The spread of COVID-19 in the United States and globally has made stark what we in the complex care field already knew: our fragmented care systems and frail safety net leave our most vulnerable community members at heightened risk, especially during times of national emergency. Individuals with complex health and social needs are particularly vulnerable to disruption of services and the social and economic fallout from social distancing measures across the country.

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Understanding a patient’s social complexities is essential to support holistic clinical care, clinical quality improvement, and tailored care interventions. However, complex care programs may find it difficult to incorporate these factors into standard risk stratification methods. They may also face distrust from patients who have historically been poorly served or harmed by healthcare institutions. This webinar featured a risk stratification process developed by the Sooner Health Access Network, which provided care management services for Medicaid beneficiaries in Oklahoma Patient-Centered Medical Homes, and research results on reported patient acceptability of social risk screening in healthcare settings conducted by the Social Interventions Research & Evaluation Network.

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The significance of trauma has become an increasingly accepted tenet of complex care. While there is general agreement on the core principles of trauma-informed care and that trauma can negatively impact an individual’s health and wellbeing, there are many ways to apply a trauma-informed approach in different settings. Presenters Katy Davis from the University of California San Francisco Women’s HIV Program and Michelle Adyniec from the Camden Coalition of Healthcare Providers discussed how they implement trauma-informed principles in a women’s primary care HIV clinic and through authentic healing relationships in Camden, New Jersey. 

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Substance use disorder has received increased public attention due to rising rates of opioid-related overdose deaths and misuse of prescription opioids. While opioid use disorder is an important issue, alcohol use disorder can also be a significant contributor to individuals’ complex health and social needs, due in no small part to alcohol’s legal status, social acceptance, and wide availability. Individuals who accrue the highest medical expenditures are more likely to use or be dependent on alcohol. This type of substance use disorder can impact one’s ability to find and maintain housing and employment, manage chronic conditions, and maintain interpersonal relationships. Alcohol also has far greater secondary harm to others than other addictions.  

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