Social Prescribing: Establishing the First Expert Consensus Definition and Implementation Guidelines
In June 2023, BMJ Open published a landmark study that aimed to establish a formal, internationally accepted definition for social prescribing. This study represents a significant milestone in the effort to bridge the gap between clinical and non-clinical supports and services, providing a more holistic approach to health and well-being of individuals and communities.
Conducted over three rounds of an online survey between April and September 2022, the study involved 48 expert participants from 26 countries. Participants were English-speaking individuals with an average of five years of involvement in social prescribing, including researchers, students, healthcare providers, and patients. The culmination of their input is the Common Understanding of Social Prescribing (CUSP) framework.
The CUSP framework provides a comprehensive definition of social prescribing as a holistic, person-centered, and community-based approach that addresses health and well-being by bridging clinical and non-clinical supports. It is designed to mitigate the impacts of adverse social determinants of health and health inequities.
Key aspects of the CUSP framework include:
1. Trusted Identifier
A trusted individual in a clinical or community setting identifies a person’s non-medical, health-related social needs.
2. Connection Process
The identifier connects the person to non-clinical community supports and services through a social prescription.
3. Role of Connectors
The identifier may connect the person directly or through a connector (such as a link worker or social worker), who then links the person to community supports and services.
4. Monitoring and Reporting
The connector monitors the person’s response to services and reports back to the identifier, ensuring comprehensive wraparound care.
Implementation Guidelines
The World Health Organization (WHO) created a toolkit that provides detailed steps for implementing social prescribing within a community. Below is a brief overview of the 7 steps outlined in the toolkit:
1. Conduct a Situation Analysis
Understand the local sociocultural context and identify gaps between the population’s needs and current services. This involves consulting key stakeholders, including clinicians, caregivers, and community partners.
2. Assemble a Core Implementation Team
Form a multidisciplinary and diverse team experienced in public health program implementation and research. At least one team member should have direct patient experience.
3. Develop an Implementation Plan
Set objectives and create a work plan covering operational management, referral pathways, community services, and monitoring and evaluation. This requires partnerships between health systems and community organizations.
4. Map Out Community Resources
Identify existing community services, assess their quality and accessibility, and address any barriers to inclusivity.
5. Get Everyone on Board
Mobilize key players, including healthcare providers, community organizations, and link workers, to support the initiative.
6. Link Worker Training
Provide uniform training for link workers, covering social prescribing, social determinants of health, communication skills, patient intake assessments, personalized well-being plans, referrals to community services, and data collection.
7. Monitoring and Evaluation
Collect quantitative and qualitative data from healthcare providers, community organizations, and patients to assess the intervention's effectiveness, implementation barriers, and cost-effectiveness.
The Arts on Prescription Field Guide introduces another dimension to social prescribing by incorporating arts, culture, or nature experiences to support health and well-being. Recognizing that access to these activities is a social determinant of health, arts prescriptions can be used to increase accessibility to arts engagement for communities and populations who may otherwise have limited access.
Specific considerations for arts prescriptions include:
1. Dose, Duration, and Frequency
Varying from a single “dose” of an arts class or museum visit, to extended programs involving a series of workshops, nature activities, or museum visits.
2. Strength-Based Programming
Programs should build on the existing local community’s strengths and resources
3. Diversity, Inclusivity, and Accessibility
Wraparound care must be considered to ensure accessibility. Considerations such as transportation, access to technology, feelings of belonging, representation, and the inclusivity of venues must be addressed. Options to include family members or friends are also important.
In summary, the establishment of a formal definition for social prescribing through the CUSP framework marks a crucial step toward integrating holistic, person-centered care into modern healthcare systems. By following the WHO Toolkit's implementation steps and considering the insights from the Arts on Prescription Field Guide, communities can begin the process of addressing health inequities through increased access to clinical and non-clinical supports, including arts, culture, and nature.
Here at the Benjamin Goldberg Foundation, we are working towards increasing awareness of Social Prescribing in Hampton Roads. Through the region’s first-ever Social Prescribing Roundtable Convening this September, we are bringing together key regional stakeholders to begin the implementation process through addressing the first 4 steps outlined in the WHO Toolkit. We are also working closely with national organizations including Social Prescribing USA, to mobilize resources, community, and insights beyond our local regional impact.
Resources
Arts on Prescription Field Guide: https://arts.ufl.edu/site/assets/files/224849/arts_on_prescription_field_guide.pdf
Muhl C, Mulligan K, Bayoumi I, et al Establishing internationally accepted conceptual and operational definitions of social prescribing through expert consensus: a Delphi studyBMJ Open 2023;13:e070184. doi: 10.1136/bmjopen-2022-070184
WHO Toolkit: https://www.who.int/publications/i/item/9789290619765