SONNET Newsletter: May 2022
May 18, 2022
New social health training for all KP providers
SONNET's new CME training module uses real-world scenarios to help KP providers build skills in talking with members about social risks
By Meagan Brown, PhD, MPH, research associate at Kaiser Permanente Washington Health Research Institute and member of the SONNET Evaluation and Research Committee, and Andrea Paolino, MA, SONNET program director at Kaiser Permanente Colorado’s Institute for Health Research
On behalf of the Social Needs Network for Evaluation and Translation (SONNET), we are excited to share a new training resource designed to help Kaiser Permanente providers communicate effectively with members about social health. Addressing Social Health in Medicine is an online training module that uses real-world scenarios to illustrate how to identify members’ social needs and risks, connect them to resources, and work with them to adapt their care plans. Now available on KPLearn, this 45-minute training provides Continuing Medical Education (CME) credit for physicians, nurse practitioners, physician assistants, and other providers.
Why develop social health training for KP providers?
Across Kaiser Permanente, providers and care teams are working hard to incorporate members’ social health into the care they provide every day. This includes providing “social needs-targeted care,” which involves screening members for social needs that they’d like help with — such as financial insecurity, housing instability, and lack of transportation — and then referring them to resources.
But there’s another aspect to integrating social health into routine care that goes a step further. After collecting information about the social risks a patient is facing, providers have an important opportunity to adapt the treatment plan based on what they’ve learned about the patient’s social context. Called “social risk-informed care,” this approach involves incorporating a person’s social risks into their care plans — without compromising the standard of care. For example, if social health screening shows that a patient doesn’t have reliable transportation, a provider could suggest phone or video visits when an in-person appointment isn’t necessary.
In SONNET’s work to understand the landscape of social health integration across Kaiser Permanente’s 8 regions, we heard loud and clear that providers and care teams are eager for training on how to provide social risk-informed care. So in 2021, with support from KP’s National Office of Community Health, SONNET prioritized developing Kaiser Permanente’s first training module to support providers in delivering integrated social health — with a special focus on helping them build skills in effectively addressing social needs and providing social risk-informed care to members.
Social risk-informed care: Small changes can make a big difference
While developing the training module, we heard many real-world scenarios from Kaiser Permanente providers that taught us that social risk-informed care doesn’t have to involve big changes in a patient’s treatment plan. Here is one example:
Kaiser Permanente’s default for prescription refills is to handle them by mail order. But if a member doesn't have stable housing or is living in their car, this may not be the best option. If the provider knows about this patient’s life circumstances — through social health screening and talking with the patient – they can find an alternative, like arranging for pick up at the pharmacy. But if that conversation never takes place, this member might never get their meds — which puts them at risk for negative health outcomes.
Sometimes the fixes are simple. And it’s important for health systems to think about how standard procedures might not be built to support people who have social risks. The key is listening and getting to know our members, so we can figure out how best to help them.
One thing we’ve heard from Kaiser Permanente members who are helping co-design universal social health screening in Washington is that they just want to be heard. They understand that their provider’s time is limited and don't necessarily expect providers to have all the answers. However, when the provider gets to know a member’s personal circumstances and can adapt their care and refer them to someone who can help — such as a community resource specialist — it really goes a long way. The solutions don’t have to be huge or complex. Small stuff adds up and makes a difference in meeting the needs of our patients.
Merging evidence with real-world experience
To develop the content of the training module, we combined the latest evidence on integrated social health with the real-world experiences of Kaiser Permanente patients and providers. Among the evidence we shared in the training are findings from Kaiser Permanente’s National Social Health Survey, conducted in 2020.
The survey found that 2 out of 3 Kaiser Permanente members were facing at least one social risk – and that 1 in 5 members had three or more social risks. These findings speak to the need to integrate social health into primary care, even among members of an integrated health system like Kaiser Permanente — a population that, at first glance, might not be expected to face many social risks.
Another piece of evidence that informed the training module was how challenging it can be to implement social risk-informed care. When looking at research from Dr. Saul Weiner1 and others who have documented what it takes to contextualize care around a person’s social risks, there are opportunities to hone the skills needed to first discuss a patient’s social risks and then work with them to enhance the care plan so it best meets their needs. This type of care adjustment can help achieve the best outcomes for our members.
To help illustrate what these skills look like in everyday care, we relied heavily on the SONNET advisory committee, made up of providers and researchers who collaborated with us to develop the training.
The providers were essential in developing the case studies that serve as the foundation of the training, all of which are based on real-world examples they’ve come across in clinic. One of the researchers on our team – Dea Papajorgji-Taylor, MPH, from Kaiser Permanente Northwest Center for Health Research – interviewed providers across Kaiser Permanente for SONNET’s report on recommendations for social risk-informed care. She was able to give us real-time input from those interviews to incorporate the perspectives of providers from all 8 regions.
We were also fortunate to partner with Kaiser Permanente Enterprise Learning to turn the evidence and case studies into an engaging and inclusive online module. One of our goals was to ensure the training represented real members. The Enterprise Learning team’s senior instructional designer, Julie Hymes, had experience and resources that helped us depict members of different backgrounds, gender identities, sizes, ages, races, and ethnicities.
Next steps
The Addressing Social Health in Medicine training module is available now for all Kaiser Permanente providers and other care team members, and we encourage anyone who is interested to check it out. Our SONNET team will also be working closely with the Kaiser Permanente National Office of Community Health and leaders in the organization’s 8 regions to engage providers in the training. To start, we’ll prioritize the 3 regions that are implementing universal social health screening practices: Colorado, Northwest, and Washington.
Thinking ahead to evaluation, we built a before-and-after quantitative survey into the training. The survey asks questions about what participants know about social risk-informed care before starting the training, and then asks the same questions again after they complete it.
To measure uptake, we’ll track the number of providers who take the training and reach out to a sample of them for interviews to learn about their experience. We’ll ask what they liked about the training, whether they’ve been able to incorporate social health care practices in their work, and what opportunities they see to improve the module or other social health trainings.
It’s important to note that the evidence on social risk-informed care is still developing. So when you ask providers to work with patients to adjust care plans around social risks, it's not like you can just point to a guideline and say, “if your patient has food insecurity, and they're on this particular medicine, you should change to it to this other medication.”
Nonetheless, it’s still important that providers understand that delivering social risk-informed care doesn’t mean changing the standard of care. It just means adapting the things you can based on what’s possible within a particular patient’s social context. Getting to know our members and understanding the social risks they’re facing puts us in a much better position to have a positive impact on their lives.
Many thanks to our advisory committee and workgroup members from across KP
Meagan Brown, Research Associate, KP Washington – project lead and workgroup member
Kat Barnes, Primary Care Physician, KP Washington – workgroup member
Caitlin Dorsey, Research Specialist III, KP Washington
Lauren Galpin, Physician, Medical Director of Medicaid, KP Colorado
Laura Gottlieb, Director, Social Interventions Research & Evaluation Network (SIREN)
Jennifer Kelloff, Physician, Medical Director for Social Health, KP Colorado
Cara Lewis, SONNET Co-Director, Senior Investigator, KP Washington
Maggie Marshall, Regional Social Services Lead, KP Northern California
Andrea Paolino, SONNET Program Director, KP Colorado – workgroup member
Dea Papajorgji-Taylor, Research Associate, KP Northwest – workgroup member
Rebecca Parrish, Administrator of Clinical Operations, Mental Health and Wellness Services, KP Washington
Loel Solomon, Professor, Health Systems Science, KP School of Medicine – workgroup member
Gina Sucato, Physician, Adolescent Health, KP Washington
1. Weiner SJ. Contextualizing care: An essential and measurable clinical competency. Patient Educ Couns. 2022 Mar;105(3):594-598. doi: 10.1016/j.pec.2021.06.016. Epub 2021 Jun 15.
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