We are sending you our best wishes for a peaceful New Year. Our December newsletter consistently offers a nice opportunity to reflect on the year’s highlights. Here are some things we thought about, watched, and/or read in 2023 (plus some gems we look forward to in 2024) that we hope interest our readers.

Throughout 2023, momentum continued to build around federal and state policy designed to encourage the healthcare sector to invest in social drivers of health as part of comprehensive strategies to achieve health equity. An ASPE report published this year (somewhat) succinctly summarized government activity on this topic to date; and the White House recently published a playbook describing opportunities to deepen capacity in this area. Ball: rolling.

Of course, that means the need for strong evidence on impactful and appropriate roles for the healthcare sector vis a vis social drivers is reaching new heights. SIREN’s library team writes below about this year’s bumper crop of social care research. They modestly don’t mention that the SIREN website is nearing one million page views. Hmm…could your holiday gift to us be getting us over the who-says-it-is-meaningful-but-it-feels-that-way 1M views mark? (Why yes, yes, it could.) And of course, not to be outdone, here’s our unique holiday gift for you, precious SIREN peeps: an EDGE-OF-YOUR-SEAT live discussion with Sherry Glied, Stacy Lindau, and Seth Berkowitz about limits to the healthcare sector’s investments in social drivers. No unwrapping necessary! Register for this February 28th event here.

The most popular SIREN resources this year were articles & reports on social risk screening, likely because 2024 will usher in new social drivers reporting requirements for NCQA, The Joint Commission, and select CMS programs (these were just voluntary in 2023). Other implementation resources were also in high demand. That includes a community-vetted set of social risk and intervention data standards published in the National Library of Medicine’s Value Set Authority Center (VSAC). These were stewarded by our friends at The Gravity Project to support interoperable health information exchange about social conditions and social care. This is a major step forward for common data standards, which will facilitate future research! With support from RWJF, this year, the Gravity team collaborated with Civitas Networks for Health to launch multiple implementation pilots for the new social care data standards.

Wowee--that’s a lot! Our takeaway: opportunities for effectiveness and implementation research on social care in 2024 are both endless and much needed. To be truly transformative, that research has to put people’s lived experiences of adversity and resilience at the center. Below, our Patient Engagement team outlines ways we’re building capacity to do that at SIREN and beyond.

Here’s to a 2024 filled with shared learning!

-The SIREN team

SIREN’s Partnerships with Experts by Experience 

This year we strengthened partnerships that help us to bring the voices and perspectives of lived experience experts into social care research, which is a key strategy for advancing racial health equity. SIREN is entering our third year of collaboration with the Patient Insight Institute on a Social Needs & Health Equity Learning Community composed of Experts by Experience from across the US with lived experience of social and/or economic adversity. We also are grateful to our SIREN Engagement Grants advisors, who worked closely with us over the last year to develop the grant announcement and to select awardees. These grants will support multiple teams to more deeply involve individuals and community organizations in social care research centered on advancing racial health equity. In the coming year, we will continue to strive to include and elevate lived experience experts in all facets of our work, including in the review and prioritization of abstracts for the upcoming Health Services Research (HSR) special issue on Social Care and the US Health Care Sector. (Subtle hint to submit your abstract by January 3rd).

Continued Growth in Evidence on Social Care

The SIREN Evidence and Resource Library now hosts 2,813 resources related to social care, including peer-reviewed articles, reports, webinars, and screening implementation tools/toolkits. We've added 536 new resources so far in 2023, including 19 RCTs and 13 systematic reviews. 

With support from the Kaiser Permanente National Community Benefit Fund at The East Bay Community Foundation, the Center for Health Care Strategies (CHCS) has launched a new initiative: the Medicaid Health-Related Social Needs (HRSN) Implementation Learning Series. This learning series is a 12-month opportunity for state Medicaid officials to learn from their peers in other states, national thought leaders, and organizations at the cutting edge of health and social care integration. In partnership with HealthBegins and SIREN, CHCS will support five to nine states uncover early lessons, best practices, and potential pitfalls. The 12-month learning series begins in March 2024. Apply by January 23rd. See more details here.

Health Services Research Special Issue Call for Abstracts: Social Care and the US Health Care Sector
Health Services Research (HSR) is partnering with SIREN on a special issue on the health care sector’s practices and opportunities for identifying and addressing social care needs. The deadline for abstracts is Wednesday, January 3, 2024. More details on this special issue sponsored by the Robert Wood Johnson Foundation here.

Journal of Clinical and Translational Science: Social Determinants of Health in Clinical and Translational Science
The Journal of Clinical and Translational Science is issuing a Call for Papers for a special themed issue focused on studies that address social determinants of health (SDoH) in clinical and translational science. Manuscripts are due December 31, 2023. Full details can be found here.

The National Institute of Nursing Research (NINR), National Institutes of Health (NIH): The Bridge-to-Care Initiative
NINR, NIH has announced NOT-NR-24-003 to communicate intent to reissue a funding opportunity, The Bridge-to-Care Initiative, to support intervention research that leverages healthcare-community partnerships to address health-related social needs at the individual or family level or social determinants of health at the community level. See more information here.

Evidence for Action (E4A): Indigenous-Led Solutions to Advance Health Equity and Wellbeing
E4A has launched a new call for proposals, Indigenous-Led Solutions to Advance Health Equity and Wellbeing. Under this call they are seeking to fund Indigenous-led community-prioritized investigation of solutions with the potential to advance health and well-being, integrating and elevating Indigenous cultures and knowledge-building practices. More detailed information can be found here.

Webinar

Partnership to Align Social Care: Contracting to Align Health and Social Care Ecosystems: A Webinar Series Sharing Leading Practices – Today December 12, 2023 | 9am PT/12pm ET

Meetings & Conferences

American Hospital Association: Accelerating Health Equity Conference – May 7-9, 2024 | Kansas City, MO | Registration open

Systems for Action: Tribal Care Coordination Dashboard Project: Coeur Adolescent Support Team (CAST) Referrals – Originally broadcast November 29, 2023

NEJM Catalyst: How Anchor Institutions Improve Patient, Community, and Workforce Health – Originally broadcast  December 6, 2023

Better Care Playbook: How the Program of All-Inclusive Care for the Elderly Can Meet the Needs of Dually Eligible Individuals in Rural Communities – Originally broadcast December 7, 2023

National Association of Community Health Centers: SDOH Academy: Fostering a Healthcare Workforce for Today’s Social Health Challenges – Originally broadcast  December 7, 2023

Below is a list of recently published research related to integrating social and medical care. See more articles like these in the searchable SIREN Evidence Library. As always, if you are aware of resources you think should be added to the Evidence Library, please send them our way!

Awareness

Accuracy of a Single Financial Security Question to Screen for Social Needs Hanmer J, Ray KN, Schweiberger K, Berkowitz SA, Palakshappa D | Pediatrics

✪ Key result: "Using the financial stress question as the first-step of a screening process would miss 9.7% of the families who reported food insecurity, 22.6% who reported housing instability, and 33.0% who reported transportation needs."

Assessing Social Needs and Engaging Community Health Workers in Underserved Kansas Counties: Insights From Primary Care Providers and Clinic Managers Bridges KM, LeMaster JW, Parente DJ, et al. | Journal of Primary Care & Community Health

Patient and Care Team Perspectives on Social Determinants of Health Screening in Primary Care: A Qualitative Study Rudisill AC, Eicken MGA, Gupta D, et al. | JAMA Network Open

Social and Health Information Platform: Piloting a Standards-Based, Digital Platform Linking Social Determinants of Health Data into Clinical Workflows for Community-Wide Use Khurshid A, Hautala M, Oliveira E, et al. | Applied Clinical Informatics

Assistance

Innovations in Social Health Delivery to Advance Equitable Pediatric and Adolescent Life Course Health Development: A Review and Roadmap Forward Liu PY, Spiker S, Holguin M, Schickedanz A  | Current Problems in Pediatric and Adolescent Health Care

Implementation and Impacts of California Senate Bill 1152 on Homeless Discharge Protocols Aridomi H, Cartier Y, Taira B, Kim H, Yadav K, Gottlieb L | Western Journal of Emergency Medicine

Referrals to Community and State Agencies to Address Social Determinants of Health for Improving Mental Health, Functioning, and Quality of Care Outcomes for Diverse Adults: North Carolina and Massachusetts, September 2019-January 2023 Alegría M, Cruz-Gonzalez M, Markle SL, et al. | American Journal of Public Health

Evaluating the Impact of a Mobile Integrated Health‒Community Paramedicine Program on Health-Related Social Needs and Hospital Readmissions Miller G, Liang Y, Stryckman B | Journal of Health Care for the Poor and Underserved 

Adoption and Implementation of Produce Prescription Programs for Under-Resourced Populations: Clinic Staff Perspectives Folta SC, Li Z, Cash SB, Hager K, Zhang FF | Frontiers in Nutrition

Integration of Special Supplemental Nutrition Program for Woman, Infants, and Children (WIC) in Primary Care Settings Goldstein B, Steiner A, Vander Wielen L, Bennett K, Tomcho M | Journal of Community Health

"Everyone's Struggling Right Now": Impact of COVID-19 on Addressing Food Insecurity in Rural Primary Care Suresh A, Jordanova KE, Boardman MB, et al. | Family Practice 

Hospital Characteristics Associated With Social Needs Activities in the US Sandhu S, Liu M, Gottlieb LM, Pantell MS | JAMA 

Reports & Policy Briefs

CalAIM Experiences: Implementer Views After 18 Months of Reforms | California Health Care Foundation

Expanding the Menu: Opportunities for Medicaid to Better Address Food Insecurity Bank A, Crumley D, Quintana V | Center for Health Care Strategies 

Commentaries & Blogs

New CMS Bulletin: Coverage of Services and Supports to Address Non-Medical Drivers of Health | Treaty Oak Strategies

Sustainably Implementing Social Determinants of Health Interventions in the Pediatric Emergency Department Assaf RR, Dolce M, Garg A | JAMA Pediatrics

Mandates and Incentives to Support Social Needs Screening-Challenges and Opportunities Bouchelle Z, Vasan A, Cholera R | JAMA Pediatrics

Prescription for Cash? Cash Support to Low-Income Families in Maternal and Pediatric Health Care Settings McConnell M, Agarwal S, Hanson E, McCrady E, Parker MG, Bona K | Milbank Quarterly

Mitigating the Burden of Medication Costs Sandhu S, Patel NR, Horn DM | JAMA Internal Medicine

Advancing Health Equity Through Social Care Interventions Peek ME, Gottlieb LM, Doubeni CA, et al. | Health Services Research