Screening for Social Determinants of Health

SDoH Questionnaires Available with CHADIS

Family Challenges, Caregiver Depression, and Family Stressors

• Family Assessment of Safety and Stress (FASS) 

  • ​Resources and Decision Support for Social Determinants - Family Stress Patient Specific Template (PST): The Family Stress PST helps busy clinicians address the “social determinants of health” – particularly those family risk factors known to be antecedents of child maltreatment, delayed development, behavior problems and a wide variety of chronic health conditions in adulthood. 

• Safe Environment for Every Kid (SEEK); SEEK-PLUS (F/U with barriers) - 

• SEEK - PQ-R (Parent Questionnaire)

• Edinburgh Postnatal Depression Scale (EPDS)

• Family Questions

• Health Screening - SoDH

• Home and School Environment (Social History)

• The Hunger Vital Sign

• Multidimensional Scale of Perceived Social Support (MSPSS)

• Parent's Concerns

• Potential Stressors

• Protective Factors Survey (PFS) 

• Psycho-social Screener

• Patient Health Questionnaire 4 (PHQ-4)

• PRIME-MD PHQ-2

• Youth Health Questionnaire - Parent (with TEENSAFE and without TEENSAFE)

Childhood Experiences

• Adverse Childhood Experiences (ACE)

• Adverse Childhood Experiences and Positive Childhood Experiences (ACE/PCE)

• Adverse Childhood Experiences Questionnaire (ACE-Q) Child Anonymous CYW; Child CYW; Teen Anonymous CYW; Teen CYW; Teen Self-Report Anonymous CYW; Teen Self-Report CYW

• PEARLS: Pediatric ACEs and Related Life Events Screener - Child, Teen; Parent/Caregiver Report, Self Report; Identified/De-identified

• Positive Childhood Experiences (PCE)

Substance Use, Substance Use Exposure

• Alcohol Use Disorders Identification (AUDIT-C) Test—Consumption

• Cannabis Use Disorders Identification Test-Revised (CUDIT-R); Brief

• CEASE Questionnaire; Follow-up

• CRAFFT

• DAST

• Drug Abuse Screening Test 10 and AUDIT (DAST-10 and AUDIT)

• GPRA Behavioral Health Form Client/Staff/Office

Relationships, Intimate Partner Violence

• Conflict Tactics Scale - Parent-Child, Short Form

• Hurt, insulted, Threatened with Harm, and Screamed (HiTS)

• McMaster Family Assessment Device, General Functioning Subscale

• Partner Violence Screen (PVS)

• PC-PTSD

• Revised Dyadic Adjustment Scale

Tools to Comprehensively Assess Needs

• PRAPARE: Protocol for Responding to and Assessing Patient Assets, Risks, and Experiences 

• Integra Social Health Questionnaire  

• Pediatric Associates SDOH Questionnaire all ages-on demand 

• Psycho-social Screener

Food Insecurity

• The Hunger Vital Sign

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Demographics

• Demographics-Short Form 

• Family Demographics

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See the entire questionnaire list.

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