Background

Addressing the social determinants of health is a critical step in reducing health disparities. Leading health agencies have organized social determinants of health into six groups: food security, economic stability, education, neighborhood and physical environment, community and social context and the healthcare system. Studies indicate that only 20 percent of health and well-being is related to healthcare; the remaining 80 percent is a result of health behaviors, the physical environment and socioeconomic factors. While there has been considerable research identifying social determinants of health and the mechanisms that explain their impact, the best approaches to integrating health services with community and social services that address social determinants of health are yet to be defined.

Community health centers are at the forefront of interacting with patients who face unmet social needs. Thus, identifying opportunities to address social determinants of health within the constraints of a community health system’s workflow and resources is essential. Student volunteers, who are eager for meaningful clinical experiences, are a low-cost and untapped resource that community health centers can leverage to help address patients’ unmet social needs.

Project Description

The project team will expand their work from previous years and continue their partnership with Lincoln Community Health Center in Durham to design a student volunteer Help Desk program. While the Lincoln Behavioral Health team has been screening patients for unmet social needs and referring patients to community services, many patients still face hurdles to connecting with community-based resources. In 2019-2020, the Help Desk team trained students to be Community Resource Navigators who could follow-up with patients over the phone to help them navigate barriers and thereby increase use of community resources.

In 2020-2021, the project will examine pathways for sustaining the existing Help Desk program as well as evaluate opportunities to scale up models that address unmet social needs by leveraging student volunteers who can build capacity in pediatric primary care, the emergency department and additional federally qualified health centers.

Team members will learn about the locally implemented and similar workforce models to address unmet social needs, and use principles in program planning, evaluation and implementation science to plan approaches to scale and sustain. These data will aim to define patients and stakeholder needs, key resources and activities and estimate associated costs. Different tools will be applied such as value stream maps and logic models to diagram the current structure and processes as well as how to narrow the gaps. Once the scalable models are defined, team members will begin to test the approach to adapt it in a real-world context.

The team will also spend 2020-2021 investigating the “digital divide” – or how the lack of access to broadband and wireless internet, digital devices and training in digital literacy perpetuates and/or exacerbates health disparities, especially among older adults and low-income residents in Durham. In collaboration with the Triangle Nonprofit and Volunteer Leadership Center and with a grant from Spectrum, the team will expand the Help Desk role to include Digital Navigators, who will be trained to help connect community members to information and navigate digital barriers.

Team Outputs

Interdisciplinary Teams Addressing Social Risks: Workforce Models (Conference Presentation)

Jacqueline Xu, Mengxi Zhao, Athina Vrosgou, Natalie Chin Wen Yu, Chelsea Liu, Han Zhang, Chunxi Ding, Noelle Wyman Roth, Yuesong Pan, Liping Liu, Yilong Wang, Yongjun Wang, Janet Prvu Bettger. Barriers to Medication Adherence in a Rural-urban Dual Economy: A Multi-stakeholder Qualitative Study. 2021. BMC Health Services Research 21(799).

Tyler Lian, Kate Kutzer, Diwas Gautam, Howard Eisenson, Jane C. Crowder, Emily Esmaili, Sahil Sandhu, Lawrence Trachtman, Janet Prvu Bettger, Connor Drake. "Factors Associated with Patients’ Connection to Referred Social Needs Resources at a Federally Qualified Health Center." 2021. Journal of Primary Care & Community Health.

Sahil Sandhu, Jacqueline Xu, Howard Eisenson, Janet Prvu Bettger. "Workforce Models to Screen for and Address Patients’ Unmet Social Needs in the Clinic Setting: A Scoping Review." 2021. Journal of Primary Care & Community Health.

Timing

Summer 2020 – Spring 2021

• Summer 2020 (optional): Leverage existing clinical and translational research database; manage Help Desk program operations; design scale-up of Help Desk
• Fall 2020: Complete didactic training in implementation science, program planning, scale-up and community engagement; learn about project partner sites; write evaluation reports and action plan
• Spring 2021: Complete evaluation reports; draft implementation action plan; continue implementation action plan; pilot model at new clinical site

This Team in the News

These Undergraduates Help Connect Patient in Duke's ER with Food, Housing and Utility Support

Senior Spotlight: Reflections from the Class of 2022

Improving Durham’s Health One Phone Call at a Time

Interdisciplinary Researchers Discuss Faculty-Student Research

Research Methods and Creative Outputs from Interdisciplinary Teams

This Bill Would Make It Harder for People with Disabilities to Access the Internet

Video

Interdisciplinary Teams Addressing Social Risks: Workforce Models

See earlier related team, Help Desk: A Student Initiative to Help Address the Social Determinants of Health (2019-2020).

Image: Help Desk project logo