The Role of Social Referrals in Addressing Social Determinants of Health (SDoH)

As the healthcare system shifts toward whole-person care, social determinants of health (SDoH) have become central to conversations around wellness, equity, and access. These are the non-medical factors—such as housing, food, transportation, and social support—that significantly affect a person's overall health.

One of the most effective ways to address these challenges is through social referrals—the process of connecting individuals with community resources that meet their non-clinical needs. Community-based organizations (CBOs), social service agencies, and healthcare providers all play a role in this ecosystem. But it's the social referral process that bridges clinical and community support, enabling real impact on SDoH.

What Are Social Determinants of Health (SDoH)?

Social determinants of health are the social, economic, and environmental conditions that influence an individual's health outcomes. These include:

• Economic stability : Employment, income, and financial assistance
• Education access and quality : Literacy, vocational training, and school environment
• Healthcare access and quality : Insurance coverage, language barriers, provider availability
• Neighborhood and built environment : Housing conditions, safety, transportation
• Social and community context : Social support networks, discrimination, community engagement

The World Health Organization (WHO) and the Centers for Disease Control and Prevention (CDC) estimate that Social Determinants of Health (SDoH) account for as much as 80% of health outcomes, while clinical care accounts for only 10-20%. This makes addressing SDoH not just important—it's essential.

What Is a Social Referral?

A social referral is a coordinated effort to direct an individual to a non-clinical support service that can help address an unmet social need. These referrals are typically generated by :

• Healthcare providers (hospitals, clinics, care coordinators)
• Social workers and case managers
• Social Impact and community-based organizations
• Schools or public agencies

The referral may involve connecting someone to a food pantry, job training program, housing assistance, transportation service, or behavioral health counseling.

Unlike traditional referrals in healthcare, which usually refer patients to specialists, social referrals extend care beyond the clinic walls, targeting life circumstances that influence health and wellness.

How Social Referrals Help Address SDoH

1. Creating Access to Essential Services

When a patient is identified as food-insecure or facing eviction, a social referral connects them to available resources. Without such coordination, the individual may fall through the cracks, unable to navigate the system independently.

2. Bridging Clinical and Community Care

Medical providers often treat the symptom, but social referrals help treat the root cause. By referring patients to local support systems, clinicians and community-based organizations (CBOs) work together to deliver comprehensive, person-centered care.

3. Improving Health Equity

Social referrals help reduce disparities by ensuring that underserved or vulnerable populations get the same access to vital services as anyone else. When executed equitably, they support racial, socioeconomic, and geographic inclusion.

4. Enabling Outcome Tracking

Modern social referral platforms enable organizations to track whether referrals are completed, the outcomes achieved, and where service gaps persist. This data-driven insight is crucial for improving programs, reporting outcomes, and scaling solutions.

Common Types of Social Referrals Supporting SDoH

1. Housing and Shelter Referrals

• Emergency housing, rental assistance, and transitional housing

2. Food and Nutrition Referrals

• SNAP enrollment, food pantries, and school meal programs

3. Behavioral Health Referrals

• Counseling, substance abuse support, peer networks

4. Transportation Referrals

• Non-emergency medical transport, transit vouchers

5. Employment and Education Referrals

• Job training, GED programs, literacy support

6. Legal and Financial Assistance Referrals

• Immigration services, financial counseling, and eviction protection

Each of these referral types corresponds directly to one or more Social Determinants of Health (SDoH) domains, underscoring their value in mitigating long-term health risks and social instability.

Why Efficient Referral Management Matters

Despite their potential, social referrals are often hindered by manual processes, including paper forms, spreadsheets, untracked emails, and siloed systems. This results in :

• Lost or delayed referrals
• Lack of follow-through or feedback loops
• Difficulty measuring outcomes
• Frustrated clients and overwhelmed staff

To scale social referrals and achieve measurable SDoH impact, organizations need modern, tech-enabled solutions that allow for centralized intake, automated routing, real-time collaboration, and closed-loop tracking.

The Importance of Social Referrals in the U.S.

In the United States, social disparities continue to widen across income, geography, and race. From food insecurity and mental health crises to housing shortages and unemployment, millions face challenges every day that are not medical but are health-related.

Social referrals offer a proactive way to connect at-risk individuals with the support they need. This is especially important as:

• Healthcare shifts toward value-based and outcomes-driven care
• CBOs and nonprofits face growing caseloads.
• Public funders demand proof of impact and accountability.
• Communities demand better coordination, transparency, and results.

The success of initiatives to improve health equity, reduce ER visits, or manage chronic conditions often hinges on whether social referrals are completed, tracked, and resolved, not just initiated.

GridSocial by SocialRoots.ai: A Smarter Way to Manage Social Referrals

To truly address social determinants of health, organizations need referral systems built for the community care landscape, not retrofitted from healthcare or CRM tools.

GridSocial by SocialRoots.ai is a modern social referral and request platform designed explicitly for CBOs, social service agencies,Social Impact organizations, and healthcare providers seeking to close the loop on social care.

With GridSocial, you can :

• Intake and triage social requests from any channel
• Auto-match requests to the most relevant partner organization
• Track status, outcomes, and resolution in real-time
• Collaborate securely across agencies.
• Generate impact reports for funders and stakeholders

Ready to take your social impact to the next level? GridSocial by SocialRoots.ai is your complete solution for managing social referrals with speed, transparency, and accountability. Built for organizations addressing SDoH, GridSocial streamlines every step—from intake to follow-up so you can focus on outcomes, not paperwork. Whether you're a CBO, nonprofit, or healthcare provider, GridSocial helps you ensure that no referral falls through the cracks. Track progress, reduce duplication, and close the loop with confidence. Join leading organizations across the U.S. using GridSocial to coordinate care, improve health equity, and deliver measurable social impact.

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