Convergence and differences across social needs identified through structured screeners and clinical assessments

AbstractIntroduction Health related social needs, such as food, transportation, and housing insecurity, influence health outcomes. While standardized social determinants of health (SDOH) screeners are increasingly used in clinical settings, it remains unclear how well these tools capture patient needs compared with conversational assessments conducted by trained staff like Community Health Workers (CHWs). Methods This observational study was conducted using deidentified electronic health record data from NYC Health + Hospitals between January 1 and December 31, 2023. Adult primary care patients (≥21 years) completed both the system's standardized SDOH screener and a CHW-led semi-structured assessment. Assessments covered 10 domains: housing insecurity, housing quality, food insecurity, transportation, childcare, education, financial assistance, insurance or medical cost help, legal assistance, and employment. The proportion of patients with ≥1 identified need and concordance across instruments were calculated. Results Among 2,077 patients who completed both instruments, 58.3% were female, 42.5% Hispanic/Latinx, 41.1% Black or African American, with a mean (SD) age of 58 (14.5) years; 33% were uninsured and 26.9% had Medicaid. Overall, 51.4% reported ≥1 social need on both instruments, 43.3% reported ≥1 need only to a CHW, and 1.8% reported ≥1 need only on the screener. CHWs identified higher rates of food insecurity (35.4% vs 10.7%), transportation needs (28.2% vs 11%), and legal assistance (23.8% vs 6.8%) compared with the screener. Conclusions and Relevance Patients disclosed social needs to CHWs at substantially higher rates than on structured screeners, suggesting that conversational, relationship-based assessments reveal unmet needs not captured through standardized tools. Policies relying solely on structured SDOH screening may underestimate social needs. Allowing clinical assessments to complement or substitute for screeners could improve identification and linkage to resources.