Birmingham health links: addressing social determinants of health in the clinical setting

Background A recent body of evidence suggests that addressing social determinants of health in the clinical setting improves health status and helps reach health targets, a topic of important public health significance. The Birmingham Free Clinic (BFC) in Pittsburgh’s South Side recently implemented Birmingham Health Links (BHL), a program to address patient’s social determinants of health. With nearly half of Birmingham patients considered homeless and over 90% living below the federal poverty level, BFC serves some of the city’s most vulnerable.\ud Program Description BHL is a social services help desk modeled after Health Leads, Inc that trains student volunteers to help patients address the broader social factors that influence health such as employment, food security and housing. Students engage with patients one-on-one to understand their situation, create an individualized action plan and follow-up on a weekly basis by phone until the patients’ needs are met to the patient’s satisfaction. \ud Methods A program evaluation included an analysis of patient case files, a patient phone survey using the Client Satisfaction Questionnaire-8 (CSQ-8), and a qualitative analysis of students’ weekly reflections. \ud Results During the first 6 months of the program, 23% of unique clinic patients used the BHL help desk. The top three needs were housing assistance (26%), food assistance (18%) and employment (16%). Twenty percent of cases (n=80) were closed because needs were met and 59% were lost to follow up after the initial encounter. The phone survey (n=14) found that patients were quite satisfied with their experience. The analysis of student reflections (n=166) found that many students noted personal and professional growth, a new understanding and appreciation for social determinants of health and a shift in their career path to include work with underserved populations as a result of this experience. \ud Conclusion This model of addressing social determinants of health in a clinical setting shows great promise for being welcomed by patients, for providing future health professionals with an applied understanding of the importance of social determinants on health and shows feasibility due to it’s low annual budget. \u