Experiences and Perspectives on Adopting New Practices for Social Needs‐Targeted Care in Safety‐Net Settings: A Qualitative Case‐Comparison Study
Authors: Nehme Eileen , de Martell Sierra Castedo , Matthews Hannah , Lakey David 
Published: September 2021

Research ObjectiveThe purpose of this qualitative study was to describe the current practice of social needs‐targeted care in three Texas safety net clinics, and facilitators and barriers to adopting new social needs‐targeted care tools and practices.Study DesignThis qualitative, case‐comparison study used data from with staff at three safety net clinics serving small and mid‐sized communities. Analysis focused on perspectives and decisions around adopting new tools or practices related to social needs‐targeted care, including standardized screening tools and community resource referral platforms.Population StudiedNine staff across three organizations were interviewed. Organization A is a five‐clinic FQHC serving two rural communities. Organization B is an independent pediatric clinic that provides medical and dental care from birth to age 21, in a mid‐sized community. Organization C is an FQHC with 12 sites serving small and mid‐sized communities. All three served patients regardless of their ability to pay.Principal FindingsOrganizations B and C were currently using a standard social needs screening tool in their routine practice, and organization A was considering doing so. Organization C had adopted a community resource referral platform in partnership with a large community collaboration. The three case studies illustrate a range of facilitators, barriers, perceived benefits, and drawbacks influencing social needs‐targeted practices.Beyond the potential usefulness of social needs screening tools to help facilitate social needs‐targeted care, interviewees from all three organizations mentioned their potential value to create aggregated social needs data to understand community problems. Drawbacks include concerns about data privacy.Community resource referral platforms were seen as valuable for creating accountability, but required an influential community partner and adequate community resources. The most salient theme related to referral platform adoption was the importance of the community context, or outer setting. Clinics can play a leadership role, but cannot establish a referral platform without a larger community coalition or organizing force and well‐resourced community partners. The CEO from Organization A did not think their community social service organizations had the technological or staffing capacity to participate in a referral platform. The pediatrician interviewed from Organization B felt her clinic wasn't influential enough to get the needed buy‐in from all the community partners.Concerns about disempowering clients and blurring roles by providing social needs‐targeted care and unintentionally disempowering clients were also voiced, and the potential beneficial impact on provider job satisfaction with an effective system for social needs‐targeted care provision in place was identified.ConclusionsBenefits and drawbacks of adopting new tools and practices related to social needs‐targeted care are strongly influenced by the community context. For the adoption of community resource referral platforms, the outer setting is particularly relevant. While screening tools are much easier than referral platforms to adopt, the ability of a clinic to address identified needs remains heavily based on the outer setting.Implications for Policy or PracticeAdoption readiness related to social needs‐targeted care interventions should be assessed at the community or regional level in addition to the clinic system level, and implementation may be most effective at a community or regional level.Primary Funding SourceEpiscopal Health Foundation.