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Social Needs Screening Tool - AAFP Home

Social Needs Screening tool housing child care 1. Are you worried or concerned that in the next two months 7. Do problems getting child care make it difficult for you to you may not have stable housing that you own, rent, or stay in work or study?5. as a part of a household?1 Yes Yes No No employment 2. Think about the place you live. Do you have problems with 8. Do you have a job?6. any of the following? (check all that apply)2. Yes Bug infestation No Mold Lead paint or pipes education Inadequate heat 9. Do you have a high school degree?6. Oven or stove not working Yes No or not working smoke detectors No Water leaks None of the above finances 10.

13.w often does anyone, including family, threaten you with Ho harm? 8. Never (1) Rarely (2) Sometimes (3) 3. Fairly often (4) Frequently (5) 14. w often …

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