Screening Questions
Provider Identification of Socio-Economic and Environmental Barriers to Child’s Health - IHELLP*
"I am now going to ask you a few questions about your family and home. I ask these questions to all families to help me better understand issues that might affect a child's health."
INCOME
Do you and/or your spouse work outside of the home? What type of work?
Who takes care of your child/children during the day?
Do you ever have trouble making ends meet?
Do you ever have trouble paying rent or buying food, or paying electricity, heat, or telephone bills?
Do you have a stove? Do you have a refrigerator?
Do you ever have to take time off work because of your child’s health?
Is anyone in your family uninsured?
Do you get Food Stamps, WIC, Social Security, TANF, etc?
Do you need help accessing benefits or services for your family?
What is your primary mode of transportation?
HOUSING
Where do you live?
Is that an apartment or a house? How many bedrooms?
Do you rent or own?
How long have you lived there?
Who lives in this home?
Is your housing ever a problem for you?
Is there anything else about the home that you are worried might worsen your child’s health like dust, mold, chemicals, poor plumbing or
heating?
Do you know if your child might be exposed to lead – for example, lead is found in old paint, old plumbing and some home remedies? Does anyone who lives in your home smoke?
Is there anyone in your home that you worry might have a problem with alcohol or other drugs?
EDUCATION
Is your child in Head Start, preschool or other early childhood enrichment?
How is your child doing in school?
Do you have any concerns about school performance or behavior?
Is your child getting the help he/she needs to learn?
Is violence at school a concern?
LEGAL STATUS
Do you have any questions about your immigration status?
LITERACY
Do you read to your child every night?
How happy are you with how you read?
PERSONAL SAFETY
Do you feel safe in your home? Do you feel safe in your neighborhood?
Is violence at home a concern?
How do you and your partner work out arguments?
How is your partner treating you and the children?
Do you feel safe in your current relationship?
Have you or anyone who lives with you ever been threatened or hurt by a family member or partner?
At end of visit to help elicit financial, cultural or other barriers to fulfilling plan: “Is there anything in our plan that you don't think you can carry out for any reason? I ask because we can always change the plan.”
* Kenyon C, Sandel M, Silverstein M, Shakir A et al. Revisiting the Social History for Child Health. Pediatrics 2007; 120(3):e734-e738.
INCOME
Do you and/or your spouse work outside of the home? What type of work?
Who takes care of your child/children during the day?
Do you ever have trouble making ends meet?
Do you ever have trouble paying rent or buying food, or paying electricity, heat, or telephone bills?
Do you have a stove? Do you have a refrigerator?
Do you ever have to take time off work because of your child’s health?
Is anyone in your family uninsured?
Do you get Food Stamps, WIC, Social Security, TANF, etc?
Do you need help accessing benefits or services for your family?
What is your primary mode of transportation?
HOUSING
Where do you live?
Is that an apartment or a house? How many bedrooms?
Do you rent or own?
How long have you lived there?
Who lives in this home?
Is your housing ever a problem for you?
Is there anything else about the home that you are worried might worsen your child’s health like dust, mold, chemicals, poor plumbing or
heating?
Do you know if your child might be exposed to lead – for example, lead is found in old paint, old plumbing and some home remedies? Does anyone who lives in your home smoke?
Is there anyone in your home that you worry might have a problem with alcohol or other drugs?
EDUCATION
Is your child in Head Start, preschool or other early childhood enrichment?
How is your child doing in school?
Do you have any concerns about school performance or behavior?
Is your child getting the help he/she needs to learn?
Is violence at school a concern?
LEGAL STATUS
Do you have any questions about your immigration status?
LITERACY
Do you read to your child every night?
How happy are you with how you read?
PERSONAL SAFETY
Do you feel safe in your home? Do you feel safe in your neighborhood?
Is violence at home a concern?
How do you and your partner work out arguments?
How is your partner treating you and the children?
Do you feel safe in your current relationship?
Have you or anyone who lives with you ever been threatened or hurt by a family member or partner?
At end of visit to help elicit financial, cultural or other barriers to fulfilling plan: “Is there anything in our plan that you don't think you can carry out for any reason? I ask because we can always change the plan.”
* Kenyon C, Sandel M, Silverstein M, Shakir A et al. Revisiting the Social History for Child Health. Pediatrics 2007; 120(3):e734-e738.
