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By Lindsay Knaus, Project Manager

Island Senior Resources presented at this year’s All-In: Data for Community Health National Meeting in Baltimore, MD.  This event is intended to bring data sharing pioneers together to share solutions and accelerate progress toward improved health equity.

Island Senior Resources’ director Chasity Smith’s presentation was titled, “Screening for Social Determinants: What’s in a Tool?”

Island Senior Resources, Island County Human Services and Public Health, Island Senior Resources, and WhidbeyHealth are all participating implementation partners with the ACH, working cooperatively on a number of initiatives related to ACH health improvement strategies. Their work has developed into cross-sector collaboration aimed to address service gaps, barriers, and risk factors in order to improve health equity in Island County.

These partners’ goal is to develop a coordinated referral system and social determinants screening tool. The tool includes demographics and nine core measures covering medical, social, and basic needs. The tool acts as both a screener and referral generator, connecting each person with the right resource.  The organizations aim to identify the needs in their community, better understand the causes, connect people with help, and improve health and well-being.

Implementation began with a local primary care clinic as the pilot site, integrating the screening tool into clinical workflows as of Fall 2019. The pilot will be followed by a formal review and process improvement plan.

Chasity’s presentation provided insights for those looking to develop a coordinated screening and referral system across sectors, using collaboration.  It also provided a rural perspective on this process, from the creation and modification of a screening tool, implementation and timeline considerations, and how small projects can be used to leverage the discussion on multi-sector data sharing in rural communities.