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There is a robust and growing market for technology-based platforms that enable linkages between healthcare providers and local ecosystems of community-based or social service organizations. But how well do these platforms address social needs for the average patient or client? The data doesn't tell a good story.
The baseline against which to compare the performance of these platforms is the 211 helpline system, which connects economically vulnerable Americans with needed health and social services (like food banks or pantries) in their communities. These free information and referral services help people access services through more than 200 call centers covering all fifty states. Nationally, the helplines made over 12.8 million referrals in 2018.
In 2016, researchers at Washington University in St. Louis published the first analysis of how 211 services help callers resolve their problems:
The nation's 211 helplines do an amazing job of helping Americans navigate their local resources. But for many reasons, only half of the callers actually get their needs met. Do electronic referral platforms do the job in a better way?
Electronic referral management platforms promise that they could potentially make linkages to social services more efficient and effective by providing electronic community resource directories and facilitating referrals to social service agencies. Only one study has been published, which reports the rate of community resource use resulting from an automated intervention delivered under real-world conditions.
This study, CommunityRx: A Real-World Controlled Clinical Trial of a Scalable, Low-Intensity Community Resource Referral Intervention published in the American Journal of Public Health, tracked the outcomes from more than 113,000 outpatients who received a referral to a community resource. Among this population:
The goal of closed-loop referral tracking is for the referral sending organization to find out what happened after a referral is made. Even with an electronic referral management platform, closed-loop referral tracking is the most challenging part of the implementation of a new integrated model of care because it requires information from either the social services organization or the patient. Researchers at SIREN at UCSF say the most common challenge in this effort is recruiting community-based social services organizations to use the platforms, which was necessary for health care organizations to be notified of referral outcomes.
Community partners do not usually have clear incentives for using a new electronic platform, and the resources required for implementation prevents many organizations, especially very small ones, from adopting a platform. As a result, many referral platform customers are not able to track referral outcomes, despite the fact that this was one of the primary reasons why they had initiated platform adoption. The SIREN team also explicitly advises communities not to assume that patients are using electronic referrals. This is consistent with the CommunityRx study data presented above.
Social needs are intersectional, dynamic, and difficult to address. An electronic referral to one service for one need is generally not sufficient to meet the multiple and complex issues affecting people with complex health and social needs.
Research has consistently indicated that despite acute needs, people experiencing social needs can be reluctant to engage with helping services. Barriers to service engagement include a lack of awareness about services, which electronic referral platforms help to alleviate. But other, more pressing barriers include service inaccessibility such as waiting lists and service location, concerns about confidentiality, not wanting to engage with strangers or tell one’s story repeatedly, mistrust of service providers, feeling judged or that staff have ‘agendas’, lack of perceived need for mental health services, a belief that services are not helpful, or disliking needing help.
As a strategy for improving outcomes, care coordination involves deliberately organizing care and services and sharing information among all of the members of a care team. An electronic referral intervention without a care coordination strategy is not actually designed to address social needs. The role of a care coordinator, community health worker, or social worker is critical to help individuals access the services they need.
The common thread that runs through everything in a successful social needs intervention is the importance of centering the network connections around authentic healing relationships. The data is clear - a referral network without a care coordination strategy simply does not meet social needs.
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