SDOH: What's My Role?

Audiologists, SLPs, and CSD clinicians may screen for social determinants of health (SDOH), make referrals and connect clients to resources, engage in interprofessional practice (IPP), and apply SDOH information to practice.

Screen for SDOH

SDOH are already part of your scope of practice. When you review a child’s social work report, read a patient’s medical chart, or ask for relevant background information during client intake, you're gathering SDOH-related information.

You may screen clients for SDOH in several ways:

Build SDOH-related questions into intakes and case histories.
Employ a formal SDOH screening tool or questionnaire.
Initiate conversations about SDOH with clients.
Note SDOH information shared by your client’s care team.
Review available documentation.

Formalizing your screening process offers many benefits. If you screen for SDOH only selectively or irregularly, then you run the risk of making assumptions and perpetuating bias about who, when, and why to screen. You can reduce the impact of bias or misunderstanding by screening all clients and by standardizing the language you use to ask about SDOH.

You may conduct screening at the beginning or middle of treatment, when planning for discharge, or when determining the next level of care for your client. Decide what makes the most sense based on your therapeutic context.

Screening Tips

To avoid redundancy, check whether your workplace already screens or records SDOH information.

Use screening methods that are most suited to your practice setting and client population.

Before screening, consider your level of rapport with your client. Some clients will be comfortable with direct questions and verbal discussion about social assistance. Other clients prefer discretion and a printed resource that they can review privately.

Be aware that clients may need you to explain your reasons for screening. Be ready to respond if someone wants to know why you’re asking about their ability to pay utilities on an intake form. Screening may involve sensitive topics and may feel judgmental, invasive, or irrelevant for some people.

For additional screening information, check out the SDOH Tools and Support.

Make Referrals and Connect Clients to Resources

Many clinicians already refer clients to colleagues and community-based programs to address unmet social needs. You can use online directories, government services, and nonprofit sites to find local resources. You can find examples of client referral sources on the Tools and Support page.

Resources that you provide may also include education about client diagnoses, recommended Internet keywords that they can use to search for relevant resources, approaches for vetting resources, and strategies for personal advocacy.

Engage in Interprofessional Practice (IPP)

If a client’s SDOH involve an asset or a barrier that influences care plans, it’s important to share the information with all members of an IPP team. Also, make sure you appropriately document the information and team communication.

When clinicians share their full understanding of a client’s health with each other, a more complete, nuanced picture of their client’s world emerges. Opportunities to provide comprehensive, meaningful care multiply.

A client's SDOH may facilitate care. If a client tells their SLP that their friends can drive them to their appointments, then it’s important that the SLP communicate this information to the IPP team. In this situation, the client’s Social and Community Context SDOH includes generous friends as a protective factor. The occupational therapist (OT) may ask the client if friends can help them practice their OT exercises. The team’s nurse practitioner can ask whether friends are able to pick up prescriptions for the client, if needed. Sharing information about the client’s big picture can help teams draw upon existing advantages to benefit client health.

Other SDOH variables may present barriers. When a client tells their audiologist that their transport service is unreliable, the audiologist should inform the whole IPP team. In this situation, unreliable transportation is a social risk factor that has the potential to inhibit the client’s Health Care Access and Quality. The audiologist may address the transportation barrier by offering telepractice sessions when the client can’t make an appointment in person. The social worker may be able to help the client acquire or navigate the technology necessary for telehealth. Other members of the client’s IPP team may also be able to accommodate access issues or direct the client to alternative transportation resources. Sharing SDOH information can be key to remediating social needs and providing optimal care.

Apply SDOH Information to Practice

Using SDOH information is all about adding a layer to your clinical perspective. Your client's big picture can reveal connections that prove crucial to treatment.

Let's explore how an audiologist might use SDOH information to support the needs of a client with tinnitus

Screening	The audiologist gathers the client’s case history. She uses screening questionnaire to guide SDOH conversation during the client’s intake appointment. In response, the client discloses that he’s worried about being able to pay his utilities. The audiologist identifies that economic instability is an SDOH playing a part in her client’s stress. She also knows that tinnitus is exacerbated by stress.
Treatment	The audiologist provides a range of options for symptom management during client education. The clinician takes time to explain the out-of-pocket costs for each option because she knows that financial stress is a concern.
Referral	The audiologist gives the client contact information for local utility assistance programs.
IPP	The audiologist tells the client’s community social worker about her client’s social need for utility assistance. The social worker then helps the client navigate the phone calls and follow-up needed to secure assistance. Also, the audiologist mentions the relationship between stress and tinnitus—in case the correlation is pertinent to the client’s mental health treatment. The audiologist documents the IPP communication appropriately.
Outcome	During his next audiology appointment, the client shares that he found a helpful utility relief program. He feels more relaxed, and his tinnitus symptoms have lessened. The audiologist’s clarification about costs were useful, and the client chose a symptom management option that works for him.

In this scenario, the audiologist was able to connect an important variable in treating her client’s tinnitus (stress) to a social need (inability to pay utilities) that she had prepared resources to address (contact information for utility assistance). This example focuses on one SDOH and a corresponding social need. However, everyone has many social determinants of health. Clients with communication disorders and differences may have multiple social needs that arise from multiple areas of SDOH. Combining the big picture of client health with clinical details helps audiologists, SLPs, and assistants provide appropriate for each client.