Under newly revised certification criteria, Certified Community Behavioral Health Clinics (CCBHCs) are required to screen clients for Social Determinants of Health (SDoH), non-medical needs that may impact diagnosis, treatment, or recovery.
Screening for safety, food, transportation, housing, or other non-medical issues gives clinicians a more realistic understanding of the person or family’s resiliency, and whether additional support may be needed for treatment and services to be effective. As an example, behavioral health needs may be less of a priority for a person with unmet housing needs -- including unsafe housing -- and the person may be more likely to miss behavioral health appointments as the family works toward a more stable housing situation.
The required SDoH screening becomes part of the foundation for care planning and case management. Its findings may dictate timelines, identify priorities, lead to greater care coordination and collaboration, and require extensive follow-up measures.
SAMSHA’s intent is for clinicians to use the SDoH assessment to drive care, with identified needs addressed as a part of ongoing care.
These 4 SDoH screening tools are allowed
With so much riding on the SDoH assessment, it’s no surprise that the screening tool the CCBHC uses is an important compliance consideration.
The Substance Abuse and Mental Health Services Administration (SAMHSA) wants clinics to use a standardized, evidence-based collection tool. This is one of the new certification requirements issued for CCBHCs by SAMHSA in March 2023.
Four standardized assessments are currently approved for use by CCBHCs, according to Kathy Dettling, SimiTree’s Vice President of Clinical Strategy. Kathy and SimiTree’s other data analytics and compliance experts have been working with CCBHCs to help them meet the new SAMHSA’s revised certification criteria, including the use of the new standardized SDoH assessment.
Here's a look at each of the four approved screening tools:
- American Academy of Family Physicians SDoH Screening Tool
The AAFP tool developed by the American Academy of Family Physicians is available in two lengths. A short-form screens for five core health-related social needs, which include housing, food, transportation, utilities, and personal safety, using validated screening questions. A longer version is available for a more in-depth assessment. - Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences. Known by the acronym PRAPARE, this tool was first developed for community health centers but has become widely used in various health settings. With questions across 21 SDoH domains, it gathers specific information on economic stability, social support, health behaviors, personal characteristics, and more. It is paired with an Implementation and Action Toolkit. The tool has its own website where the questionnaire may be downloaded.
- Accountable Health Communities Health-Related Social Needs Screening Tool. This tool is known by the acronym CMS-AHCM. The Centers for Medicare and Medicaid Services (CMS) uses it for testing to determine whether identifying and dealing with health-related social needs is improving the health outcomes of beneficiaries and/or impacting their total healthcare costs.
- WellRx Questionnaire © 2014, University of New Mexico. The WellRx screening tool was developed by Janet Page-Reeves, PhD, and Molly Bleecker, MA, at the Office for Community Health at the University of New Mexico in Albuquerque. It is part of the WellRx Toolkit and includes 11 validated social determinant questions designed to capture information about food insecurity, housing, utilities, income, employment, transportation, child care, safety, and more.
Embedding the SDoH tool in the EHR
Embedding one of these four standardized assessment tools in the clinic’s Electronic Health Record (HER) and incorporating it into the clinic’s workflow is considered the best practice for compliance with the new CCBHC certification requirement.
Note that of the four screening tools, only the CMS-AHCM does not have a copyright. This means clinics may incur some costs associated with embedding the tool in the EHR.
However, many software developers have begun to integrate SDoH screening tools into EHRs, including templates with basic questions about family life, housing situation, reliability of transportation, whether the client can afford to pay for food and medication, etc.
SimiTree compliance and analytics experts routinely look for the presence of SDOH screening tools in the EHR when working with clients and check to make certain the questions included are adequate for meeting the new quality measure requirement.
As part of our data analytics services, our consultants also work with clients to design the right workflow for these SDoH assessments.
SimiTree’s consultants take it one step further.
SimiTree’s analytics and compliance experts always go the extra mile for our clients. While we are helping our clients ensure compliance with new CCBHC certification criteria, we show them how to build improvements into their data-collecting processes, including:
- Processes for easily identifying clients who are eligible for the measures
- Reliable tracking and alert systems to stay within required timeframes
- Use of standardized screening tools and assessments for stronger compliance
The new SDoH assessment is just one of many changes CCBHCs will see under revised certification criteria. Clinics are working now to meet timelines for compliance based on their CCBHC expansion grant status and state demonstration pilot requirements.
NEXT WEEK: Here’s where your staff training and education efforts are probably falling short.
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J’non Griffin serves as Senior Vice President/Principal for the Compliance as well as Coding divisions at SimiTree. Her healthcare career spans three decades of clinical and leadership experience, and she has a track record of helping many provider types implement effective compliance programs. She is a certified ACHC and CHAP consultant and holds additional certifications in diagnosis coding and other healthcare specialties. As an AHIMA ambassador, she was instrumental in the implementation of ICD-10.