• Emilia H De Marchis, Benjamin Aceves, Na'amah Razon, Chang WeirRosyRFrom the Department of Family & Community Medicine, University of California, San Francisco (EHDM, RMG); School of Public Health, San Diego State University (BA); Department of Family & Community Medicine, University of California, Davis (N, Michelle Jester, and Laura M Gottlieb.
• From the Department of Family & Community Medicine, University of California, San Francisco (EHDM, RMG); School of Public Health, San Diego State University (BA); Department of Family & Community Medicine, University of California, Davis (NR); Association of Asian Pacific Community Health Organizations, San Francisco, CA (RCW); National Association of Community Health Centers (now with America's Health Insurance Plans, Washington, DC) (MJ).
• J Am Board Fam Med. 2023 Oct 11; 36 (5): 817831817-831.

BackgroundMany community health centers (CHC) are scaling social risk screening in response to growing awareness of the influence of social adversity on health outcomes and concurrent incentives for social risk data collection. We studied the implementation of social risk screening in Texas CHCs to inform best practices and understand equity implications.MethodsConvergent mixed methods of 3 data sources. Using interviews and surveys with CHC providers and staff, we explored social risk screening practices to identify barriers and facilitators; we used electronic health record (EHR) data to assess screening reach and disparities in screening.ResultsAcross 4 urban/suburban Texas CHCs, we conducted 27 interviews (15 providers/12 staff) and collected 97 provider surveys; 2 CHCs provided EHR data on 18,672 patients screened during the study period. Data revealed 2 cross-cutting themes: 1) there was broad support for social risk screening/care integration that was rooted in CHCs' mission and positionalities, and 2) barriers to social risk screening efforts were largely a result of limited time and staffing. Though EHR data showed screens per month and screens/encounters increased peri-pandemic (4.1% of encounters in 8/2019 to 46.1% in 2/2021), there were significant differences in screening rates by patient race/ethnicity and preferred language (P < .001). In surveys, 90.0% of surveyed providers reported incorporating social risk screening into patient conversations; 28.6% were unaware their clinic had an embedded screening tool.ConclusionsStudy CHCs were in the early stages of standardizing social risk screening. Differences in screening reach by patient demographics raise concerns that social screening initiatives, which often serve as a path to resource/service connection, might exacerbate disparities. Overcoming barriers to reach, sustainability, and equity requires supports targeted to program design/development, workforce capacity, and quality improvement.© Copyright by the American Board of Family Medicine.

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