Understanding Maven’s social determinants of health screener
Social determinants of health (SDOH)—like housing, education, and systemic racism—play an outsized role in pregnancy outcomes, leading to vast inequities and disparities among races, classes, and geographies. According to the World Health Organization, social determinants of health account for 30-55% of health outcomes. In spite of their critical importance, social needs are rarely screened for or addressed during routine pregnancy health care. A main barrier to screening is the length of traditional screeners and the time it takes to complete them. Many SDOH screeners used today are long and burdensome, asking respondents over 20 questions about their health needs outside of physical health.
Maven’s clinical team developed a new, three-question social needs screening tool that takes less than one minute and can be completed digitally. The screening tool is effective when compared to the current gold standard for detecting any social need (sensitivity: 80%).
As part of testing the screener, Maven conducted a survey of 200 pregnant and postpartum people (100 with public insurance and 100 with commercial insurance) about social needs screening and found the following:
1. People want to share their social needs, and most methods for screening and connection to resources are acceptable.
Over 80% of participants reported it was important for their care team to know about their social needs and were comfortable sharing social needs with their provider. All methods of social needs screening and connection to resources were acceptable to over 80% of participants, including SMS, email, app, and care team member conversations.
2. Screening without attention to historical inequities could further alienate marginalized groups.
While all methods of screening were acceptable to most participants from historically marginalized groups, there was a greater preference for SMS and other non-human screening methods compared to other participants. These findings suggest that using asynchronous communication methods may help members of historically marginalized communities feel more comfortable reporting their needs. Additionally, participants with social needs worried that sharing these needs could negatively impact their ability to parent, highlighting the need for supportive counseling during the process.
3. Most participants are open to sharing their needs even in the absence of assistance.
Many health care workers worry that screening for social needs when assistance is not available may do more harm than good. However, over half of participants were comfortable sharing social needs even if their healthcare team could not provide support. In lieu of this tangible care, participants indicated that their care team could help by showing empathy and checking in.
More information about the screener can be found in the full study on AJOG Global Reports and Maven’s blog about the topic.
Instructions for using the SDOH screener
Preparing for use
The SDOH screener can be administered in a format that best meets the needs of the provider and respondent populations. As described above, it is recommended that asynchronous administration may be more acceptable to some populations.
If you will be using the results for purposes other than those described in the screener introduction, the language should be modified to reflect how it will be used. To further avoid traumatizing or stigmatizing patients, it is important that you share the purpose for collecting the information.
It is recommended that you include contact information for a person who can provide additional information or support to respondents by customizing that section of the screener introduction.
If a respondent indicates “yes” to any of the items in the screener, follow-up is recommended to better understand the nature of the need and the support required.
Attribution and modifications
Maven Clinic’s screening toolkit is licensed under a Creative Commons CC BY-SA 4.0 license, which means you can freely share and adapt the tool however you like. All we ask is you include attribution to Maven Clinic and, if you modify the tool, that you distribute the modifications under the same licensing structure. Full details on the Creative Commons license are available here.
Questions? Please contact email@example.com.
The social determinants of health screener
Health starts in our homes and communities. Knowing about where people live, work, learn and play can help health care teams better support the people they care for.
The following questions ask about your social needs: the parts of your life that affect your health, wellness, and ability to receive healthcare. These questions will only be used to help your care team better know and care for you, including connecting you to resources where possible, if you would like.
If you have any concerns or would like to speak with someone, you can contact: [fill in contact information].
1. In the past year have you or any family members you live with been unable to get any of the following when it was really needed?
- Housing [Yes / No / I prefer not to say]
- Food [Yes / No / I prefer not to say]
- Utilities (example: water, gas, electricity) [Yes / No / I prefer not to say]
- Medicine or any health care [Yes / No / I prefer not to say]
- Phone/internet [Yes / No / I prefer not to say]
- Supplies for baby and family [Yes / No / I prefer not to say]
- Care for children, elders, or household members with disabilities [Yes / No / I prefer not to say]
- Work/employment [Yes / No / I prefer not to say]
2. Do you feel lonely or isolated from those around you?
- I prefer not to say
3. Do you feel physically and emotionally safe?
- I prefer not to say
SDOH Short Screener 2022 by Maven Clinic Co. is licensed under the Creative Commons Attribution-ShareAlike 4.0 International Public License (CC BY-SA 4.0). To view a copy of this license, visit http://creativecommons.org/licenses/by-sa/4.0/legalcode.
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