Social Determinants of Adolescent Health: Screening Students for Community Needs

Coordinating Care around the Social Determinants of Health is a blog series featuring clinician stories that illustrate the impact of safety-net health centers coordinating adolescent care through a social determinants lens. Read more posts in the series here.


By Seleena Moore, Program Manager, School-Based Health Alliance

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When addressing social determinants of health, the first step is asking patients about this aspect of their lives. At Curtis High School in Staten Island, New York, every student has access to a comprehensive care system, including primary, mental, and reproductive health–as well as vision services and chronic condition management. Regardless of the reason for the visit, a student entering the school-based health center (SBHC) for their first-time visit or for an annual checkup get screened using the Rapid Assessment for Adolescent Preventive Services (RAAPS) survey. Following this system, clinicians are able to have crucial information about students’ holistic health—before students even enter the exam room. “It gives us the red flags” Amalfi Gutierrez, Curtis’ SBHC Medical Office Manager explains. These red flags—like trauma, risky behaviors, or an unstable home environment—can be indicators that a student isn’t as healthy as they look physically. “Screening [for social determinants] helps us get kids to the care they really need.” The screening also helps students develop a relationship with the provider—this way, students know they can speak up, and know where to go.

Using RAAPS, Children’s Aid Society (Curtis High School’s SBHC sponsor agency) compiles quarterly presentations highlighting topical community issues. Both internal management and quality improvement teams get in on the data, ensuring the clinical and business operations are able to keep up with community demands. Dr. Lisa Handwerker, Chief Medical Officer at Children’s Aid Society explains that the importance of data is two-fold: 1) to justify the work the clinicians are doing, and 2) to help prioritize where more community resource partnerships would be beneficial.

With such integrated and inclusive care available in the center, coordination can often be a matter of ensuring that students make their appointments and checking in with other clinicians down the hall.  Since starting this screening process, Gutierrez reports the center has seen more referrals —both to other services within the center, and to services provided by community agencies. Additionally, establishing monthly meetings help staff stay up to date on specific cases and general concerns within the community. This coordination within the center helps staff to plan new outreach, and new education/prevention initiatives, as well as know what to be on the lookout for. It also helps the center coordinate outreach within the school—letting teachers know what trends have been coming up in the center and might affect their classrooms.

Coordinating care outside of the SBHC requires an extra level of commitment when finding the proper community resource proves challenging. Connecting with their sponsor helps to address this issue as Children’s Aid Society offers assistance in locating and referring their health center staff to community-based services of local partners.  Additionally, Children’s Aid Society is working with a local partner to develop a database of providers and community agencies by social need to help centers identify available services in and out of typical health care settings.

By looking at students’ lives in addition to their heart rate and BMI, and by coordinating students care—whether in the center, the school, or the community— the Curtis High School SBHC is helping students achieve their highest potential.

Meet Ana*

In November of 2014, Ana was in crisis. During an appointment and screening at the Curtis High School SBHC, the mental health counselor learned that Ana was living at home with her physically abusive mother.  With the help of the SBHC social worker, the mental health counselor was able to facilitate Ana’s removal from her mother’s home and into a safe and caring environment with her grandmother.

Months later, friends of Ana’s (who had been to the health educator at the center before) brought Ana in for reproductive services counseling. After a discussion with the health educator, Ana was able to get started on birth control, and get tested for STIs. During that same screening, she was also referred to the dental hygienist. But more importantly, because of the existing relationship with the center, Ana felt comfortable disclosing a history of sexual abuse. The health educator explained the mental health services available and Ana agreed to start regular counseling with the mental health counselor.

From housing instability and food insecurity to social isolation and exposure to violence, understanding the health behaviors of adolescents and their willingness to seek care depends on asking tough but critical questions. Screening tools like RAAPS serve as the gateway to providing interventions that address adolescent needs beyond the clinic walls. (Click here to see a chart that compares different screening tools).

*Names have been changed to protect confidentiality.


Acknowledgements

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under cooperative agreement number U30CS09738-08-00, award title “Technical Assistance to Community and Migrant Health Centers and Homeless” for $450,000. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS, or the U.S. Government.

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3 Comments

  1. by parrish@youthempoweredsolutions.org on October 6, 2016 at 10:26 am

    Hello! Great post and what an interesting idea to frame RAAPS as a tool for digging into social determinants. I do think that, when I have heard discussions around social determinants, they have been more framed around structural barriers (food or health care desert, under funded school system, no day-care or child care or parental leave for families) rather than personal behaviors/symptoms (trauma, risky behaviors, etc.). I wonder how RAAPS might be used to identify some of these structural barriers AND then what does the conversation look like for health care providers to engage in efforts to remove those structural barriers that then potentially decreases the likelihood of trauma and risky behaviors in the entire community?

    I don’t know much about it, but Health Leads has a screening tool that seems really cool and pairs with many EHRs and gets at some of this.

    Nice work and great post!!!

  2. by Jennifer Salerno on November 4, 2016 at 8:13 pm

    Thank you for the discussion. Social determinants include both structural and personal/behavioral factors. At Possibilities for Change, we are working closely with the American Public Health Association to create a RAAPS-PH tool that includes additional questions to uncover social determinants that may be impacting health and well-being. I’m happy to talk with anyone interested in learning more about the process used to develop the questions and some of the pilot results from the RAAPS-PH. – Jennifer Salerno

  3. by Jennifer Salerno on November 4, 2016 at 8:14 pm

    Jennifer Salerno: jsalerno@raaps.org

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