Sustaining and Scaling a Clinic-Based Approach to Address Health-Related Social Needs

Scaling evidence-based interventions from pilot phase remains a pressing challenge in efforts to address health-related social needs and improve population health. This study describes an innovative approach to sustaining and further spreading Developmental Understanding and Legal Collaboration for Everyone (DULCE), a universal evidence-based intervention. The authors found that an innovative, lighter-touch continuous quality approvement (CQI) approach to a second phase of scale-up resulted in sustainment or improvements in most processes and outcomes. Outcomes-oriented CQI measures (i.e., family receipt of resources) are an important addition to more traditional process-oriented indicators.