Academic journal article International Public Health Journal

Addressing Social Determinants of Health at a Federally Qualified Health Center

Academic journal article International Public Health Journal

Addressing Social Determinants of Health at a Federally Qualified Health Center

Article excerpt


Margaret Whitehead, DBE was one of the first to establish inequity in health as unfair and unjust (1). In cities across the United States health inequity can result in a life expectancy gap between the rich and the poor of up to fifteen years (2). Limited access to medical care and unhealthy behaviors have traditionally been accepted as causes for poor health outcomes (3). However, limited access to medical care and unhealthy behaviors only account for a portion of poor health outcomes (4). A broader explanation for health disparities may be attributed to a person's social environment, or "the circumstances in which people are born, grow up, live, work, and age" as the social determinants of health (SDH) (5). Children living in poverty with its associated SDH, are at greater risk for adverse health outcomes such as asthma and are less likely to receive consistent preventive care (e.g., Well-Child Checks) than children from families with high incomes (6-8).

Pediatric primary care providers have long provided primary prevention, and the screening necessary for secondary prevention (9) with a variety of guidelines and screening tools to address SDH in the primary care setting (10, 11). It is currently recommended that SDH screening tools be used for families of pediatric patients during well-child checks and paired with education on available community resources (12, 13). Despite the growing evidence of the important role of SDH in child health, addressing SDH is not a standard of care and does not systematically occur in the primary care setting. Common barriers to addressing SDH include minimal financial incentive, a lack of professional awareness and training, limited familiarity with screening tools, and disconnection with community resources to address SDH (11, 14).

The quality improvement project assessed in this paper explored the process of systematically screening pediatric patients and their families for SDH risks within a federally qualified health center (FQHC) clinic serving Southwestern Ohio/Northern Kentucky. FQHC care sites provide health care service regardless of the client's ability to pay; largely serving patients in households with income at or less than the 200% poverty level (90% of FQHC clients) (15). FQHC patients, particularly children, are at the greatest risk for negative physical and social/emotional outcomes due to SDH. Incorporating regular SDH assessment and support into pediatric FQHC appointments is one strategy for "Breaking the cycle" in health disparities among low-income populations. This project sought to affect the SDH cycle at these points: compound risk factors, personal characteristics, environmental risk factors, environmental characteristics, and health risk factors (see Figure 1).


Data Source: Our quality improvement project focused on pediatric patients and families attending a primary care clinic within a FQHC in Southwestern Ohio between January and April 2016. As the project's intent was to improve current clinic operations, the FQHC did not require IRB approval for this quality improvement assessment.

Patients and families who registered at the clinic were invited into a side consultation room prior to their clinic appointment to learn about the new operational screening. They met with one of four volunteer students; undergraduates and graduates who were recruited and trained in Health Insurance Portability and Accountability Act (HIPAA) regulations, cultural competency, and professionalism. The student described the screening, its potential benefit to the patient and family, and its use for improving clinic services. The pediatric patients and families who chose to participate were screened immediately, and those who chose not to participate returned to the clinic waiting room for their regular clinic visit. Regardless of screening participation, all patients saw the clinic provider per their scheduled appointment.

The screening lasted approximately 6 minutes. …

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