Assess Unmet Social Needs
Understanding the often complex social and psychological needs of patients is critical to creating interventions that achieve better health and wellbeing. Every 3 months, we ask patients about their unmet social needs across 17 domains based on an assessment developed by Health Leads. We ask about a wide array of needs including public benefits, insurance, housing, transportation, healthy eating, and social engagement. We find that the types of needs vary widely, which makes it difficult to target the top few needs alone. To address this, we are developing strategies to target clusters of unmet social needs.
The C4P clinical team uses these assessments to better understand the myriad of factors impacting their patients and provide more holistic care by connecting patients to the right social resources as needed.