View source for Social emergency medicine

==Background==
*Organizing framework which recognizes that social, economic, environmental, and legal issues play a large part in health outcomes
*In the emergency department, downstream effects of these social determinants of health are seen on a daily basis and ED serves important role as a social safety net
*Goals include integrating consideration of social influences to help improve population health and potentially improve costs of emergency care<ref name="ann">Anderson ES, Hsieh D, Alter HJ. Social Emergency Medicine: Embracing the Dual Role of the Emergency Department in Acute Care and Population Health. Ann Em Med. 2016; 68(1):21-25.</ref>

==Areas of Focus==
*Homelessness/unstable housing<ref>InsKushel, M.B., Perry, S., Bangsberg, D. et al. Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002; 92: 778–784ert footnote text here</ref><ref>Feldman BJ, Calogero CG, Elsayed KS, et al. Prevalence of Homelessness in the Emergency Department Setting. Western Journal of Emergency Medicine. 2017;18(3):366-372. doi:10.5811/westjem.2017.1.33054.</ref>
*Hunger<ref>Seligman HK, Laraia BA, Kushel MB. Food insecurity is associated with chronic disease among low income NHANES participants. J Nutr. 2010 Feb:140(2):
 304-310</ref>
*Substance abuse
*Community violence
*Guns and public health<ref>Ranney ML, Fletcher J, Alter H, et al. A Consensus-Driven Agenda for Emergency Medicine Firearm Injury Prevention Research. Ann Emerg Med 2016 Dec 18. </ref><ref>Newgard C, Kuppermann N, Holmes JF, Haukoos J, Wetzel B, Hsia R, Wang NE, Bulger EM, Staudenmayer K, Mann NC, Barton E, Wintemute GJ. Gunshot Injuries in Children Served by Emergency Services Compared with Other Injury Mechanisms. Pediatrics. Nov;132(5):862-70. </ref><ref>Long-term mortality of patients surviving firearm violence. Academic Journal. Fahimi, J, Anderson, E, Schnorr, CD, Alter, HJ, Larimer, E, Hamud-Ahmed, W, Yen, I. Inj Prev. Apr 2016, 22(2):129-134.</ref>
*Domestic or intimate partner violence
*Chronic diseases such as HIV, hepatitis C
*Human trafficking

==Aims==
*Encourage and promote research, with aim of developing useful interventions
**A research agenda should emphasize the potential for expanding the role of the ED as a site of public and population health research and intervention, extend the surveillance and data collection capacity of the ED, and increase research on the cost-effectiveness of a diverse array of preventive services<ref name="ann" />
*Integration of social determinants of health into medical school and residency training
*Community and legislative advocacy

==Interventions==
*Screening, brief intervention and referral to treatment (SBIRT) for patients dealing with substance abuse <ref>Bernstein, S.L., Bijur, P., Cooperman, N. et al. A randomized trial of a multicomponent cessation strategy for emergency department smokers. Acad Emerg Med. 2011; 18: 575–583</ref><ref>D'Onofrio, G., Fiellin, D.A., Pantalon, M.V. et al. A brief intervention reduces hazardous and harmful drinking in emergency department patients. Ann Emerg Med. 2012; 60: 181–192</ref><ref>Bernstein, S.L. and D'Onofrio, G. A promising approach for emergency departments to care for patients with substance use and behavioral disorders. Health Aff (Millwood). 2013; 32: 2122–2128</ref><ref>Bernstein, E., Bernstein, J., Feldman, J. et al. An evidence based alcohol screening, brief intervention and referral to treatment (SBIRT) curriculum for emergency department (ED) providers improves skills and utilization. Substance Abuse. 2007; 28: 79–92</ref>
*Medication assisted treatment (MAT) in the ED for opioid abuse<ref>D’Onofrio G, O’Connor PG, Pantalon MV, Chawarski MC, Busch SH, Owens PH, Bernstein SL, Fiellin DA. Emergency Department–Initiated Buprenorphine/Naloxone Treatment for Opioid Dependence: A Randomized Clinical Trial. JAMA. 2015;313(16):1636–1644. </ref>
*Public health screening 
**[http://www.levittcenter.org/public-health-screening-in-the-emergency-department/ HIV, Hepatitis C]<ref>Paltiel, A.D., Weinstein, M.C., Kimmel, A.D. et al. Expanded screening for HIV in the United States—an analysis of cost-effectiveness. N Engl J Med. 2005; 352: 586–595</ref><ref>Silva, A., Glick, N.R., Lyss, S.B. et al. Implementing an HIV and sexually transmitted disease screening program in an emergency department. Ann Emerg Med. 2007; 49: 564–572</ref><ref>Sanders, G.D., Bayoumi, A.M., Sundaram, V. et al. Cost-effectiveness of screening for HIV in the era of highly active antiretroviral therapy. N Engl J Med. 2005; 352: 570–585</ref><ref>Anderson, E.S., Pfeil, S.K., Deering, L.J., Todorovic, T., Lippert, S. and White, D.A., High-impact hepatitis C virus testing for injection drug users in an urban ED. The American Journal of Emergency Medicine, 2016; 34(6), pp.1108-1111.</ref>
*Help desks/Advocate programs - help connect patients with key community resources
**[https://healthleadsusa.org/ HealthLeads]
**[http://www.foundationahs.org/needs-we-support/reducing-health-disparities-and-improving-access/ Highland Health Advocates]
**[https://emed.stanford.edu/specialized-programs/sem/shared.html Stanford health advocates and research in the emergency department (SHARED) help desk]
**[https://hotspotting.camdenhealth.org/ Camden Coalition]
**[http://www.ucdenver.edu/academics/colleges/medicalschool/administration/alumni/CUMedToday/features/Pages/Hot-Spotters-Program.aspx Aurora Student Hotspotters]
*[http://medical-legalpartnership.org/ Medical-Legal Partnerships]
*Housing first
**Housing First initiatives are shown to be cost-effective mainly by cost savings through decreased health care use<ref>Doran, K.M., Ragins, K.T., Gross, C.P. et al. Medical respite programs for homeless patients: a systematic review. J Health Care Poor Underserved. 2013; 24: 499–524
</ref><ref>Larimer, M.E., Malone, D.K., Garner, M.D. et al. Health care and public service use and costs before and after provision of housing for chronically homeless persons with severe alcohol problems. JAMA. 2009; 301: 1349–1357
</ref>
*[http://www.chcf.org/projects/2008/frequent-users-of-health-services-initiative California Frequent Users of Health Services Initiative]
*[http://www.streetmedicine.org/ Street Medicine Programs]

===Education===
*Resident Bedside Teaching: [http://www.idheal-ucla.org/page-12/ IDHEAL Modules]

==Fellowships==
[https://emed.stanford.edu/specialized-programs/sem.html Stanford Social Emergency Medicine Fellowship]

[http://www.idheal-ucla.org/page/ UCLA International and Domestic Health Equity Fellowship]

[https://sites.google.com/challiance.org/healthequityfellowship Cambridge Health Alliance/Harvard Health Equity, Policy and Leadership Fellowship]

==External Links==
* [http://www.levittcenter.org/ Andrew Levitt Center for Social Emergency Medicine]
* [https://www.camdenhealth.org/national-center/ Camden Coalition, National Center for Complex Health and Social Needs]
* [https://www.newyorker.com/magazine/2011/01/24/the-hot-spotters The Hot Spotters]
* [https://www.rwjf.org/en/library/articles-and-news/2014/02/improving-management-of-health-care-superutilizers.html A Revolutionary Approach to Improving Health Care Delivery]
* [http://www.jieponline.com/article/S2405-4526(15)30102-6/abstract Transforming health care education to address social determinants of health: The 2014 hot spotters student program]
* [https://endhomelessness.org/resource/housing-first/ Housing First]
* [http://www.acepnow.com/can-social-emergency-medicine-give-different-perspective-community-health/ ACEP Now - Can social emergency medicine give a different perspective on community health?]
* [https://www.acep.org/socialem/#sm.0008oix1319o6dvcqc41a68v79yyw ACEP Social EM section]
* [https://community.saem.org/communities/community-home?CommunityKey=a8063683-11c8-4136-b90c-247bc2e9267b SAEM interest group in social EM and population health (login required)]
* [http://westjem.com/articles/addressing-social-determinants-of-health-from-the-emergency-department-through-social-emergency-medicine.html WestJEM, Addressing social determinants of health from the emergency department through social emergency medicine]
* [https://www.emra.org/uploadedFiles/EMRA/EMRA_Publications/2016AdvocacyHandbook-Online.PDF Emergency Medicine Advocacy Handbook, Ch. 26, Social Determinants of Health]
* [https://www.ncbi.nlm.nih.gov/pubmed/20053234 Public health in the emergency department: surveillance, screening, and intervention--funding and sustainability.]
* [http://www.who.int/social_determinants/sdh_definition/en/ WHO - Social Determinants of Health]
* [http://nmcgv.org/ National Medical Council on Gun Violence]

==References==
<references/>

[[Category:Misc/General]]