Screening for Unmet Social Needs: Patient Engagement or Alienation?

This article offers guidance that will enable health care leaders to ensure that their organizations’ social needs screening programs engage patients rather than alienate them. The momentum behind social needs screening is mounting, spurred by National Academy of Medicine guidelines, risk-based managed-care contracts, and electronic health record (EHR) vendors. Even with external incentives, social needs screening has not exactly been embraced by providers: only 16% of physician practices and 24% of hospitals currently screen for key social risk domains. Perhaps more importantly, “screen and refer” programs have had low uptake by patients and minimal effect on outcomes.  Screening without careful deliberation can harm patients through trauma, discrimination, or legal consequences such as loss of child custody or deportation. Early social needs screening in many health care settings can be insensitive to these risks, with untrained clinical staff speeding through a rote checklist, often without explicit consent. Moreover, when clinicians are not able to offer effective solutions to patients who disclose dire needs, they may set unrealistic expectations and frustrate patients. Despite a relatively small evidence base and valid concerns about patient harm, widespread social needs screening is upon us and will involve significant resources and millions of patients. In this article, we offer pragmatic advice to help health care leaders make their social needs programs more patient centered and effective.