Metrics, Measures, and Instruments

We’ve gathered some of the available metrics, measures, and instruments relevant to research on screening and addressing social needs in health care settings. To the extent information is available to us, along with the actual instrument we provide a brief summary about where and when the tool has been used and links to any existing evidence about it.

AAFP Short-Form Social Needs Screening Tool

American Academy of Family Physicians
Eleven-question Provider Short-Form Social Needs Screening Tool. Questions 1-10 are reprinted with permission from the National Academy of Sciences, courtesy of the National Academies Press, Washington, D.C. Published as part of the American Academy of Family Physician's EveryONE Project. Download...

Total Health Assessment Questionnaire for Medicare Members

Kaiser Permanente
The Medicare Total Health Assessment (MTHA) is a survey used at several Kaiser Permanente locations to assess several things, including food insecurity, in the elderly. The survey is offered to Medicare Advantage members in advance of Annual Wellness Visits that are a CMS-mandated benefit offering...

Kaiser Permanente's Your Current Life Situation Survey

Kaiser Permanente
Kaiser Permanente's Your Current Life Situation (YCLS) survey was developed to capture a range of social and economic needs, including living situation, housing, food, utilities, childcare, debts, medical needs, transportation, stress, and social isolation. Download the PDF > Yellow highlights...

Accountable Health Communities Screening Tool

A. BilliouxK. VerlanderS. AnthonyD. Alley
From the National Academies of Medicine: "With input from a panel of national experts and after review of existing screening instruments, CMS developed a 10-item screening tool to identify patient needs in 5 different domains that can be addressed through community services (housing instability,...

IOM Recommended Social and Behavioral Domains and Measures for Electronic Health Records

Committee on Recommended Social & Behavioral Domains & Measures for Electronic Health Records
Determinants of health—like physical activity levels and living conditions—have traditionally been the concern of public health and have not been linked closely to clinical practice. However, if standardized social and behavioral data can be incorporated into patient electronic health records (EHRs...

PRAPARE: Protocol for Responding to and Assessing Patients’ Assets, Risks and Experiences

NACHCAssociation of Asian Pacific CHOsOregon Primary Care AssociationInstitute for Alternative Futures
The Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) was developed by NACHC and partners to help health centers and other providers collect the data needed to better understand and act on their patients’ social determinants of health. The PRAPARE...

Health Leads Social Needs Screening Toolkit

Health 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...

The Hunger Vital Sign: Best practices for screening and intervening to alleviate food insecurity

Rebecca RottapelRichard Sheward
The Hunger Vital Sign(TM) (HVS) is a validated 2-question food insecurity screening tool that allows clinicians to accurately identify households at risk of food insecurity and address patient needs appropriately. Endorsed by the American Academy of Pediatrics, the tool is being used by hundreds of...

HealthBegins Upstream Risk Screening Tool

This social needs screening survey contains questions on: education, employment, social support, immigration, financial strain, housing insecurity and quality, food insecurity, transportation, violence exposure, stress, and civic engagement. The survey also includes recommended screening frequency...

IHELP Pediatric Social History Tool

IHELP is a screening tool initially presented by Kenyon et. al. in 2007 as a tool for collecting pediatric social histories. As a result, it includes both household needs (financial strain, insurance, hunger, domestic violence, housing stability and housing conditions) and several child-specific...