Talking about social needs in healthcare? Here's how.

[Esther Kang, MSN, RN]

If there is one major lesson the pandemic taught healthcare, it would be that people's socio-economic needs all have a greater impact on health and wellness than medical conditions themselves. These socio-economic needs include the need for safe housing, definite transportation, access to healthy food, adequate income, ability to pay utilities, access to childcare or adult care, education, etc. If we want individuals, families, and communities to thrive by accessing various medical and non-medical services, we need to address their socio-economic needs first. 

Because how can we expect a patient with high blood sugar or high blood pressure to get better if he or she cannot even access healthy food because the neighborhood only has fast-food restaurants or convenience stores? Or how can we expect a patient, who is well-known for missing appointments, to show up to appointments - without first realizing that the patient cannot drive, cannot take public transportation, and has trouble finding someone to take him or her to appointments? And how can we expect patients to take their prescribed pills correctly and on time without first realizing that they actually do not fully understand what the pills are for and have trouble reading instructions?

These are, for sure, heavy, serious, and uncomfortable questions -- questions that weren't commonly asked or openly discussed before with other healthcare providers -- questions that only see the light of day within a social work or case management office.

So, as healthcare providers, where can we start? It starts with appropriate and effective communication.

Here are the top 3 ways to communicate effectively with patients about their social needs:

| 1. Establish a standardized social needs screener

In your clinic or practice, have a standardized social needs screener. This can help patients feel like they're not being "targeted" or solely chosen to take the screener. Standard screener means that everyone takes the screener regardless of age, race, income, background, zip code, education, etc. No person ever wants to feel like he or she is being singled out to answer a questionnaire about his or her housing, transportation, or income situation. Thus, make the screener standardized for patients to feel more comfortable and open to sharing sensitive information about their social needs. 

| 2. Assure patients their answers in the screener are private and secure in their health records and only used to refer them to appropriate social needs services.

Research found that patients with greater social needs are more worried and concerned about the answers to social needs screener documented in their health records. The concerns may include being reported to local authorities without their consent (in the case of adult domestic violence), deportation of self or loved ones (in the case of refugees or illegal immigrants), or losing employment. By assuring patients that their answers to the screener remain private and secure in their electronic health record, they can feel rest assured that their social needs answers will not be exploited or reviewed by people who are not involved in their care - just as how their medical record is handled through HIPAA compliance.

| 3. Follow the RESPECT Model

This model has 7 parts or approaches to communicating effectively with patients: Establish Rapport, provide Empathy, show full Support, create a Partnership with the patient, give clear Explanations, exercise Cultural competence, and take the time to build Trust.

• Establish Rapport - by intentionally releasing judgment, recognizing and avoiding any bias or assumptions, and understanding the other person's point of view
• Provide Empathy - by realizing that the patient came to you for help and assistance, consciously seeking to understand the patient's reasons or explanations for behaviors or medical conditions, and verbally validating and acknowledging the patient's feelings.
• Show full Support - by asking about the barriers to getting necessary and complying with care, collaborating with patients on how to overcome these barriers, involving family or loved ones if needed, and constantly reassuring the patient of your availability and desire to help.
• Create a Partnership - by stressing the importance of working together to address medical problems, clearly negotiating roles and expectations, and being flexible when it comes to issues of control. 
• Give clear Explanations - by being mindful about whether you understand what the patient is trying to explain and using verbal or non-verbal body language or techniques for clarification
• Exercise Cultural competence - by respecting the patient's culture and beliefs, recognizing your own limitations in addressing issues that involve culture, and understanding the patient's view of you as a healthcare provider is influenced by ethnic or cultural bias or stereotypes
• Take time to build Trust - by taking the time and consciously working to build trust with patients and family members or loved ones and by recognizing that self-disclosure may not be as common practice in some cultures as it is in the Western culture. 

This model was created as an easy-to-remember guideline on how we can approach patients with matters or topics that are sensitive or controversial. Though it isn't impossible, it takes training and practice to effectively enact these communication approaches.

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