Social needs screening tools

Social Determinants of Health (SDOH): Social Needs Screening and Referral is a coordinated care organization (CCO) incentive measure.To meet the measure's requirement for Component 2, Rate 1 (percent of members screened), an OHA-approved or exempted screening tool must be used. A list of approved screening tools is in the table below. OHA strongly encourages CCOs and organizations conducting SDOH screenings to use tools from this list for the following reasons: 

• The approved tools align with national social needs screening measures and often have a range of languages available.
• The approved SDOH screening tools include housing, food and/or transportation questions that automatically qualify as acceptable for the identified SDOH metric domains.
• A common screening tool across the CCO population can streamline the process administratively and lead to better coordination of care.

Approved tools are not separated by adult and pediatric to prevent potential confusion and over screening within the same household. Screening tools should be used for the population for which they were developed. For example, the Accountable Community Health tool can be given to a child's caretaker.

As new tools are added, OHA will notify CCOs through the Metrics Technical Advisory Group (TAG) listserv. To be added to the TAG listserv, please email Metrics.Questions@odhsoha.oregon.gov.

Annual review of new screening tools

CCOs may submit screening tools not currently on the OHA-approved screening tool list for review annually. Two types of reviews may be conducted through this process: 1) exemption to use the tool for a limited group of providers and community partners and 2) addition to the statewide approved SDOH screening tool list. For more detail, see Appendix 2: Social Needs Screening Tools Process of the measure technical specifications on the CCO Metrics Program Resources website.

The deadline for submitting additional tools for approval is June 30 and will apply to the next measurement year. For example, the tool submission deadline for 2025 is June 30, 2024.

Start the exemption request process 

If you have questions or comments about the updated list or need support with the exemption request process, please email Metrics.Questions@odhsoha.oregon.gov  

OHA-approved social needs screening tools (2024)