• Elena Byhoff, Arvin Garg, Michelle Pellicer, Yareliz Diaz, Grace H Yoon, Martin P Charns, and Mari-Lynn Drainoni.
• From the Department of Medicine, Tufts Medical Center; Institute for Clinical Research and Health Policy Studies, Tufts CTSI, Boston, MA (EB); Department of Medicine, Tufts University School of Medicine, Boston (EB); Department of Pediatrics, Boston University School of Medicine, Boston Medical Center, Boston (AG, MP); Department of Health Law Policy & Management, Boston University School of Public Health, Boston (YD, GHY, MPC, M-LD); VA Center for Healthcare Organization and Implementation Research, Department of Veterans Affairs, Boston, MA (MPC); Section of Infectious Diseases, Evans Center for Implementation and Improvement Sciences, Department of Medicine, Boston University School of Medicine, Boston (M-LD). ebyhoff@tuftsmedicalcenter.org.
• J Am Board Fam Med. 2019 May 1; 32 (3): 297306297-306.

IntroductionScreening 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.MethodsWe 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.ResultsAll 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.DiscussionThis 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.© Copyright 2019 by the American Board of Family Medicine.

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