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Housing Instability and Homelessness is the second of three Social Determinants of Health (SDOH) domains the Gravity Project will address during Phase 1 work.  

Community Homework


Housing Instability and Homelessness Data Elements



Click here to download the draft Housing Instability and Homelessness Master List (updated 07/27/20).
Click here to download the Housing Instability and Homelessness Screening Summary (updated 06/19/20).

  • To submit end-to-end review comments via the Master List or Summary spreadsheet:


    1. Download the Housing Instability Master List or the Housing Instability and Homelessness Screening Summary (see document links directly above these instructions).
    2. Do a "Save As" to your name and organization to the file name (example:  j_smith_ABCHealth_housing insecurity screening summary.xlsx)
      1. For data elements currently ON the Master List
        1. Include data element ID # and reason(s) you do not feel the element is appropriate for Housing Instability and Homelessness.
      2. For data elements NOT ON the Master List
        1. Indicate the data element type you would like to propose. (Screening, Diagnosis, Goal, Intervention)
        2. Include a description for the data element you propose.
        3. For a screening element, attach a copy or link to the screening tool.
    3. Email the spreadsheet with all comments regarding data elements to gravityproject@emiadvisors.net


  • To submit end-to-end review comments via email or text document:


    1. Draft all your comments in the body of an email or in a Word document that can be attached.
      1. For data elements currently ON the Master List
        1. Include data element ID # and reason(s) you do not feel the element is appropriate for Housing Instability and Homelessness.
      2. For data elements NOT ON the Master List
        1. Submit the data element type (Screening, Diagnosis, Goal, Intervention).
        2. Include a description for the data element you propose.
        3. For a screening element, attach a copy or link to the screening tool.
    2. Email all comments (with attachment, if applicable) regarding data elements to gravityproject@emiadvisors.net

Adjudicated Data Element Submission Statistics

Below is a list of how many of each housing instability data element type has been adjudicated as of the date listed.

Date

Screening Tool/Questions

Diagnosis/Needs

Goals

Interventions

Total

11JUN2029 tools / 360 questions151474103
28MAY2029 tools / 360 questions15107499
14MAY2029 tools / 360 questions15107499
30APR2024 tools / 330 questions964156
16APR2016 tools / 212 questions544150
02APR2014 tools / 207 questions513844
19MAR2014 tools / 45 questions503843

Interventions Framework


This is an updated draft (07 July 2020) of the framework for intervention data element concepts.  Thank you to everyone who submitted comments to help with this version!

Gravity TermGravity Definition Issues/Suggestions 
Referral

A type of order wherein clinicians/providers request services and/or assessment from other professionals and/or programs.

The act of clinicians/providers sending or directing a patient to professionals and/or programs for services (e.g., evaluation, treatment, aid, information, etc.)

Evaluation/ Assessment

The process of both provider clinical observation and interpretation, and the application of assessment tools.  In both activities the aim is to arrive at outcomes that define the status of the patient in order to guide further care.

Determination of a value, conclusion, or inference by evaluating evidence.

 

Evaluation of eligibility (for <x>)

Subtype of Evaluation

Used to mark the activities prior to determination of eligibility.

(Crucial for federal assistance programs).

Suggestion: Process of determining eligibility by evaluating evidence

Assistance/ Assisting

Non-clinical aid with the tasks of care such as applications and setting up appointments

To give support or aid to; help

Counseling

Psychosocial procedure that involves listening, reflecting, etc. to facilitate recognition of course of action / solution.

Psychosocial procedure that involves listening, reflecting, etc. to facilitate recognition of course of action / solution.

Education

Procedure that is synonymous with those activities such as teaching, demonstration, instruction, explanation, and advice that aims to increase knowledge and skills, change behaviors, assist coping

Procedure that is synonymous with those activities such as teaching, demonstration, instruction, explanation, and advice that aim to increase knowledge and skills.

Provision

Covers any concrete support that is able to be given to the patient directly at the point of service

To supply/make available for use

Coordination

Organizing activities and sharing information

Process of organizing activities and sharing information to improve effectiveness

Screening Tools


Screening Tool

Description

Source(s)

Accountable Health Communities (AHC)This is a Center for Medicare & Medicaid Innovation (CMMI) pilot.https://innovation.cms.gov/Files/worksheets/ahcm-screeningtool.pdf
American Academy of Family Physicians Social Needs Screening ToolThis is tool is part of the EveryONE Project toolkit.  The EveryONE Project offers a collection of tools and resources to use at the point of care to tackle your patients' social determinants of health.https://www.aafp.org/dam/AAFP/documents/patient_care/everyone_project/hops19-physician-form-sdoh.pdf
Children's HealthWatch (CHW) Housing Instability Vital Sign

Children’s HealthWatch has defined a scale of housing security in order to understand better the challenges and consequences of hidden homelessness.

http://www.rootcausecoalition.org/wp-content/uploads/2017/10/Childrens-HealthWatch-Root-Cause-Presentation-1.pdf
Protocol for Responding to and Assessing Patients’ Assets, Risks, and Experiences (PRAPARE) Implementation and Action ToolkitPRAPARE is a national effort to help health centers and other providers collect and apply the data they need to better understand their patients’ social determinants of health, transform care to meet the needs of their patients, and ultimately improve health and reduce costs. PRAPARE is both a standardized patient risk assessment tool as well as a process and collection of resources to identify and act on the social determinants of health. The PRAPARE Implementation and Action Toolkit is designed to provide interested users with the resources, best practices, and lessons learned to guide implementation, data collection, and responses to social determinant needs.

http://www.nachc.org/research-and-data/prapare/toolkit/

LOINC Panel:  https://loinc.org/93025-5/

LOINC Questions:  https://loinc.org/71802-3/

VA HOMELESS

To improve VA’s ability to identify Veterans who are at risk of homelessness—or experiencing homelessness but not accessing services—the VA National Center on Homelessness Among Veterans, in collaboration with the VA National Clinical Reminders Committee, developed a two-stage Homelessness Screening Clinical Reminder (HSCR) to conduct an ongoing, universal screen for homelessness and risk among Veterans accessing healthcare services.

https://www.va.gov/HOMELESS/Universal_Screener_to_Identify_Veterans_Experiencing_Housing_Instability_2014.pdf

Well RX

Addressing Social Determinants of Health in a Clinic Setting: The WellRx Pilot in Albuquerque, New Mexico

https://www.jabfm.org/content/jabfp/29/3/414.full.pdf

Terminology, Definitions and Resources


Term

Definition or Description

Source(s)

Homeless Management Information System (HMIS) Data StandardsHMIS data standards have been established by the Department of Housing and Urban Development (HUD), the Department of Health and Human Services (HHS), and the Department of Veterans Affairs (VA) to allow for standardization data collection on homeless individuals and families across systems.https://www.hudexchange.info/programs/hmis/hmis-data-standards/
Housing Insecurity Definition

Limited or uncertain access to stable, safe, adequate, and affordable housing and neighborhoods; or the inability to acquire stable, safe, adequate, and affordable housing and neighborhoods in socially acceptable ways.”  (Cox et al. 2017)

https://papers.ssrn.com/sol3/papers.cfm?abstract_id=2817626


Housing Instability Definition

The Healthy People 2020 Social Determinants of Health topic area is organized into 5 place-based domains:

  1. Economic Stability
  2. Education
  3. Health and Health Care
  4. Neighborhood and Built Environment
  5. Social and Community Context

Housing Instability is a key issue in the Economic Stability domain.

https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-health/interventions-resources/housing-instability

HUD's Definition of Homelessness: Resources and Guidance

This listserv reviews existing resources related to HUD’s definition of homelessness and provides important reminders when documenting someone’s homeless status. Additionally, it announces the availability of a new resource to help intake workers document someone’s homeless status.

https://www.hudexchange.info/news/huds-definition-of-homelessness-resources-and-guidance/
Road Map to a Unified Measure for Housing InsecurityThis article discusses the evolution of the concept and measurement of housing insecurity. Our survey of the literature uncovers that multiple terms and definitions are used to describe housing insecurity.https://www.huduser.gov/portal/periodicals/cityscpe/vol21num2/article5.html
Unstable Housing and Caregiver and Child Health in Renter FamiliesAn evaluation of how 3 forms of housing instability relate to caregiver and child health among low-income renter households.https://childrenshealthwatch.org/unstable-housing-and-caregiver-and-child-health-in-renter-families/

Data Element Concept Leads



Role

Name

Organization

Value Set Subject Matter Expert

Linda Hyde

EMI Advisors, LLC
Technical DirectorLisa NelsonMaxMD

SDOH Clinical Informatics Lead

Sarah DeSilvey

SIREN

SDOH Policy Lead

Mark SavageSIREN
Domain Subject Matter ExpertMegan Sandel, MD, MPHChildren's HealthWatch
Domain Subject Matter ExpertAllison Bovell-Ammon MDivChildren's HealthWatch
Domain Subject Matter ExpertRichard Sheward, MPPChildren's HealthWatch
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