Camarena Health initiated a new workflow in efforts to improve our community health outcomes. To address unmet patient needs that could negatively affect their overall health, we began assessing patients for Social Determinants of Health (SDOH). Our initial efforts were focused on patients with uncontrolled diabetes. We understand patients struggling with behavior changes, such as getting enough sleep and selecting healthy foods could involve an underlying issue. If we don’t know someone is struggling to afford their medication, put food on the table, or are having financial issues and may lose their housing we are unable to provide the resources and support they may need to allow them to reach their health goals.

Screening for SDOH is an important first step in addressing the major needs affecting the patients’ overall health. Camarena Health implemented an assessment tool in order to identify patients’ employment status, education, physical environment, material hardships, mental health needs, trauma, violence, and veteran status. A resource library was created to enable Camarena Health staff to provide patients with resources as needed. Some of the recourse included: food, housing, medical insurance, medication discount programs, mental health services, transportation, unemployment, and victim services. Identifying patient’s individual needs, addressing barriers, and providing support and resources allows Camarena to help patients on a larger scale, which will in turn help improve their overall health.