You can document the social determinants of health (SDoH) needs of each member, set goals based on those needs, and track when needs and goals have been met.
Identify SDoH Needs
- SDoH needs are automatically added to a member’s profile based on social services that have been selected for a member: services that have been recommended after a screening has been completed, services from referrals that have been created, or services related when a SDoH goal is created.
Set SDoH Goals
You can add a goal by clicking on the Add Goal button on the client profile page.
- Title your goal
- Select the needs this goal is related to
- Add a text description for the goal
Manage SDoH Goals
- Add additional notes to the goal as you are tracking progress
- See which referrals your team has created related to this goal. Referrals are connected to the goal automatically based on the services referred and the needs you connected to the goal.
- Edit your goal to either change the title or description.
- Check the Completed Goal box when the goal has been met
- If you have to re-open the goal, unselect the Closed Goal checkbox
Please note once a goal is created, the "Needs" on the goal cannot be changed.
You can view all active goals and needs related to each member. You can also view all completed goals and completed needs as well.
- Select the Closed Need checkbox to close the SDoH Need. This will move the need to the Closed Need section.
- If you have to re-open the need, unselect the Closed Need checkbox
You will only see your client's Goals and Needs within the profile that is shared within your organization.
- If a referral is sent to your organization, the client's goals from the sending organization are not shared with your organization.
- If you send a referral to another organization, the client's goals with your organization are not shared with the receiving organization.
Needs are shared between organizations who have access to the profile, but the actual service offering related to the need will not be shared across organizations due to PHI restrictions.