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Social Drivers of Health Are Affecting Your Students

In a few short weeks, fall term will be upon us and millions of students will flood classrooms. While their past transcripts, test scores, and applications indicate something about who they are and how they are doing, the truth is that we won’t know much about their lives without asking better questions. If one thing’s certain these days, it’s that we are constantly changing with the world around us.

Dr. Sara Goldrick-RabDr. Sara Goldrick-RabIt's incredibly hard to meet students where they are and effectively teach and support them without a sense of their basic needs. Doctors know this — when it comes to treating patients, they require a standard check-in battery of information to set the stage for each visit. Imagine a doctor meeting with a patient without the nurse first, briefly assessing their weight, blood pressure, and heart rate? Without those data, the physicians could easily miss something crucial about the patient’s needs and mess up the treatment.

In this century, doctors begun going beyond those physical measures and asking patients to answer another set of questions which get at the safety and security of their current lives. “Social drivers of health” (SDOH) assessments are used to identify people who could use help with food or housing, figure out who might be in a domestic violence, abuse or trafficking situation, and connect them with support. Why? Because these factors impact quality of life, functioning, and overall wellbeing. I’ve answered questions about these issues at least twice a year during standard check-ups, and when I was pregnant, I answered also a few every time I went to the hospital for an ultrasound. They weren’t an annoyance — they made me feel noticed and cared for, and as someone who experienced undetected abuse as a child, I wish they’d been put into practice a long time ago.

There’s plenty of evidence that SDOH also matter for college education. Just last week the U.S. Government Accountability Office issued its second report about the high rates of food insecurity among college students, and last year the U.S. Department of Education confirmed that 8% of students experiences homelessness. Colorado’s Department of Higher Education frames its basic needs efforts with a “social determinants of student success” lens and the California Community College System uses a “social determinants of education” framework. Yet neither has translated that work into an ongoing assessment tool. And nationwide, an estimated 1% of basic needs-insecure students connect with support.

While more and more college field annual surveys to assess the prevalence of these challenges (including the #RealCollege survey, which I created and made freely available) those surveys provide insights too late for real action. It’s time to check in on students with a regular cadence that reflects how crucial their well-being is for college success.

I often advocate for faculty to use a “welcome survey” along with a syllabus statement to find out what students need. That’s a good step, and faculty need to be part of this work, but those surveys are voluntary and unevenly implemented. I’ve also worked with colleges who’ve integrated a basic needs screener into their early alert systems, but again those only help when a staff member or professor create the flag (and often those screeners are insufficiently comprehensive).

That’s why I urge college leaders to go further this fall and try using an SDOH screener placed in their learning management system, asking students to complete it within the first two weeks of term start. Then do it again each subsequent term. Give advisors access to the resulting data and consider giving it to faculty too. Collecting and using these data will advance your basic needs and mental health services, while also activating on institutional commitments to parenting students, diverse populations, and addressing completion gaps.

To my knowledge, there isn’t (yet) a well-tested SDOH screener recommended for use in higher education, but that shouldn’t stop our talented field from acting and learning along the way. Having reviewed many options, I think the PRAPARE Screening Tool  (the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences) is a good place to start. It’s been used for more than a decade and is the most common social needs screening tool deployed by health networks, health and hospital systems, Medicaid managed care organizations, behavioral health providers, health departments, and community-based organizations. Plus, it is available in 25 languages!

Whatever approach you choose to use, please be sure to ask students meaningful questions to learn about their lives as they return to your classrooms.  This promotes a sense of care and will yield information to reveal a fuller picture. More complete understandings of the humans we seek to support and educate will lead to better outcomes.

Dr. Sara Goldrick-Rab is author of  Paying the Price, College Costs, Financial Aid, and the Betrayal of the American Dream, senior fellow at Education Northwest, adjunct professor at the Community College of Philadelphia, and founder of The Hope Center for College, Community, and Justice.

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