At Spring Street Exchange, we developed the SDOH Spectrum of Impact framework because we found ourselves articulating this concept so often in meetings and conversation that we decided we needed a visual representation. The discussion of where to focus social interventions is frequently presented in a linear model, starting with point of care and then the shift to moving ‘upstream’ to address social gaps at the root cause. We agree with this trajectory but had also been seeking a way to more clearly represent interventions at different points of impact from the perspective of a health plan or health system.
The Spectrum of Impact provides five points of impact, each with its own goal(s) and outcomes. They are not arranged in a hierarchical manner because there is a critical need for support at each point. The ideal point for intervention depends upon the organizational strategy and the goal of the initiative. While we share the goal of shifting resources upstream with a preventive focus, there are still social risks and social needs throughout.
Point of Care
Provide immediate relief for pressing social needs during clinical and social interactions of care through either direct services or referral. This includes providing food, transportation, or housing support directly to individuals currently in need. This can also refer to identification of needs at non-clinical intersections, such as at the time of enrollment.
Actively Managed
Augment the care for those already receiving support through care management, case workers, or other services to address their social as well as medical needs.
In Need But Not in Care Management
Identify those who have health and social care needs or may even be in crisis, but who have some barrier to interacting with the healthcare system. Social analytics can help to identify those who may be falling through the cracks while providing a point of intervention for engagement. Advanced analytics through segmentation and person-centered profiles can help focus supports to those in greatest need.
At-Risk, Pre-Crisis
Intervene upstream, before greater health needs emerge. Identify individuals who are at risk for health issues by using social screening and data, partner referrals, and other forms of identification or forecasting.
Community-level prevention
Provide support and prevention by addressing social risks and needs at the community level. This could involve housing, food, sanitation, safety, green spaces, and other means of strengthening community health.