Applying a process mapping methodology to identify barriers and facilitators to social needs screener and medical-legal partnership integration into primary care facilities

Background: Primary care providers understand the importance of collecting social needs screener (SNS) information from patients. Gathering this information permits more comprehensive, patient-centered care plans and allows primary care settings to serve as a hub where patients can receive resources and referrals to address their social needs. Medical-legal partnerships (MLPs) are a legal intervention that can also connect patients to social services. However, barriers exist that prevent full integration of SNS and MLPs. This study aims to understand how best to integrate SNS and MLPs into primary care. Methods: Informed by the Consolidated Framework for Implementation Research (CFIR), an idealized process map and semi-structured interview guide were developed to facilitate interviews with primary care providers. The process map included four swim lanes, including planning, patient-provider interaction, referrals, and MLPs. Eleven primary care providers from three different health systems were interviewed in January-March 2025. Interviews were recorded, transcribed verbatim, and data were coded inductively. Results: Eleven themes were identified from the interviews, including review and adaptation of SNS should be regular, involvement of providers and staff is necessary for SNS integration, cross-disciplinary training, physical space, and information technology is needed to promote MLP, and identification of local resources for social need referrals is critical for providers' buy-in. These themes were matched to constructs from CFIR. Conclusion: SNS and MLPs can be integrated into the clinical workflow, but external factors may negate the impacts of SNS success and MLP referrals. By addressing the barriers identified using implementation strategies, integration of SNS and MLPs into primary care can be more feasible.