PRP083: Evaluating a Health-Related Social Needs Screening and Referral Program among Veterans

Lauren Russell, MPP; Dawn Mello; Steven Chrzas, MPH; Alicia Cohen, MD, MSc, MSc


Context: Given the adverse impact of unmet social needs on health, professional societies have called for improved identification and management of health-related social needs (HRSN) in clinical settings. The Veterans Administration (VA) currently screens Veterans for food and housing insecurity but lacks a process to screen for HRSN more broadly. Objective: To field-test an HRSN screening and referral program—Assessing Circumstances and Offering Resources for Needs (ACORN). Study Design: Mixed methods multi-site pilot. Setting: 3 VA outpatient clinics in the greater Boston area. Population Studied: Veterans presenting for routine care (n=469). Follow-up interviews were conducted with a purposive sample of Veterans (n=27). Intervention: Veterans completed an electronic assessment encompassing 7 HRSN domains. Based on identified needs, Veterans were provided geographically tailored resource guides composed of VA and non-VA resources. Outcome Measures: 1) prevalence and sociodemographic characteristics associated with screening positive for HRSN (multivariable logistic regression) and 2) Veteran acceptability of ACORN and effectiveness of tailored resource guides in helping Veterans connect with services (qualitative content analysis). Results: Among Veterans screened, 68.1% reported ≥1 HRSN; 22.8% reported ≥3 HRSN. Rates of HRSN included social isolation (45.2%); employment (31.0%) and legal needs (10.9%); as well as housing (11.4%), utility (11.2%), food (9.9%), and transportation (9.4%) insecurities. Preliminary qualitative results show Veterans overall find HRSN screening both acceptable and appropriate and feel the VA should continue such screening. While some Veterans found the resource guides helpful, others did not use the guides for reasons ranging from having already received needed assistance to feeling uncomfortable contacting non-VA organizations. Final analyses including sociodemographic correlates of identified HRSN will be presented. Conclusions: Early findings show Veterans feel ACORN is both acceptable and important. Over 2/3 reported at least 1 HRSN. Almost half reported social isolation, and 1 in 7 reported at least one form of material hardship. Screening for HRSN is a critical step towards connecting Veterans with needed services, identifying gaps in current service delivery, and informing future VA resource allocation. This pilot will provide information to better ensure equitable delivery of health care to Veterans at risk for HRSN.

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