Identifying at-risk individuals for diseases of despair through integration of clinical practice and social service systems

Background: Individuals who are unable to meet their basic needs are more likely to respond reactively to their immediate social and financial hardships with behaviors that lead to diseases of despair, which include suicide, drug overdose, and alcohol-induced liver diseases. We sought to assess the feasibility of a community-to-clinic referral approach for diseases of despair-related behaviors. Methods: Guided by the Model for Adaptation Design and Impact, we adapted existing clinical risk assessments into a six-item screener and integrated it into the PA 211 Southwest helpline's workflow. The screener was created to identify helpline callers at risk for suicidal ideation/behavior, alcohol abuse, drug use, and those in need of seasonal flu vaccination. The screener was implemented from December 2020 to March 2021. We invited at-risk individuals who accepted a service referral to complete baseline and follow-up surveys to learn about their satisfaction with screening and use of referrals. Results: 2,868 callers were invited to take the screener, with 37% (n = 1047) participation. Among screened callers, 19% (n = 196) were at risk of alcohol abuse, 11% (n = 118) for drug use, 9% (n = 98) for suicidal ideation/behavior, and 54% (n = 568) needed flu vaccination. Of those, 265 callers accepted at least one of the offered referrals. Forty-seven individuals took our surveys, with almost half of them (n = 22) reported engaging with a referral and 90% recommended the helpline for health referrals. Conclusion: Our findings demonstrate the feasibility of using existing community infrastructure and social service systems to actively screen and link at-risk individuals to needed health referrals in their communities.