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Resources for Addressing Social
Determinants of Health

Social determinants of health are the social and environmental factors that impact our health and wellness. The conditions in which we are born, grow, live, work, and play have a bigger influence on how healthy we are than the medical care we receive. To make sure every person has the same opportunities to be healthy and have a good quality of life, we need to work on addressing unmet social needs at the individual, provider, community, and policy levels.

Tackling social and environmental issues that impact health outcomes is complex, but there are some general best practices emerging

SCREEN

Identify unmet social needs through screening. This can be done in any setting, and there are a variety of screening tools available. AHI and many partners use these tools.

ENGAGE

Use person-centered, health-literate engagement strategies to talk with the patient about their screening results, in order to understand how to best meet their needs. Unmet social needs can have different root causes. More information will help a provider to make a more effective referral.

CONNECT

Establish closed-loop referral processes to link individuals to community providers that can address identified needs. Health care providers don’t have to meet their patients’ social needs on their own; collaboration between clinical and non-clinical providers is an effective approach to addressing social determinants of health. Examples of common cross-sector partnerships can be found here.

ADVOCATE

Use data collected from screening and referral processes to develop targeted interventions, seek funding, and advocate for programmatic and policy changes.

SCREEN

Identify unmet social needs through screening. This can be done in any setting, and there are a variety of screening tools available. AHI and many partners use these tools.

ENGAGE

Use person-centered, health-literate engagement strategies to talk with the patient about their screening results, in order to understand how to best meet their needs. Unmet social needs can have different root causes. More information will help a provider to make a more effective referral.

CONNECT

Use person-centered, health-literate engagement strategies to talk with the patient about their screening results, in order to understand how to best meet their needs. Unmet social needs can have different root causes. More information will help a provider to make a more effective referral.

advocate

Use data collected from screening and referral processes to develop targeted interventions, seek funding, and advocate for programmatic and policy change

MAKING RESOURCE ACCESS A REALITY
Introducing ADK Wellness Connections Referral Network

ADK Wellness Connections is a coordinated referral network of social, medical, community, and human service providers which covers Clinton, Essex, Franklin, Fulton, Hamilton, Warren, Washington, St. Lawrence, and northern Saratoga counties. Sponsored by AHI, it provides a centralized platform for providers from all sectors to collaborate around the care of a shared patient or client, and to address their patient or client’s social needs. Community members can directly request assistance with finding a resource or service provider or they can access the benefits of ADK Wellness Connections network through participating organizations.

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