Title : Findings from a quality improvement project: Implementation of health-related social needs screening

Background: Unmet health-related social needs (HRSN) can worsen behavioral health crises and impede recovery, yet standardized screening and referral processes are not routinely used in crisis settings.

Purpose: This quality improvement project evaluated whether implementing the Centers for Medicare & Medicaid Services Accountable Health Communities Health-Related Social Needs (AHC-HRSN) screening tool increased referrals to community resources among adults admitted to a Colorado behavioral health crisis stabilization unit.

Methods: A quantitative, quasi-experimental pre- and post-implementation design was conducted over 16 weeks, comprising an 8-week pre-implementation period and an 8-week post-implementation period. The AHC-HRSN tool assessed five domains: housing, food insecurity, transportation, utilities, and safety. A chi-square test of independence evaluated the association between screening implementation and referral receipt. Five multiple logistic regression models examined relationships between demographic predictors and referrals within each HRSN domain. Statistical significance was established at p < .05.

Results: Implementation of the AHC-HRSN tool was associated with a statistically significant increase in community resource referrals. Prior to implementation, 13 of 78 clients received referrals, representing a referral rate of 16.7%. After implementation, 54 of 64 screened clients received referrals, representing a referral rate of 84.4%. Chi-square analysis showed a significant association between implementation of the screening tool and referral receipt, χ² (1, N = 142) = 64.671, p < .001. During the post-implementation period, referred resources most addressed food insecurity (79.6%), housing (66.7%), transportation (50.0%), safety (27.8%), and utilities (25.9%). Client engagement was high: 87.7% of eligible post-implementation clients agreed to screening, and 100% of those with identified HRSN accepted community resource referrals.

Conclusion: Standardized AHC-HRSN screening produced a statistically and clinically significant increase in community resource referrals and was accepted by most clients receiving crisis stabilization services. Findings support incorporating routine HRSN screening into behavioral health crisis care, with particular attention to clients with low incomes, smaller households, lower educational attainment, and recent emergency department use.

Hedy Gerber, DNP, APRN, PMHNP-BC, CNE, is an Assistant Professor of Nursing at Colorado State University Pueblo, teaching in the Psychiatric Mental Health Nurse Practitioner (PMHNP) and Doctor of Nursing Practice (DNP) programs. She earned her DNP degree from Chatham University in 2016. She is a board-certified PMHNP and a Certified Nurse Educator (CNE). With over ten years of PMHNP practice and teaching experience, she brings expertise in evidence-based practice and nursing education. She frequently chairs DNP projects, guiding students in quality improvement and research initiatives.