TABLE 1.
Major screening tools for social determinants of health
| Outcome | Screening tool, description incl # of items, cutpoint(s), sensitivity and specificity when available | Administration | Age range and specifications | Available languages | Public domain or requires authorization and/or licensing agreement |
|---|---|---|---|---|---|
| Child Maltreatment—physical, sexual and/or psychological abuse | Child Trauma Questionnaire (CTQ)—28-item; emotional abuse, physical abuse, sexual abuse, emotional neglect, physical neglect | Self-administered; 5 min | Age 12 and order | English | May be purchased for use at http://www.pearsonclinical.com/psychology/products/100000446/childhood-trauma-questionnaire-a-retrospective-self-report-ctq.html?Pid=015-8102-339&Mode=summary. Accessed 08.07.15. |
| History of Victimization Form—65-item instrument with 5 subscales: sexual abuse, physical abuse, neglect, witness to family violence and psychological abuse | Self-report | Children | English | No cost. Contact Vicky.wolfe@lhsc.on.ca | |
| Kempe Family Stress Inventory—10-items; 80–90% sensitivity; 21–89% specificity; used by a number of Healthy Start programs | Parent, self-administered | Adults | English | No copyright when used in service settings. Need permission to re-publish. | |
| Family Financial Support | US Department of Agriculture Household Food Security Module—18 questions assessing general household and child food security, categorized into high, marginal, low, and very low food security | Researchers | Adults | English and Spanish | Free and in the public domain. See http://www.ers.usda.gov/datafiles/Food_Security_in_the_United_States/Food_Security_Survey_Modules/hh2012.pdf. Accessed 11.11.15. |
| Two question screen validated for clinical use: sensitivity 97%; specificity 83%; “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.” | Healthcare clinician or staff | Caregivers of children (validated in families with a child less than 36 months old) | English, Spanish and Somali | Free and in the public domain.65 | |
| Intimate Partner Violence | HITS (Hurt, Insult, Threaten, Scream) tool—4-items; assesses frequency of IPV; <1minute to score; 86–96% sensitivity; 91–99% specificity; Conflict Tactics Scale (CTS)82 used as gold standard | Self-report or clinician administered; less than 20 s | Adults | Available in Spanish, Chinese Mandarin and Arabic | Copyrighted. For permission to use, contact: Dr. Kevin Sherin by e-mail: kevin_sherin@doh.state.fl.us |
| PVS (Partner Violence Screen): 3 items; assesses current safety and IPV in past year; 35–71% sensitivity; 80–94% specificity; CTS used as gold standard. Positive response to any item represents positive screen | Self-report or clinician administered; less than 1 min | Adults | English | Copyrighted. Contact developers. See original article: Feldhaus KM, et al. Accuracy of 3 brief screening questions for detecting partner violence in the emergency department. J Am Med Assoc. 1997;277: 1357-61. | |
| WAST (Women Abuse Screening Tool), WAST-SF (Women Abuse Screening Tool—Short Form); 8 items, 2 items in SF. Long form: 74% sensitive, specificity 96%. SF is 91% sensitive, and 100% specific compared to long form | Self-report | Adult women | Available in Spanish (long form) | Copyrighted. For permission, contact the Society for Teachers of Family Medicine, www.stfm.org. Accessed 08.07.15. | |
| Maternal Depression and Family Mental Illness | Patient Health Questionnaire-9 ((PHQ-9) Items, max score 27; depression severity: score 5–9 = mild; Score 10–14 = moderate; 15–19 moderately severe; 20–27 = severe; sensitivity 81%; specificity 92% for major depression | Self-administered, staff or physician | Adult or adolescent | English and multiple other languages developed for specific countries | In the public domain. No permission required to reproduce, translate, display or distribute. See http://www.phqscreeners.com/overview.aspx. Accessed 12.07.15. Developed by Drs. Robert L. Spitzer, Janet B.W. Williams, Kurt Kroenke and colleagues, with an educational grant from Pfizer, Inc. |
| Edinburgh Postnatal Depression Scale (EPDS)– 10 items, max score 30, cutpoint ≥13 for major depression; sensitivity 67–100%, specificity 68–100% | Self-administered | Mother | English and Spanish http://www.beyondtheblues.info/Docs/edinburgh%20espanol.pdf. Accessed 12.07.15 | Copyrighted. Users may reproduce the scale without further permission providing they respect copyright by quoting the names of the authors, the title and the source of the paper in all reproduced copies. See http://www.fresno.ucsf.edu/pediatrics/downloads/edinburghscale.pdf. Accessed 12.07.15 | |
| Household Substance Abuse | Safe Environment for Every Kid (SEEK) parent screening questionnaire-5–10 min | Self report or staff person | Parent | English, Chinese, Spanish, and Vietmanese | Copyrighted. For permission to use, see: University of Maryland School of Social Work: The Institute for Innovation and Implementation. http://theinstitute.umaryland.edu/seek/seek_pq.cfm. Accessed 08.07.15 |
| Survey of Well-Being of Young Children (SWYC), Family Questions-5 min | Self report or staff person | Family member | English, Spanish. Portugese, Burmese, Nepali | Free and in the public domain. See: Floating Hospital for Children at Tufts Medical Center. The Survey of Wellbeing of Young Children (SWYC). http://www.theswyc.org/. Accessed 08.07.15 | |
| HEADSS (Home, Education & Employment, Activities, Drugs, Sexuality, Suicide/Depression)–1–2 min | Self report or staff person | Adolescents | English | Free and in the public domain. BC Children’s Hospital. HEADSS: A Psychosocial Interview for Adolescents. http://www.bcchildrens.ca/nr/rdonlyres/6e51b8a4-8b88-4d4f-a7d9-13cb9f46e1d6/11051/headss20assessment20guide1.pdf. Accessed 08.07.15 | |
| CRAFFT (Car, Relax, Alone, Forget, Friends, Trouble)– 1–2 min | Self report or staff person | Adolescents | Multiple languages | Free and in the public domain. See: The CRAFFT Screening tool at http://www.ceasar-boston.org/CRAFFT/index.php. Accessed 26.03.16 | |
| Parental Health Literacy | TOFHLA (Test of Functional Health Literacy in Adults)– 4 prose passages, 17 numerical ability items, average 22 min; S-TOFHLA −2 prose passages, 4 numeracy items, average 12 min | Staff or healthcare professional | Adults | English and Spanish | Copyrighted. For details, see Peppercorn Books: http://www.peppercornbooks.com/catalog/information.php?info_id=5. Accessed 11.11.15. |
| The Newest Vital Sign–6 questions about a sample nutrition label; 3 min | Staff or healthcare professional | Adults | English and Spanish | Trademark with Pfizer, Inc. For the free toolkit, see https://www.pfizer.com/files/health/nvs_flipbook_english_final.pdf. Accessed 08.07.15 | |
| Rapid Estimate of Adult Literacy in Medicine (REALM)— list of 66 medically related words, which patients are asked to read aloud to check for correct pronunciation. REALM-R – shortened, revised version; 2 min | Staff or healthcare professional | Adults | English | Free and in the public domain. See http://www.impact-information.com/impactinfo/newsletter/realm.pdf. Accessed 08.07.15 REALM-R available at: http://www.ahrq.gov/professionals/quality-patient-safety/pharmhealthlit/realm-r.html. Accessed 08.07.15 |