Help Desk: A Student Initiative to Help Address the Social Determinants of Health (2019-2020)
Addressing the social determinants of health (SDOH) is a critical step in reducing health disparities. Leading health agencies have organized SDOH into six groups: food security, economic stability, education, neighborhood and physical environment, community and social context and the healthcare system. Studies indicate that SDOH account for nearly 70% of all health outcomes.
While there has been considerable and quality research identifying SDOH and the mechanisms that explain their impact, the best approaches to integrating health services with community and social services 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 SDOH within the constraints of a community health system’s workflow and resources is essential. Student volunteers, 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.
This Bass Connections project will expand and evaluate a “Help Desk” program at Lincoln Community Health Center, in which student volunteers are included in the process that connects patients to community-based resources. The study will help facilitate data-driven improvements in implementation and establish the foundation for sustainability.
As a federally qualified health center in Durham, North Carolina, Lincoln cares for a particularly vulnerable population. The Lincoln Behavioral Health team currently screens patients for unmet social needs and refers them to community services. However, patients face many hurdles when looking for community-based resources, like identifying a service location accessible by public transport or understanding service eligibility criteria.
Beginning in Spring 2019, student volunteers will help patients navigate these barriers and thereby increase use of community resources. Furthermore, feedback from patients will help the behavioral health and student team to evaluate the capacity, appropriateness and effectiveness of the various community-based organizations to which they refer their patients.
The project team will serve as executive leadership for the Help Desk program and manage a volunteer cohort external to the project team. The team will be divided into three task forces:
- Task Force 1: Health Service Delivery (HSD)
- Task Force 2: Quality Improvement and Evaluation (QIE)
- Task Force 3: Community Relations, Communications and Health Policy (CRCHP).
This project team also has the opportunity to inform state policy as North Carolina transitions to Medicaid managed care and recognizes the importance of addressing SDOH for population health management. In partnership with other community health centers in the state, the team will assess the barriers and facilitators to implementing standardized SDOH screening in response to new state policy. Findings from the Help Desk projects will be of interest to policymakers looking to sustain value-based care. Ultimately, this project aims to improve patients’ use of community resources, support volunteers’ development of pre-health professional core competencies and inform state policy.
Fully functional and sustainable student volunteer Help Desk program at Lincoln Community Health Center; implementation toolkit on adopting student Help Desk model; manuscripts for publication; policy briefs; dissemination of findings through project website and blogs
Spring 2019 – Spring 2020
- Spring 2019: Kick-off meeting with new team; introduction to previous Bass Connections project team; begin volunteer onboarding process with Lincoln Community Health Center
- Fall 2019: Complete summer reading on social determinants of health; didactic training in social determinants, community engagement, quality improvement and implementation science; begin volunteering at Lincoln Help Desk; begin task force meeting and individual roles
- Spring 2020: HSD task force conducts semi-structured interviews with students involved in the program and with Lincoln staff; QIE task force begins develops implementation toolkit; CHCHP collects data for project; CRCHP writes and disseminates policy brief
Team Outputs to Date
Addressing the Social Determinants of Health (Fortin Foundation Bass Connections Virtual Showcase 2020)
Closing the Loop: NC Healthcare Transformation and Local Efforts for Addressing Non-Medical Needs (presentation by Tyler Lian, Meril Pothen, Sahil Sandhu, Duke-Margolis Seminar in Health Policy & Management, Duke University, April 17, 2020)
Development and Implementation of a Volunteer Community Resource Navigator Program to Address Patients’ Unmet Social Needs (poster by Sahil Sandhu, Lillian Blanchard, Jacqueline Xu, Veronica Sotelo Munoz, Connor Drake, Howard Eisenson, Carolyn Crowder, Janet Bettger; presented at 12th Annual Conference on the Science of Dissemination and Implementation in Health, Arlington, VA, December 5, 2019)
Are Needs Met When Social Determinants Are Screened and Social Service Referrals Are Made? Examining the Construct Validity of a “Resolved Referral” as a Measure of Quality (poster by Connor Drake, Erika Dennis, Sahil Sandhu, Howard Eisenson, Carolyn Crowder, Jacqueline Xu, Lillian Blanchard, Rebecca Whitaker, Robert Eick, Janet Bettger; presented at 12th Annual Conference on the Science of Dissemination and Implementation in Health, Arlington, VA, December 5, 2019)
Data Expeditions grant, Rhodes Information Initiative at Duke, 2019, $1,500
Help Desk: A Student-led Initiative to Address Social Determinants of Health in Durham, N.C. (poster by Sahil Sandhu, Connor Drake, Erika Dennis, Diwas Gautam, Elizabeth Gu, Elmira Hezarkhani, Kate Kutzer, Tyler Lian, Meril Pothen, Anisha Watwe, Janet Bettger, presented at Global Health Showcase, Duke University, November 4, 2019; Winner, Best Poster, Bass Connections in Global Health)
Closing the Loop: NC Healthcare Transformation and Local Efforts for Addressing Nonmedical Needs (presentation by Janet Bettger, Erika Dennis, Connor Drake, Meril Pothen, Sahil Sandhu, Duke Global Health Institute, October 22, 2019)
Implementation and Evaluation of PRAPARE Including a Novel “Help Desk” Feature (presentation by Connor Drake, Sahil Sandhu, D’Nicole Tangen, Nekoba Mutima, and Howard Eisenson, North Carolina Community Health Center Association Primary Care Conference, Asheville, NC, June 27, 2019)
This Team in the News
See related teams, Help Desk: Scaling Volunteer Models that Address Patients’ Social Needs (2020-2021) and Global Alliance on Disability and Health Innovation (GANDHI): What Makes Innovation Stick? (2018-2019), and related Data+ summer project, Smartphones and the Sixth Vital Sign (2018).
- Janet Prvu Bettger, School of Medicine-Orthopaedic Surgery
- Connor Drake, School of Medicine-Duke Personalized Health Care
- Sahil Sandhu, Trinity - Program II-BS
/graduate Team Members
Erika Dennis, Bachelors of Science - Nursing
Meril Pothen, Masters of Public Policy
/undergraduate Team Members
Diwas Gautam, Neuroscience (BS)
Katherine Kutzer, Biology (BS)
Tyler Lian, Mathematics (BS)
Anisha Watwe, Public Policy Studies (AB)
/yfaculty/staff Team Members
Cynthia Broderius, Arts & Sciences
Tara Ilsley-Murillo, School of Medicine-Family Medicine and Community Health: Community Health
Leslie Parkins, Office of Civic Engagement
Jen'nan Read, Arts & Sciences-Sociology
Laura Richman, School of Medicine-Population Health Sciences
Taruni Santanam, Margolis Center for Health Policy
Gillian Sanders Schmidler, School of Medicine-Population Health Sciences|Margolis Center for Health Policy
/zcommunity Team Members
Lincoln Community Health Center