Care Coordination
Community Health Workers’ Role in Screening for Social Determinants of Health
By Tanikka C. Price, Data and Finance Director,
Central Ohio Pathways HUB
Health is more than just going to a doctor’s appointment. It is wellness; feeling good and being empowered to make decisions for yourself and your family. Health is impacted by where you live, where you work, what you eat, how you provide for your basic needs, how you get where you need to be and how safe you feel in your most intimate relationships. For too many families, health is impacted by all the things that happen before they get to the doctor’s office. These elements are known as Social Determinants of Health (SDoH).
The Central Ohio Pathways HUB (the HUB), a care coordination program managed by the Healthcare Collaborative of Greater Columbus (HCGC), deploys community health workers (CHWs) to address clients' SDoH in order to provide connections to appropriate health and social services and care to our region’s most vulnerable populations.
On December 19th, HCGC will welcome our partners at Franklin County Public Health, who will provide an update on CORE 5, a screening tool for SDoH. We know that clients in the HUB all have unique needs that need to be addressed, and learning more about CORE 5 and how it is being introduced into medical settings will be very helpful to inform the work that CHWs do for HUB clients. Click here for more information and to register for the webinar.
The Core 5 basic determinants of health are:
Food insecurity;
Housing instability;
Utilities;
Transportation; and
Interpersonal Violence (IPV)
CHWs have the unique perspective to meet clients where they are, address their needs, as well as provide referrals to medical and social services. This has the potential to build an ongoing, trusting relationship with providers in the communities in which the HUB serves for future collaboration.
As we move into programming and education opportunities for HUB CHWs in 2020, HCGC plans to continue providing training on the various services that each HUB Care Coordination Agency (CCA) has to offer HUB clients. The ten CCAs currently participating in the HUB provide a wide array of services including pre-and post-natal care to address the infant mortality crisis, opioid prevention and treatment, theft diversion, mental health referrals and several chronic disease management and wellness services and referrals.
HUB CHWs meet clients where they are and provide access to nutritious food, housing, funding for utilities, transportation and support for those experiencing IPV. Serving as community connecters, CHWs have the unique opportunity to connect clients to services provided by CCAs, and have first-hand knowledge of what referrals are appropriate and where the most up-to-date referral sites are located. It is the relationship and trust that is built with the CHW that allows the client to follow through with the plan and referral process, which results in better outcomes and overall health for people in Central Ohio.
We hope you will join us on December 19th to learn more about the current state of the CORE 5 SDoH screening tool, and partake in a community conversation about the future of screening for SDoH.
