33 - Tools to Understand Individual and Systems Level Competency to Identify and Address Health-related Social Needs

Abstract Information: The Emory Centers for Public Health Training and Technical Assistance (Emory Centers) has developed and implemented a series of evaluation activities to assess individual and organizational capacity to address patient’s health-related social needs. Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes which are reflected in the conditions in which people live, work, and play. While changes in partnerships, practices, and policies help change SDOH, healthcare providers are increasingly working to address patient’s health-related social needs (the social and economic needs that individuals experience that affect their ability to maintain their health and well-being, such as employment, housing, healthy food, transportation, and affordable utilities). Individual level. To understand healthcare provider self-efficacy around SDOH, Emory Centers evaluators, subject matter experts, and research faculty at the Emory School of Nursing developed a competency assessment. Using literature review findings, the team identified 23 SDOH dimensions ensuring relevance to nursing clinical practice and the use of updated terminology in each dimension. A competency scale, based on Benner’s novice to expert model, included descriptions specific to patient interactions for each scale point. The tool was validated with support from Emory’s Biostatics Collaboration Core. Emory Centers has used this tool and related adaptations in multiple evaluation activities, including an assessment of nursing professional competency (March-June 2023, 690 respondents), an assessment of student nursing competency (August 2023, 137 respondents), and a survey of patient encounters by student nurses (September-December 2023, 522 encounters reported by 133 respondents). Both students and professionals reported similar areas of strength and gaps in self-efficacy. Findings from a survey of patient encounters, indicated that the SDOH topics most often addressed echo those where students and nursing professionals reported the highest competency. Not surprisingly, SDOH topics least frequently addressed also matched the competency gaps reported by students and professionals. Based on the gaps identified, experts from Emory’s School of Nursing developed targeted web-based continuing education modules for nursing professionals and are incorporating these modules into student nurse education. Emory Centers evaluators are collecting data to understand how those modules equip nurses with strategies and resources to improve patient care and health outcomes. Organizational level. Emory Centers has also expanded this individual self-efficacy framework to assess organizational capacity to address social needs and connect patients to necessary resources. The development of an organizational level capacity assessment, deployed in tandem with an individual assessment of care team members, helped federally qualified health centers identify ways to improve their ability to address patient social needs. The organizational capacity assessment included an expanded set of SDOH-related competencies, such as existence and frequency of use of standardized screening processes, referral processes, and the development of supportive staff cultures. Conclusion. These tools have been used to inform the development of training programs and organizational practices to improve patient care for historically underserved populations. Perspectives from diverse student and professional nurses were integral to the development and implementation of these tools. In future refinement of these tools, Emory Centers plans more deeply involve student and patient perspectives.