Screening Tools for SDOH Domains
The following is an excerpt from Evaluating Social Determinants of Health: Best Practices, Opportunities, and Resources for Collaborative Quality Initiatives. (July 2022)
Screening Tools for Social Determinants of Health (SDOH) Domains
While screening for multiple social needs domains has begun in some clinical settings like primary care, healthcare providers or CQIs newly embarking on screening may choose to focus on screening for a select number of social needs domains. This should be based on the patient population and community setting.
For example, in rural areas transportation needs are often higher than in urban or suburban areas. Similarly, some communities with high rates of food insecurity should be more regularly screened for food needs. Certainly not all social needs have to be screened for and addressed in every encounter. Beginning with a needs assessment by investigating community prevalence of SDOH, or conducting an informal poll of practices or hospitals can help inform which social needs are prime targets for new SDOH-focused initiatives.
Health care providers and CQIs can selectively screen for individual social needs. Here we summarize focused screening tools for MSHIELD’s three focus areas (Food Insecurity, Housing Instability, and Transportation/Access to Care). Using the Hunger Vital Sign, which offers a validated 2-item version of the USDA food security screener, and items addressing housing instability and transportation needs from the AHC and PRAPARE tools, MSHIELD recommends the following five questions as a starting place for social needs screening in health care settings:
The MSHIELD Five
Within the past 12 months, we worried whether our food would run out before we got money to buy more. [Often true, Sometimes true, Never true]
Within the past 12 months, the food we bought just didn't last and we didn't have money to get more.
[Often true, Sometimes true, Never true]
What is your living situation today? [Choose one]
I have a steady place to live
I have a place to live today, but I am worried about losing it in the future
I do not have a steady place to live (I am temporarily staying with others, in a hotel, in a shelter, living outside on the street, on a beach, in a car, abandoned building, bus or train station, or in a park)
Think about the place you live. Do you have problems with any of the following? [Choose all that apply]
Pests such as bugs, ants, or mice
Lead paint or pipes
Lack of heat
Oven or stove not working
Smoke detectors missing or not working
In the past 12 months, has lack of reliable transportation kept you from medical appointments, meetings, work, or from getting things needed for daily living? [Yes/No]
Screening Tools for Multiple SDOH Domains
Several screening tools have been developed to assess multiple domains of patients’ individual social needs or broad SDOH and are summarized in detail by the UCSF Social Interventions Research & Evaluation Network (SIREN): sirenetwork.ucsf.edu/tools-resources/resources/screening-tools-comparison
Information on some of the most commonly used multi-SDOH screening tools recommended by MSHIELD is included in Table 2 in the Best Practices Guide for Evaluating Social Determinants of Health, where you can find a breakdown of the number of questions included in each screening tool by area and sub-domain.