screening methods currently used in Boston CHCs, and the need for workflow and process individualization of SDOH screening and referral. Providers and clinical staff should be part of the discussion when implementing SDOH screening and referral procedures to ensure appropriate work flow, staff buy-in, and to maximize resources available.