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
Mold
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]
In the past 12 months has the electric, gas, oil, or water company threatened to shut off services in your home [Yes, No, Already shut off]
Do you feel physically and emotionally safe where you currently live? [Yes, No, Unsure]
Arabic
Bengali
Burmese
SimpChinese
Spanish
Several screening tools have been developed to assess multiple domains of patients’ individual non-medical needs that drive adverse health outcomes 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-domain screening tools recommended by MSHIELD is included in Table 2 in the Best Practices Guide for Evaluating Social Drivers of Health, where you can find a breakdown of the number of questions included in each screening tool by area and sub-domain.