Use of and barriers to adopting standardized social risk screening tools in federally qualified health centers during the first year of the COVID-19 pandemic

Objective: To describe the national rate of social risk factor screening adoption among federally qualified health centers (FQHCs), examine organizational factors associated with social risk screening adoption, and identify barriers to utilizing a standardized screening tool in 2020. Data Source: 2020 Uniform Data System, a 100% sample of all US FQHCs (N = 1375). Study Design: We used multivariable linear probability models to assess the association between social risk screening adoption and key FQHC characteristics. We used descriptive statistics to describe variations in screening tool types and barriers to utilizing standardized tools. We thematically categorized open-ended responses about tools and barriers. Data Collection: None. Principal Findings: In 2020, 68.9% of FQHCs screened patients for any social risk factors. Characteristics associated with a greater likelihood of screening adoption included having high proportions of patients best served in a language other than English (18.8 percentage point [PP] increase, 95% CI: 6.0, 31.6) and being larger in size (10.3 PP increase, 95% CI: 0.7, 20.0). Having higher proportions of uninsured patients (14.2 PP decrease, 95% CI: -25.5, -0.3) and participating in Medicaid-managed care contracts (7.3 PP decrease, 95% CI: -14.2, -0.3) were associated with lower screening likelihood. Among screening FQHCs, the Protocol for Responding to and Assessing Patients' Assets, Risks, and Experiences (PRAPARE) was the most common tool (47.1%). Among non-screening FQHCs, common barriers to using a standardized tool included lack of staff training to discuss social issues (25.2%), inability to include screening in patient intake (21.7%), and lack of funding for addressing social needs (19.2%). Conclusions: Though most FQHCs screened for social risk factors in 2020, various barriers have prevented nearly 1 in 3 FQHCs from adopting a screening tool. Policies that provide FQHCs with resources to support training and workflow changes may increase screening uptake and facilitate engagement with other sectors. KEYWORDS cross-sector collaboration, federally qualified health centers, safety net, social determinants of health, social risk factor screening What is known on this topic * The COVID-19 pandemic elucidated the importance of cross-sector collaborations between health care, public health, and social services to jointly advance health equity, which may be facilitated through social risk screening. * Federally qualified health centers (FQHCs) are safety-net providers that serve over 30 million low-income people in the United States, and many FQHCs collect social risk data. * FQHCs are pivotal health care partners because of their social risk screening efforts, but there is limited data about the characteristics and barriers associated with social risk screening at FQHCs. What this study adds * Using a 100% sample of US FQHCs, we identified the patient- and organization-level characteristics associated with social risk screening at FQHCs in 2020, the first year of the COVID-19 pandemic. * Despite high rates of social risk screening at FQHCs, one in three FQHCs did not screen; FQHCs with higher proportions of uninsured patients and FQHCs smaller in size were less likely to screen. * In the first-known national examination of barriers to standardized social risk screening at FQHCs, common barriers included lack of staff training, inability to include screening in workflow, and limited funding.
1 | INTRODUCTION The onset of the Coronavirus 2019 (COVID-19) pandemic disrupted communities globally. In the United States (US), the impact of the pandemic was especially devastating for marginalized communities [...]