Based on extensive research highlighted in the Journal of the American Medical Association, the landscape of multi-domain social risk screening tools is vast and varied. These tools play a crucial role in healthcare by helping providers identify patients’ social needs that can significantly impact their health outcomes. While numerous tools are available, they differ significantly in how they assess social risk. For healthcare professionals and organizations aiming to implement effective social risk screening, understanding these differences is paramount. This article delves into some of the most widely utilized social risk screening tools, with a special focus on the WE CARE Screening Tool and resources specifically designed to address homelessness screening.
Here are ten prominent social risk screening tools that are currently in use:
1. Hunger Vital Sign Tool: Addressing Food Insecurity
Food insecurity is a critical social determinant of health, and the Hunger Vital Sign tool is a validated, two-question screening method designed to quickly identify households at risk. Developed in 2010 by physicians at Children’s HealthWatch, this tool is widely used due to its brevity and effectiveness.
Households are flagged as potentially food insecure if they respond “often true” or “sometimes true” to either or both of these statements:
- “Within the past 12 months we worried whether our food would run out before we got money to buy more.”
- “Within the past 12 months the food we bought just didn’t last and we didn’t have money to get more.”
This simple yet powerful tool allows healthcare providers to initiate conversations about food access and connect families with necessary resources.
Learn more about the Hunger Vital Sign from Children’s HealthWatch.
2. PRAPARE Screening Tool: A Comprehensive Approach to Social Determinants
PRAPARE, or the Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences, offers a more comprehensive approach to social risk screening. Developed by the National Association for Community Health Centers (NACHC), PRAPARE includes a set of national core measures alongside optional measures tailored to community-specific priorities.
This tool is designed to help health centers and other healthcare providers systematically collect data on patients’ social determinants of health. Recognizing the importance of integrating social needs data into healthcare systems, PRAPARE offers Electronic Health Record (EHR) templates compatible with various systems like eClinicalWorks, Cerner, and Epic, making implementation more seamless.
Explore the PRAPARE Screening Tool further at NACHC.
3. USDA Household Food Security Tool: Measuring Food Security at the Household Level
The United States Department of Agriculture (USDA) developed the Household Food Security Tool to thoroughly assess the degree and intensity of food insecurity within households. This survey-based tool categorizes households based on their responses to a series of questions about food access and hunger experiences.
The tool classifies households into different food security levels, ranging from food secure (minimal reported food insecurity) to food insecure with hunger (severe). This detailed categorization helps in understanding the spectrum of food insecurity and tailoring interventions accordingly.
Learn more about the Household Food Security Tool from the USDA.
4. Health Leads Screening Toolkit: Best Practices and Sample Questions
The Health Leads Screening Toolkit provides a valuable resource for organizations looking to implement or refine their social needs screening processes. This toolkit includes best practices, a sample screening tool, and a library of screening questions.
The sample tool focuses on common unmet social needs such as food insecurity, housing instability, utility needs, financial strain, and transportation. It also includes optional domains like childcare, employment, and mental health, allowing for customization based on specific needs and contexts. Updated in 2018 with insights from leading health authorities, the Health Leads Toolkit is a robust guide for effective social needs screening.
Discover more about the Screening Toolkit from Health Leads.
5. WE CARE Screening Tool: Integrating Social Needs into Pediatric Care
The WE CARE Screening Tool, standing for Well Child Care, Evaluation, Community Resources, Advocacy, Referral, Education, is specifically designed as a social determinants of health screening and intervention model within pediatric primary care. This tool is notable for its family-centered approach.
The WE CARE survey instrument aims to identify unmet social needs, including childcare, employment, and housing, through direct questions. Crucially, it incorporates a follow-up question asking if parents desire assistance with any identified needs (“If no, do you want help?”). This element is vital as it respects patient autonomy and avoids assumptions about wanting intervention simply because a need is identified. The WE CARE model emphasizes not just screening but also connecting families with community resources, advocating for their needs, and providing education.
Explore the WE CARE Screening Tool from Boston Medical Center to understand its application in pediatric settings.
6. Children’s HealthWatch Survey: A Broad Scope of Child and Family Well-being
The Children’s HealthWatch Survey is a comprehensive tool that measures various aspects of young children’s nutrition, health, and development, alongside the economic well-being of their families. Administered since 1998, this survey collects extensive data on demographics, health indicators, housing, food security, and access to social programs.
The survey’s modular format, adopted in 2020 for telephone administration, allows for a broader range of topics to be covered, including Adverse Childhood Experiences (ACEs) and experiences of discrimination, without placing undue burden on participants. This in-depth approach provides a holistic view of the factors influencing child and family health.
Learn more about the comprehensive Survey Tool from Children’s HealthWatch.
7. Homelessness Screening Clinical Reminder: Targeted Screening for Housing Instability in Veterans
Addressing the specific needs of veterans, the Homelessness Screening Clinical Reminder is designed to assess housing instability and the imminent risk of homelessness within this population. Developed by the National Center on Homelessness Among Veterans and used by the Veterans Health Administration, this tool is integrated into patients’ electronic medical records for universal screening.
The primary goal of this national screening instrument is to swiftly identify veterans and their families who are experiencing or are at immediate risk of homelessness. This rapid identification is crucial for ensuring timely referrals to appropriate support services and housing assistance programs. This tool directly targets homelessness screening within a specific at-risk population.
Further details on the Homelessness Screening Clinical Reminder are available from the Veterans Health Administration.
8. Accountable Health Communities Screening Tool: Core and Supplemental Social Needs Domains
The Accountable Health Communities Screening Tool, developed by the Centers for Medicare and Medicaid Services (CMS), assesses health-related social needs across a wide spectrum of domains. It includes five core domains: living situation, food, transportation, utilities, and safety, and eight supplemental domains, such as financial strain, employment, and mental health.
This tool is versatile and appropriate for use in various clinical settings, from primary care practices to emergency departments and behavioral health clinics. Available in self-administered, proxy, and multi-use versions, it offers flexibility for diverse patient populations and care scenarios.
Explore the Accountable Health Communities Screening Tool at the Centers for Medicare and Medicaid Services.
9. VI-SPDAT: Prioritizing Services for Homeless Populations
VI-SPDAT, which stands for Vulnerability Index – Service Prioritization Decision Assistance Tool, is specifically designed for triaging and assessing the needs of individuals experiencing homelessness. Created by OrgCode and Community Solutions, VI-SPDAT helps prioritize individuals for housing and support interventions based on their vulnerability and needs.
Unlike a simple assessment, VI-SPDAT is a survey that can be administered by anyone to help prioritize clients for assistance. It moves beyond basic eligibility to identify those in greatest need, ensuring that limited resources are directed most effectively. This is a critical tool in the effort to combat homelessness and provide targeted support.
Learn more about VI-SPDAT from OrgCode and its role in addressing homelessness.
10. Pathways Community Hub Model: Community-Based Care Coordination
The Pathways Community Hub Model offers a framework for community-based care coordination, encompassing processes, systems, and resources to address health, social, and behavioral health risk factors. Screening within this model utilizes checklists with “trigger questions.” A “yes” answer to a trigger question indicates a specific risk factor and the need for an interventional pathway.
These checklists are crucial for systematically gathering information, especially on sensitive topics like domestic violence or mental health issues that clients may not spontaneously disclose. The Hub Model emphasizes proactive screening and coordinated care to address a wide range of social determinants of health at both individual and community levels.
Discover more about the Pathways Community Hub Model from PCHI.
Conclusion: Choosing the Right Tool for Effective Social Risk Screening
The array of social risk screening tools available reflects the growing recognition of social determinants of health in healthcare. From focused tools like the Hunger Vital Sign to comprehensive models like PRAPARE and the WE CARE Screening Tool, healthcare providers have a range of options to identify and address patients’ social needs. For those specifically concerned with homelessness screening, tools like the Homelessness Screening Clinical Reminder and VI-SPDAT offer targeted approaches for vulnerable populations.
Selecting the most appropriate screening tool depends on the specific context, patient population, and organizational goals. Understanding the nuances of each tool, as outlined above, is the first step towards implementing effective social risk screening and ultimately improving patient outcomes by addressing their holistic needs. By integrating these tools into practice, healthcare organizations can move towards a more equitable and patient-centered approach to care.
