Authors :
Presenting Author: Meredith Olenec, BA, CHW – Dartmouth Health
Laura De Muro, MA – Dartmouth Health
Sarah Kaden, BA – Dartmouth Health
Trina Dawson, BA – Dartmouth Health
Elaine Kiriakopoulos, MD, MPH, MSc – Dartmouth Health
Rationale:
Background: Social determinants of health (SDOH) influence access to basic needs and contribute to poor epilepsy outcomes. The Home-Based Self-Management and Cognitive Training Changes Lives (HOBSCOTCH) program aims to improve quality of life for people with epilepsy (PWE) by teaching self-management and compensatory cognitive strategies. To address participant needs from a broader perspective, two targeted SDOH screening questions (1) financial need (2) transportation, were integrated from the Accountable Health Communities, Health Related Social Needs CMS tool into the epilepsy self-management (ESM) prescreening process, conducted through telehealth by epilepsy-trained community health workers (CHWs).
Methods:
Methods: Two questions were added to the prescreening process to identify self-reported unmet social needs. The first assessed transportation access by asking whether the participant experienced transportation challenges in the past 12 months. The second evaluated financial insecurity by asking if the participant had difficulty affording basic necessities such as food, housing, or medical care. Participants who indicated need and consented to support were referred to a CHW, who provided connections to relevant local, state, and national resources and services.
Results:
Results: From October 2024 to May 2025, 359 participants were screened for SDOH and enrolled in the HOBSCOTCH program; 128 (35.7%) reported at least one unmet social need related to transportation or financial insecurity, representing 34 U.S. states (Figure 1). Among PWE screening positive, 104 (81%) consented to receive support and were referred to a CHW. Financial hardship was reported by 80.7%, transportation challenges by 51.1%, and 31.9% reported both. Demographically (Table 1), positive screen respondents were female (59.4%); 38.3% resided in rural areas. Clinically, 73.4% of positive participants reported a seizure in the past 12 months, and 50.8% reported a seizure in the past 30 days; 51.6% reported uncontrolled epilepsy. Global Assessment of Severity of Epilepsy scores varied, with 10.2% rating their condition “extremely severe” and 24.2% “moderately severe”. Each participant who requested support received at least one tailored resource referral, with an average of four resources per individual (range: 1 to 11). Due to geographic limitations, 12 participants received only national resources, as local resources were not available.
Conclusions:
Conclusion: Integrating SDOH screening into the ESM prescreening process effectively identifies critical unmet needs among PWE, particularly related to financial insecurity and transportation. The majority of ESM registrants who screened positive at enrollment requested and received tailored resource referrals, demonstrating both the importance and feasibility of addressing targeted social needs. These findings highlight the value of incorporating SDOH assessments into telehealth interventions to aid a systematic approach for improving QoL and support equitable care of PWE.
Funding: None