SDH Screen Youth (18 and Under)

SDH Screen Youth (18 and Under)

SDH Screen Youth (18 and Under)

Social Determinants of Health Screening (Youth)

Health starts in our homes, schools, and jobs. When we know more about you, we can provide better care to support your health and wellness.
1. How hard is it for you to pay for the very basics like food, housing, heating, medical care, and medications?
2. What is your living situation today? (Check one)
3. Think about the place you live. Do you have problems with any of the following? (Check all that apply)
4. In the past 12 months, has lack of transportation kept you from medical appointments, meetings, work or from getting things needed for daily living? (Check all that apply)
5. How often do you see or talk to people that you care about and feel close to? (For example: talking to friends on phone, visiting friends or family, going to church or club meetings)


6. If you marked somewhat or very hard on the first question of this survey, please check all that are hard to pay for.


Some people have made the following statements about their food situation. Please answer whether the statements were OFTEN, SOMETIMES, or NEVER true for you and your household in the last 12 months.
7. Within the past 12 months, you worried that your food would run out before you got money to buy more?
8. Within the past 12 months, the food you bought just didn’t last and you didn’t have money to get more?


9. In the past 12 months has the electric, gas, oil, or water company threatened to shut off services in your home?




Stress means a situation in which a person feels tense, restless, nervous, or anxious, or is unable to sleep at night because his or her mind is troubled all the time.
12. Do you feel these kinds of stress these days?


13. How often do you feel lonely or isolated from those around you?
14. Do you have someone you could call if you needed help?


Because violence and abuse happen to a lot of people and affects their health, we are asking the following questions.
15. How often does anyone, including family and friends, physically hurt you?
16. How often does anyone, including family and friends, insult or talk down to you?
17. How often does anyone, including family and friends, threaten you with harm?
18. How often does anyone, including family and friends, scream or curse at you?


19. Are you currently employed?
IF YES: What is your current work situation?
Are you having any problems with your boss?
IF NO: Are you seeking work?
Would you like help finding a job?
Would you like to be connected to job training resources?
Would you like information about language classes or other educational opportunities?
20. Would you like assistance with any of the following (check all that apply)?
IF YES: How would you like to be contacted?