Behavioral Health Integrator

Now more than ever, health centers know that addressing social determinants of health is key to ensuring patients from underserved and disadvantaged groups receive quality, informed, and comprehensive care. This resource explores how health centers can effectively and safely collect critical patient information, including sensitive information like social need screening, through digital patient intake solutions that rely on paper-free, data-smart registration and EHR integration. Health centers can walk through why adding these solutions to their clinics can engage rather than alienate patients, and how to implement these technologies to screen for social risk and improve the patient experience.

The resource is available in the Documents to Download section below.

Food insecurity has doubled since the onset of the COVID-19 pandemic in March 2020, and has tripled among families with children. Not having enough access to food is a key contributor to negative health outcomes for adults and children alike, and it is important now more than ever for health centers to identify and support patients who are experiencing food insecurity.
This resource is designed to support health center efforts to identify and assist patients who are experiencing food insecurity. It outlines key considerations around integrating social determinants of health (SDoH)-related screening and intervention into the electronic health record (EHR) workflow, highlights standardized screening tools and data elements to monitor the prevalence of food insecurity among patients, and describes several strategies to meet food-related needs. 

Health centers now report on social determinant of health screening activities and many use the PRAPARE tool for this purpose; for years, however, health centers have focused on the broader health and social needs of the individuals they serve often making referrals to community based organizations and utilizing available enabling services. Today, there is growing interest and awareness on the value and use of interoperable social determinants of health (SDoH) data to support individual, community, and population level health improvement. View this HITEQ Center webinar, where the The Health and Human Services, Office of the National Coordinator for Health IT present on the current state of federal activities and standards based approaches for collecting, sharing, and using SDoH data with a focus on technical and policy considerations. The presentation describes available standards, tools, and initiatives for health center use and input.

Health centers are interested in using social determinants data to manage and improve the health of their patient population and community, and are at different places on the population health management (PHM) and social determinants of health (SDH) adoption curve. The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) is a national effort to help health centers and other providers collect the data needed to better understand and act on their patients’ social determinants of health. In this webinar, the Colorado Community Managed Care Network (CCMCN), a Health Center Controlled Network (HCCN) highlighted a Tableau data dashboard that they have developed to help their health centers make decisions on population health management. They discussed the rationale for developing the tool, challenges and facilitators to integration, and how their health centers benefit from data sharing across Tableau.

The purpose of the infographic is to describe how SDH data would be used for a variety of goals that would have traction with the clinic staff audience who may likely need to modify workflows and behavior in order to collect such data.  The visual case could be used in presentations or hung on a provider break room wall.