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Social Risk Screening and Interventions in Healthcare Settings: Opportunities, Challenges, and Future Research

  • Deepak Palakshappa
    Correspondence
    Address correspondence to Deepak Palakshappa, MD, MSHP, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC, 27157
    Affiliations
    Department of Internal Medicine (D Palakshappa), Wake Forest University School of Medicine, Winston-Salem, NC

    Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC

    Public Health Sciences (D Palakshappa, CL Brown, and JA Skelton), Wake Forest University School of Medicine, Winston-Salem, NC
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  • Callie L. Brown
    Affiliations
    Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC

    Public Health Sciences (D Palakshappa, CL Brown, and JA Skelton), Wake Forest University School of Medicine, Winston-Salem, NC
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  • Joseph A. Skelton
    Affiliations
    Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC

    Public Health Sciences (D Palakshappa, CL Brown, and JA Skelton), Wake Forest University School of Medicine, Winston-Salem, NC
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  • Meggan Goodpasture
    Affiliations
    Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC
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  • Laurie W. Albertini
    Affiliations
    Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC
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  • Kimberly Montez
    Affiliations
    Department of Pediatrics (D Palakshappa, CL Brown, JA Skelton, M Goodpasture, LW Albertini, and K Montez), Wake Forest University School of Medicine, Winston-Salem, NC
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Published:August 11, 2022DOI:https://doi.org/10.1016/j.acap.2022.08.001
      Food insecurity, the insufficient or uncertain access to enough food, affected 14.8% of US households with children in 2020 and is associated with adverse physical, mental, and behavioral health across the lifecourse.
      • Coleman-Jensen A
      • Rabbit MP
      • Gregory CA
      • et al.
      Household Food Insecurity in the United States in 2020, ERR-298.
      National healthcare organizations have recommended that clinicians screen patients for food insecurity and other social risk factors (Figure). In our study, “Written Versus Verbal Food Insecurity Screening in One Primary Care Clinic,” we evaluated a natural experiment that occurred at one clinic that converted from clinicians verbally asking a 2-item food insecurity questionnaire to parents/caregivers responding on a written form.
      • Palakshappa D
      • Goodpasture M
      • Albertini L
      • et al.
      Written versus verbal food insecurity screening in one primary care clinic.
      We found that changing from a verbal to written screen resulted in an immediate and significant increase in the proportion of families who reported food insecurity (10.4% vs 16.3%).
      • Palakshappa D
      • Goodpasture M
      • Albertini L
      • et al.
      Written versus verbal food insecurity screening in one primary care clinic.
      In this progress report, we consider our results in light of the published literature since we submitted our manuscript in May 2019 and discuss the increased focus on social inequities, growing investment in integrating social care, areas for future research, and potential challenges with social risk screening.
      Figure 1
      FigureDifferences in social terms used in healthcare.
      Illustrated are differences in the definitions of terms that are commonly used in healthcare. The social drivers of health can lead to patients and families having individual social risk factors and social needs. Although there may be overlap, families who are identified as having social risk factors may not feel they need assistance and those who feel they have needs may not be identified by a social risk screening tool.

      Keywords

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