Social Needs Response Team (SNRT) at Penn Medicine
Title: BTG Experience With the Social Needs Response Team (SNRT)
Student Interns:
Anastasia Elfar
University of Pennsylvania, School of Dental Medicine
Calina He
University of Pennsylvania, School of Dental Medicine
Kayla Mengden
University of Pennsylvania, School of Nursing
Academic Preceptor:
Dalmacio Dennis Flores, PhD, ACRN, FAAN
University of Pennsylvania, School of Nursing
Abby Quinn Peterson, DMD, MPH
University of Pennsylvania, School of Dental Medicine
Elizabeth Powell, DDS, MPH
University of Pennsylvania, School of Dental Medicine
Community Preceptor:
Ana Bonilla Martinez, MPH, CHES
Senior Program Manager, Social Needs Response Team
August Wilson, LCSW
Social Worker, Social Needs Response Team
Community Site:
Founded during the COVID pandemic, the Social Needs Response Team (SNRT) aims to address patients’ unmet needs by working with community-based organizations and local clinics to refer patients to food, medical care, transportation, and health support resources. Patients can be referred to SNRT by a healthcare provider, or they may leave a voicemail to be connected with someone from an interdisciplinary team of nursing, medical, dental, and social work professionals who can work with them to find resources to meet their needs.
Team’s Experience:
The Bridging the Gap interns worked with patients in Philadelphia and the surrounding areas to help address numerous social needs. Every day, the interns received a list of patient referrals from the voicemail box or various Penn Medicine departments. As the interns spoke to patients, they provided empathetic support and a listening ear while finding resources and solutions to meet their needs. The interns faced many challenges regarding access to resources, including loss of funding, changes to eligibility, and long application processes. In addition, throughout the program, the interns updated and revised the SNRT “tip sheets,” documents with information on available resources that the team uses when working with patients. The interns worked on tip sheets for senior programs, medical transportation, and housing options.
Reflections
My experience this summer with the Social Needs Response Team reinforced that effective healthcare extends far beyond diagnosis and treatment. Speaking with patients experiencing food insecurity, transportation barriers, housing instability, and financial hardship demonstrated how social factors directly influence health outcomes and access to care. One of the most meaningful resources available was the FAST referral process, which allowed families facing immediate food insecurity to be connected with emergency food assistance when they did not have enough to eat. Transportation barriers consistently prevented many patients in Philadelphia from getting the care they needed and learning how to help patients overcome this struggle has been greatly helpful. This experience strengthened the importance of advocacy and meeting patients with empathy. As I continue my career in dentistry, these lessons will guide me to treat each patient holistically while advocating for resources that improve both oral health and overall well-being.
Anastasia Elfar
My experience with the Social Needs Response Team transformed the way I understand our healthcare system. Speaking with patients who face food insecurity, language barriers, financial hardship, and limited access to healthcare showed me how well-being often does not begin in a clinic. It was a pleasure to speak with patients, and I was continually inspired by their resilience, kindness, and stories. I not only learned about the many resources that address homelessness, food insecurity, and transportation barriers in Philadelphia, but also saw the gaps in the systems that failed to meet the overwhelming needs of our community. Many of the patients who I worked with directly struggled with transportation to their medical appointments, and it stood out to me that few paratransit resources exist. This is just one of many gaps in our system that prevent patients from accessing care, even when they are motivated to seek treatment. I will carry the stories and lessons from Bridging the Gaps with me throughout my career in dentistry, aiming to meet each patient with empathy and compassion to recognize the circumstances that shape one’s health.
Calina He
Working with the Social Needs Response Team this summer was both a challenging and rewarding experience. I enjoyed speaking with patients and providing empathetic support while helping them navigate complex resources such as insurance, SNAP benefits, transportation, and healthcare services. This experience gave me a deeper understanding of the many barriers patients face, including not only financial hardship but also the complexity and inaccessibility of the systems designed to help them. It also taught me that listening can be just as important as providing resources, as many patients need someone to hear and validate their experiences. As I continue my nursing education, I will carry these lessons with me and advocate for my patients both inside and outside of the clinical setting.
Kayla Mengden
Partners
