|A Flexible Framework for Effective Essential Needs & Social Health Initiatives – Health Leads has published a framework and curated library of tools, best practices, implementation guidance, and other dynamic content. Both of these are organized into six “drivers” that are key to successful social needs strategies in clinical settings.
|How Understanding Trauma Can Strengthen Health Care Organizations: A Q&A with Sandra Bloom: CHCS recently spoke with Sandra Bloom, MD, associate professor at Drexel University’s Dornsife School of Public Health and co-founder of the Sanctuary Model, to better understand how trauma influences health care organizations and how organizations can strengthen care delivery through trauma-informed care.
|Complex Construction: A Framework for Building Clinical-Community Partnerships to Address Social Determinants of Health: United Hospital Fund has released a framework designed to help primary care providers screen their patients for social determinants of health and partner with community-based organizations (CBOs) that can respond to those needs.
|Community Resource Referral Platforms Guide: SIREN has developed a guide that explores the landscape of community resource referral platforms, the experiences of early adopters, features and functionalities of these technologies and lessons learned and recommendations on how to implement a community resource referral platform.
|PRAPARE Implementation and Action Toolkit: This free toolkit contains resources, best practices, and lessons learned to help guide users in each step of the implementation process of using the PRAPARE tool, ranging from implementation strategies and workflow diagrams to Electronic Health Record templates and sample reports to examples of interventions to address the social determinants of health.
|Social Determinants of Health Tools and Resources: This is a collection of tools and resources that Oregon Primary Care Association compiled, including on topics like screening and workflows, food insecurity, housing insecurity, integrating SDoH into clinical care, community partnerships and more.
|Association for Academic Health Centers – SDoH Initiative: This website has a scorecard to measure your organization’s efforts to address SDoH, as well as related reports and resources.
|Social Determinants of Health 101 for Health Care: HealthPartners Institute published this discussion paper about five things we know and five things health care organizations need to learn to address SDoH for the national quality strategy.
|Pathways for Determinants of Health Poster: This downloadable poster diagram is a model of all factors correlated with health outcomes for an individual.
|Caring with Compassion: The website supports health professionals who care for socioeconomically disadvantaged populations: homeless, uninsured, and underserved patients. It offers a curriculum that introduces the bio-psychosocial model for the provision of personalized care for at-risk patients.
|Health Leads Collaborative for Advancing Social Health Integration Change Package: This change package is designed to guide participating health care delivery organizations through the process of addressing patients’ social needs as a standard part of quality care. It defines key drivers of success and recommended changes and strategies that, when implemented, will help teams improve quality and advance towards their aim.
|Pathways Community HUB Manual: This is a guide to help those interested in improving care coordination to individuals at highest risk for poor health outcomes. The Pathways Community HUB (HUB) model is a strategy to identify and address risk factors at the level of the individual, but can also impact population health through data collected.
|Poverty Screening Tool: This tool from Canada is a diagram for screening for poverty and steps primary care teams can take to intervene.
|ROI Calculator for Partnerships to Address SDoH: This financial tool calculates the ROI from integrating social services with medical care. The calculator compares how the financial returns and risks could be divided between the cross-sectional partners (social service and medical) under a variety of payment arrangements and levels.
|Innovation Spotlight – Using Social Determinants Data: Petaluma Health Center has refined its workflow to collect social determinants data using a waiting room kiosk, exam room questioning and their patient portal.
|Innovation Spotlight – Emancipators Initiative for Former Inmates: Roots Community Health Center is giving formerly incarcerated Californians a fresh start — at home, in the workplace, and for their health.
|Growing Deep Roots in Kalihi Valley: Learn about how Kokua Kalihi Valley (KKV) Comprehensive Family Services approaches their role as a health center supporting the needs of their community.
|Tackling Institutionalized Racism: This perspective discusses health inequities and the ways in which our health care system intentionally and unintentionally perpetuates institutionalized racism.
|Building Data Capacity & Community Health Collaboration: This case study describes West County Health Centers’ new model for community stakeholders to interact with community health data, as part of a larger movement towards community-based care transformation.
|Optimizing the Flow of Information and Work for Social Needs: This webinar discusses how to integrate social needs information and work into current clinical settings, such as how to map workflows.
|Using Data to Drive SDOH Priorities: This webinar discusses how Cincinnati Children’s Hospital uses data to identify and prioritize key social determinants of health to improve child health outcomes.
|Tech Demo – Online Community Resource Directory and Referrals: This is a demo of Aunt Bertha, which makes it easy for people facing social needs – and those who help others – to find and make referrals to appropriate programs and services for food, shelter, health care, work, financial assistance and more.
|Paying for Population Health: Case Studies on the Role of the Health System in Addressing Social Determinants of Health: This report focuses on four case study sites in Vermont, Michigan, Ohio, and South Carolina. Each case study includes a detailed description of the intervention, outlines enabling factors, and provides considerations for the future.
|Addressing Social Determinants of Health through Medicaid Accountable Care Organizations: Early State Efforts: This webinar from The Commonwealth Fund explores early efforts to address SDOH through Medicaid ACO programs. This includes SDOH approaches that states are considering, including partnership requirements, social needs screening, referral, and service delivery, financial incentives, and quality metrics.
|Public Health Field Guide: How to Engage Payers in Addressing Social Determinants of Health: This blog explores four approaches that state and local health departments have used to collaborate with payers to address social determinants of health.
|Sustainably Financing Community Health: Where to Look, When to Pursue, and How to Access Different Sources of Capital Webinar: The Center for Community Investment and Quantified Ventures will discuss a range of key questions and alternative models intended to expand knowledge of, comfort level with, and capacity to take advantage of different financing options for multi-sector community work.
|The ROI for Addressing Social Needs in Health Care Webinar Series:The California Improvement Network spotlights in-progress efforts of leading health organizations to accurately measure return on investment (ROI) for social needs that impact health.
|Enabling Services Improve Access To Care, Preventive Services, And Satisfaction Among Health Center Patients: A new study from the UCLA and HRSA shows that patients that used services at health centers that address SDOH needs (e.g. care coordination, health education, transportation, food assistance, etc.) were more likely to visit a health center and get a routine checkup compared to patients that did not use these services.
|Health Equity IHI Resources – Check out IHI’s resources that address what health equity is and why it matters, and achieving and improving health equity.