Screening and Interventions for Social Risk Factors: Technical Brief to Support the US Preventive Services Task Force

• Published in: JAMA : the journal of the American Medical Association Vol. 326; no. 14; pp. 1416 - 1428
• Main Authors: Eder, Michelle, Henninger, Michelle, Durbin, Shauna, Iacocca, Megan O, Martin, Allea, Gottlieb, Laura M, Lin, Jennifer S
• Format: Journal Article
• Language: English
• Published: Chicago American Medical Association 12-10-2021
• Subjects: Clinical trials; Domains; Evaluation; Food; Food security; Health care; Health risks; Housing; Instability; Literature reviews; Risk analysis; Risk factors; Social services; Stability; Synthesis; Task forces; Transportation safety; United States > US
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2021.12825

IMPORTANCE: Evidence-based guidance is limited on how clinicians should screen for social risk factors and which interventions related to these risk factors improve health outcomes. OBJECTIVE: To describe research on screening and interventions for social risk factors to inform US Preventive Services Task Force considerations of the implications for its portfolio of recommendations. DATA SOURCES: Cochrane Database of Systematic Reviews, Cochrane Central Register of Controlled Trials, Ovid MEDLINE, Sociological Abstracts, and Social Services Abstracts (through 2018); Social Interventions Research and Evaluation Network evidence library (January 2019 through May 2021); surveillance through May 21, 2021; interviews with 17 key informants. STUDY SELECTION: Individual-level and health care system–level interventions with a link to the health care system that addressed at least 1 of 7 social risk domains: housing instability, food insecurity, transportation difficulties, utility needs, interpersonal safety, education, and financial strain. DATA EXTRACTION AND SYNTHESIS: One investigator abstracted data from studies and a second investigator evaluated data abstractions for completeness and accuracy; key informant interviews were recorded, transcribed, summarized, and integrated with evidence from the literature; narrative synthesis with supporting tables and figures. MAIN OUTCOMES AND MEASURES: Validity of multidomain social risk screening tools; all outcomes reported for social risk–related interventions; challenges or unintended consequences of screening and interventions. RESULTS: Many multidomain social risk screening tools have been developed, but they vary widely in their assessment of social risk and few have been validated. This technical brief identified 106 social risk intervention studies (N = 5 978 596). Of the interventions studied, 73 (69%; n = 127 598) addressed multiple social risk domains. The most frequently addressed domains were food insecurity (67/106 studies [63%], n = 141 797), financial strain (52/106 studies [49%], n = 111 962), and housing instability (63/106 studies [59%], n = 5 881 222). Food insecurity, housing instability, and transportation difficulties were identified by key informants as the most important social risk factors to identify in health care. Thirty-eight studies (36%, n = 5 850 669) used an observational design with no comparator, and 19 studies (18%, n = 15 205) were randomized clinical trials. Health care utilization measures were the most commonly reported outcomes in the 68 studies with a comparator (38 studies [56%], n = 111 102). The literature and key informants described many perceived or potential challenges to implementation of social risk screening and interventions in health care. CONCLUSIONS AND RELEVANCE: Many interventions to address food insecurity, financial strain, and housing instability have been studied, but more randomized clinical trials that report health outcomes from social risk screening and intervention are needed to guide widespread implementation in health care.