SDOH: Tools and Support

Before you begin social determinants of health (SDOH) screening, review a range of tools and resources to find the options that work for you. For decision-making tips, check out ASHA's guide, What to Ask When Evaluating Any Procedure, Product, or Program. The following are examples of standardized screening tools and referral resources. ASHA does not endorse or recommend programs, products, or services from external sources.

Screening Tools

To screen clients, you may incorporate questionnaires into your standard intake forms. You can also screen clients in conversation, using SDOH tools to inform your approach. Check with your employer and payers to see if they have requirements related to SDOH screening. Make sure everyone's role in the process is clear and that your team is on the same page. Who administers screening, how and how often clients are screened, where screening data is stored, how results are communicated, how clients' social needs are prioritized, and how follow-up strategies are documented are all crucial steps to consider.

PRAPARE: Protocol for Responding and Assessing Patients' Assets, Risks, and Experiences

  • Downloadable PDF questionnaire
  • 15 core questions, 5 supplemental questions
  • Each question offers the option, "I choose not to answer this question."
  • Designed to be self-administered by client, or administered by clinical or non-clinical staff
  • Available in 30+ languages
  • The PRAPARE Implementation and Action Toolkit includes modules on how to use the screening tool. A downloadable Excel PRAPARE Readiness Assessment is also offered to help administrators gauge how ready their organization is to use the questionnaire and resulting data.
  • Collaborative effort from the National Association of Community Health Centers, Association of Asian Pacific Community Health Organizations, and the Oregon Primary Care Association


The Accountable Health Communities (AHC) Health-Related Social Needs Screening Tool

  • Downloadable PDF questionnaire
  • 10 core questions, 16 supplemental questions
  • Designed to be self-administered by client
  • Available in 11 languages:
    • Arabic, Chinese, English, Korean, German, Ilocano, Japanese, Portuguese, Spanish, Tagalog, and Vietnamese
  • Includes a guide geared toward administrators.
    • Chapters include "Cultivate staff buy-in," "Use customized scripts to engage patients in screening," and "Train staff to manage privacy and address safety concerns."
  • Offered by Centers for Medicare and Medicaid Service (CMS)

AHC Screening Tool

The EveryONE Project Toolkit: Assessment and Action

  • Toolkit includes
    • Guide to screening
    • Downloadable PDF questionnaire
    • Neighborhood Navigator resource (partnership with
    • Action plan template
  • 15 questions
  • The 15th question is "Would you like any help with any of these needs?"
  • Designed to be self-administered by client or administered by clinical or non-clinical staff
  • Available in 7 languages
    • Chinese, English, French, Korean, Spanish, Tagalog, and Vietnamese
  • Created by the American Academy of Family Physicians (AAFP)

EveryONE Project Toolkit

Referral Resources

You may already refer clients to specialists in your professional network. Passing along information about community resources can also elevate care and improve treatment outcomes. Be aware that people have different levels of comfort with governmental, nonprofit, and faith-based community organizations.

Community SDOH Information

County Health Rankings & Roadmaps
Enter your client's state, county or zip code to explore SDOH statistics

Enter your client's ZIP code to find nearby resources

United Way 211
National and local hotline for crisis, food, housing, and health assistance

Search Terms and Starting Points

  • Area Office on Aging or area agencies on aging
  • County hotlines for social services
  • Large area health systems
  • Local community and faith-based social need organizations
  • Local health department
  • Payer resources
  • Shelters
  • State Early Intervention services


ASHA staff are available to support you and answer your questions about how social determinants of health relate to clinical practice and payment.

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