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Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health (2019)

Chapter: Appendix: Social Need Screening Tools Comparison Table

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Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
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Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
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TABLE A-1
Social Need Screening Tools Comparison Table

AHC-Tool HealthBegins Health Leads
Number of social needs questions 19 24 10
Number of non-social needs questions 8 4 0
Patient or clinic population Medicare and Medicaid Non-specific Non-specific
Reading level 8th grade 11th grade 6th grade
Reported completion time NR NR NR
Additional languages
Scoring Y Y N
Cost Free Free Free
Benefitsa
Caregiver responsibilitiesa
Child care access and affordabilitya 1
Civic engagementa 1
Clothinga
Disabilitiesa 2
Educationa 1 3
Employmenta 1 1
Financial straina 1 2
Food insecuritya 2 1 1
Health care/medicine access and affordabilitya 1
Housing insecurity/instability/homelessnessa 1 2 1
Housing qualitya 1 1
Immigration/migrant status/refugee statusa 1
Incarcerationa
Incomea
Interpersonal violencea 4 4
Literacya 1
Neighborhood safetya 1
Power of attorney/guardianshipa
Social supporta 2 5 1
Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
×
MLP IHELLP Medicare Total Health Assessment Questionnaire NAM Domains PRAPARE WellRx Your Current Life Situation
10 9 12 17 10 19
0 30 12 4 1 10
Non-specific Medicare beneficiaries Non-specific Community health centers Primary care Non-specific
8th grade College 6th grade 8th grade 2nd grade 9th grade
NR 10–20 min NR NR NR NR
      Spanish Spanish  
N N N N N N
Free Free Free Free Free Free
1          
          1
      1 1 1
           
      1    
           
1   2 1 1  
1     1 2  
    1     1
  2   1 1 3
      2   2
2 1   2 1 2
1 1       1
2     2    
      1    
3   1b 1    
3   4 1 2 3
          1
      1 1 1
1 1        
  2 4 1   5
Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
×
AHC-Tool HealthBegins Health Leads
Stressa 1 1
Transportationa 1 1 1
Utilitiesa 1 1
Veteran statusa
Health behaviors/behavioral health/health status MH, PA, SU DP, PA
Desire for assistance/urgent needs Integrated into some domains; see domain-specific questions Integrated into “civic engagement”; see domain-specific question 2 stand-alone questions

NOTE: AA = alcohol abuse; AHC = Accountable Health Community; DP = dietary pattern; HS = health/functional status; MH = mental health (including depression); MLP IHELLP = Medical-Legal Partnership Patient Screening Tool; NAM = National Academy of Medicine; NR = not reported; PA = physical activity; PRAPARE = Protocol for Responding to and

Assessing Patients’ Assets, Risks and Experiences; SA = substance abuse; SU = substance use; TU = tobacco use.

a Number refers to number of screening questions about the specified social need.

b Geocoded.

SOURCE: UCSF (University of California, San Francisco). SIREN: Social Interventions Research and Evaluation Network. 2019. https://sirenetwork.ucsf.edu (accessed April 4, 2019). Used with permission from Laura Gottlieb and Caroline Fichtenberg.

REFERENCES

Baer, T. E., E. A. Scherer, E W. Fleegler, and A. Hassan. 2015. Food insecurity and the burden of health-related social problems in an urban youth population. Journal of Adolescent Health 57(6):601–607.

Gundersen, C., E. E. Engelhard, A. S. Crumbaugh, and H. K. Seligman. 2017. Brief assessment of food insecurity accurately identifies high-risk U.S. adults. Public Health and Nutrition 20(8):1367–1371.

Hager, E. R., A. M. Quigg, M. M. Black, S. M. Coleman, T. Heeren, R. Rose-Jacobs, J. T. Cook, S. A. Ettinger de Cuba, P. H. Casey, M. Chilton, D. B. Cutts, A. F. Meyers, and D. A. Frank. 2010. Development and validity of a 2-item screen to identify families at risk for food insecurity. Pediatrics 126(1):e26–e32.

IOM (Institute of Medicine). 2014. Capturing social and behavioral domains and measures in electronic health records: Phase 2. Washington, DC: The National Academies Press.

Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
×
MLP IHELLP Medicare Total Health Assessment Questionnaire NAM Domains PRAPARE WellRx Your Current Life Situation
2 1 1 2
1 1 2
2 1 1
1
A, DP, HS, MH, PA, TU A, MH, PA, TU A, SA
Integrated into “immigration”; see domain-specific question 1 stand-alone question Integrated into some domains; see domain-specific questions 2 standalone questions
Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
×

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Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
×
Page 173
Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
×
Page 174
Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
×
Page 175
Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
×
Page 176
Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
×
Page 177
Suggested Citation:"Appendix: Social Need Screening Tools Comparison Table." National Academies of Sciences, Engineering, and Medicine. 2019. Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation's Health. Washington, DC: The National Academies Press. doi: 10.17226/25467.
×
Page 178
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Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health was released in September 2019, before the World Health Organization declared COVID-19 a global pandemic in March 2020. Improving social conditions remains critical to improving health outcomes, and integrating social care into health care delivery is more relevant than ever in the context of the pandemic and increased strains placed on the U.S. health care system. The report and its related products ultimately aim to help improve health and health equity, during COVID-19 and beyond.

The consistent and compelling evidence on how social determinants shape health has led to a growing recognition throughout the health care sector that improving health and health equity is likely to depend – at least in part – on mitigating adverse social determinants. This recognition has been bolstered by a shift in the health care sector towards value-based payment, which incentivizes improved health outcomes for persons and populations rather than service delivery alone. The combined result of these changes has been a growing emphasis on health care systems addressing patients’ social risk factors and social needs with the aim of improving health outcomes. This may involve health care systems linking individual patients with government and community social services, but important questions need to be answered about when and how health care systems should integrate social care into their practices and what kinds of infrastructure are required to facilitate such activities.

Integrating Social Care into the Delivery of Health Care: Moving Upstream to Improve the Nation’s Health examines the potential for integrating services addressing social needs and the social determinants of health into the delivery of health care to achieve better health outcomes. This report assesses approaches to social care integration currently being taken by health care providers and systems, and new or emerging approaches and opportunities; current roles in such integration by different disciplines and organizations, and new or emerging roles and types of providers; and current and emerging efforts to design health care systems to improve the nation's health and reduce health inequities.

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