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Accountable Health Communities Health-Related Social Needs Screening Tool

CMS. "Accountable Health Communities (AHC) Health-Related Social Needs Screening Tool."

Key findings used in wiki

  • The AHC tool defines a concise, actionable screening structure across housing instability, food insecurity, transportation, utility needs, and interpersonal safety.
  • Its supplemental questions extend the framework into financial strain, employment, family/community support, education, substance use, mental health, and disability.
  • The tool is designed to support assessment and referral, not just description, which aligns with GiveCare's action-oriented support model.
  • It is especially useful as a public framework source for housing and material-hardship domains in GiveCare's caregiver-SDOH adaptation.
  • It does not address caregiver-specific realities like navigation burden, legal authority, or role-related emotional load, which is part of why GiveCare extends beyond it.
  • CMS's companion guide says the collection of questions was assembled from commonly used or evidence-based sources but has not been tested as a whole, which may affect validity and reliability. It should therefore be treated as a standardized screening and referral framework, not a single validated psychometric scale.