Screening and Referral for Social Needs Among Veterans: A Randomized Controlled Trial

Background: Healthcare-based social need screening and referral (S&R) among adult populations has produced equivocal results regarding social need resource connection. Objective: Assess the efficacy of S&R on resource connection (primary outcome) and unmet need reduction (secondary outcome). Design: Intention-to-treat randomized controlled trial. Analyses adjusted for demographics (e.g., age, race), comorbidity (Elixhauser), and VA priority group (PG). Participants: Veterans with and at-risk for cardiovascular disease and one of more (hereafter “ ≥ 1”) social needs receiving healthcare at one of three Veterans Healthcare Administration (VHA) medical facilities. Intervention: Study arms represented referral strategies of varying intensity. Arm 1 (control) received generic resource information; Arm 2 (low intensity) received generic and tailored resource information; Arm 3 (high intensity) received all the above plus social work navigation assistance. Main Measures: Post index surveys at 2-months assessed resource connection (connection to ≥ 1 new resources) and 6-months assessed need reduction (≥ 1 needs at the index screen no longer identified). Key Results: A total of 479 Veterans were randomized: 50% were minoritized Veterans, mean age was 64, and 91% were male. Arm 3 was associated with greater resource connection but differences across study arms were not statistically significant. For example, compared to the control arm, participants in Arm 3 had higher but non-statistically significant odds of connecting to ≥ 1 resources (OR = 1.60, CI [.96, 2.67]). Conclusions: Among VHA-enrolled Veterans, a high-intensity S&R intervention was associated with a non-statistically significant increase in connection to social need resources. Further study needed to establish S&R efficacy. Trial Registration: NCT04977583.