Methods: C4H manages client caseloads on the Unite Us digital platform. De-identified, cross-sectional data from October 1, 2021 to August 31, 2024 was extracted from Unite Us. We conducted descriptive analysis and developed a logistic regression model to identify high and low-resolution social needs.

Results: C4H completed intake of 1,510 unique clients involving 4,206 unique cases with an average of 3.17 cases per client served. The most prevalent HRSN included individual & family support (22%), housing & shelter (18%), physical health (16%), food assistance (12%), and clothing & household goods (12%). Of all cases, nearly 40% were resolved, with the rest equally split between unresolved and open (pending). Several social needs had significantly improved odds of resolution including food assistance (OR 2.86 [1.90, 4.32], p <0.001), clothing & household goods (OR 2.28 [1.51, 3.45], p <0.001), and utilities (OR 2.73 [1.74, 4.28], p <0.001) while mental/behavioral health needs had significantly lower likelihood of resolution (OR 0.28 [0.11, 0.72], p = 0.008). Referred cases (46% of total cases) had significantly lower odds of being resolved compared to cases managed internally (OR 0.38 [0.34–0.44], p <0.001).

Conclusion: C4H provides critical social care for patients in RI. Future efforts should be focused on enhancing access to more complex social care at the point-of-care.