Health Leads Social Needs Screening Toolkit

2016Health Leads

Drawing on Health Leads' experience and recent federal guidelines, this toolkit provides screening best practices, a questions library, and a sample recommended screening tool for some of the most common unmet social needs: food insecurity, housing instability, utility needs, financial resource strain, transportation, exposure to violence, and socio-demographic information.


Health care leaders and front-line clinicians have long recognized the connection between unmet basic resource needs – e.g., food, housing, and transportation – and the health of their patients. One of the first steps to addressing social needs is asking patients about this aspect of their lives.

Building on Health Leads’ 20 years of experience implementing programs to screen patients for social needs, as well as recent guidelines from the Institute of Medicine and Centers for Medicare & Medicaid Services, this Social Needs Screening Toolkit shares the latest research on how to screen patients for social needs and provides recommendations for questions to use.

The toolkit includes:

  • Essential social needs domains, representing the most common unmet social needs facing patients today;
  • Screening best practices, including guidance on question development, ease of use and clinical workflow integration;
  • Sample recommended screening tool, offering sample questions around the essential social needs domains–in English and Spanish;
  • Questions library, providing clinically-validated and patient-centered questions for each social needs domain, for a range of patient literacy levels.

Social need domains included in the recommended screening tool include food insecurity, housing instability, utility needs, financial resource strain, transportation, exposure to violence, and socio-demographic information. Optional social need domains include childcare, education, employment, health behaviors, social isolation & supports, and behavioral/mental health.

Citation: Health Leads. Social needs screening toolkit. 2016. https://healthleadsusa.org/wp-content/uploads/2016/07/Health-Leads-Screening-Toolkit-July-2016.pdf. Accessed December 14, 2016.

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