Brief Description
The Health-Related Social Needs Screening Tool (HRSN) asks about social needs such as housing, food needs, exposure to violence, transportation needs, safety needs, work needs, and more. It was created by the Centers for Medicare & Medicaid Services (CMS) Center for Medicare and Medicaid Innovation (CMMI) with the goal of identifying and helping with social needs to improve health outcomes and decrease healthcare costs. Results of the screener are used to inform treatment plans and also to make referrals to community services; clinicians and their staff can use this short tool as part of their busy clinical workflows with people of all different ages, backgrounds, and settings. Respondents answer a variety of questions about health-related social needs (e.g., “What is your living situation today?”) on a variety of scales.
Assessment Administration Type
Self-report (can also be taken by a parent or caregiver, if applicable)
Number of questions
27
Age Range for Administration
5+
Recommended Frequency of Administration
Yearly
Summary of Scoring and Interpretations
The HRSN has 27 questions scored on a variety of scales. A total score is not used; each domain stands alone and has criteria for whether the respondent has those specific health needs. See table below for domains and associated items, as well as scoring information.
Domain | Items | Respondent has an HRSN in the domain if… |
Living Situation | 1, 2 | If they don’t have a steady place to live and/or select any of the response options about problems associated with their living place. |
Food | 3, 4 | They responded “Sometimes true” or “Often true” for one or both questions. |
Transportation | 5 | They responded “Yes” to the question. |
Utilities | 6 | They responded “Yes” or “Already shut off". |
Safety | 7, 8, 9, 10 | Each question is scored from 1 to 5; sum the values for all four questions, with a total score ranging from 4 to 20. A score of 11 or higher meets the threshold for identifying a safety need/shows that the person might not be safe. |
Financial Strain | 11 | They responded “Somewhat hard” or “Very hard.” |
Employment | 12 | They responded “Yes, help finding work” or “Yes, help keeping work.” |
Family and Community Support | 13, 14 | For Q13, they responded, “I could use a little more help” or “I need a lot more help.” For Q14, they responded, “Often” or “Always.” |
Education | 15, 16 | They responded “Yes” to one or both questions. |
Physical Activity | 17, 18 | Whether patients are identified as having an HRSN in the physical activity domain depends on (1) the amount of exercise patients engage in each week and (2) the individual’s age. First, calculate [number of days selected] x [number of minutes selected] = [number of minutes of exercise per week]. Second, apply the applicable age threshold: • Under 6 years old: Not applicable • Age 6 to 17: Fewer than an average of 60 minutes per day indicates HRSN. • Age 18 or older: Fewer than 150 minutes per week indicates HRSN. |
Substance Use | 19, 20, 21, 22 | They responded with anything other than “Never” to at least one question. |
Mental Health | 23, 24, 25 | For Qs 23 and 24, each answer option for the first question is scored from 0 to 3. Sum the values for both questions, with a total score ranging from 0 to 6. Patients are identified as having an HRSN in the mental health domain if they have a combined score of 3 or higher. They also may have a need if they answer anything other than “Not at All” for Q25. |
Disabilities | 26, 27 | They responded “Yes” to one or both of the questions. |
Blueprint Adjustments
Blueprint's HSRN has 27 questions, versus 26 in the original because on the original measure, #23 is split into 23a. and 23b. Also, for the physical activity domain, Blueprint displays the HRSN need for adults 18+.
Clinical Considerations
Estimated completion time: 8-10 minutes
Growing evidence shows that if we deal with unmet HRSNs like homelessness, hunger, and exposure to violence, we can help undo their harm to health. Just like with clinical assessment tools, providers can use the results from the HRSN Screening Tool to inform patients’ treatment plans and make referrals to community services.
Using the AHC HRSN Screening Tool is an option for health care providers seeking to prevent chronic illnesses and improve health outcomes, given the extent to which social context is known to influence health care and health outcomes.
This measure is also available on Blueprint in Spanish.
Citation
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