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Health Related Needs Resource Hub

NCFH has created the Health Related Needs Resource Hub to increase awareness and knowledge of commonly used screening tools and to identify the health related needs that impact the Agricultural Worker population across the country.

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Health related needs are conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and life outcomes and risks (Healthy People, 2030). 

 

Health related needs can be grouped into 5 domains: Education Access and Quality, Health Care and Quality, Neighborhood and Built Environment, Social and Community Context, and Economic Stability. Click on each tab below to view health related need resources per Domain.

The Health Related Needs Resource Hub provides health centers (HCs) access to available screening tools, educational materials such as guides, fact sheets, infographics, videos and other resources related to the health related needs that affect people’s health, to assist staff efforts in screening, documenting, and addressing health related needs impacting the ag worker population. This Hub also features screening tools and resources shared and discussed with participant HCs from NCFH’s IAC Plus Learning Collaborative (IAC PLUS LC), a HRSA supported collaboration intended to increase knowledge about health related needs factors impacting the health care, access, and health status of the ag worker population. 

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Education Access and Quality

The connection of Education to health and wellbeing.

Childhood Education and Development

English as a Second Language Proficiency

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Health Care and Quality

The connection between people’s access to and understanding of health services and their own health.

Access to Health Care

  • Guide for Patient Self-Management of Chronic Illness through “Tele-education” a tool developed by NCFH to support Health Centers in assessing participants’ readiness for tele-education, providing an overview of WhatsApp® and its features to improve patient self-management of chronic illnesses, and aiding in training participants while enhancing engagement and communication with providers.
  • Financial Responsibility Tool for Health Centers: a brochure developed by NCFH that provides information about the billing and payment process. It explains what patients may have to pay for health care services and how they can pay.  

Access to Primary Care

Resources for Limited English Proficient Speakers

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Neighborhood and Built Environment

The connection between where a person lives – housing, neighborhood, and environment – and their health and well-being.

Access to Healthy Food

Crime and Violence

Quality of Housing

Workplace Conditions

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Social and Community Context

​The connection between characteristics of the contexts within which people live, learn, work, and play, and their health and wellbeing.

Civic Participation

Incarceration

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Economic Stability

employment

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Poverty

Lorem Ipsum is simply dummy text of the printing and typesetting industry. Lorem Ipsum has been the industry’s standard dummy text ever since the 1500s, when an unknown printer took a galley of type and scrambled it to make a type specimen book. It has survived not only five centuries, but also the leap into electronic typesetting, remaining essentially unchanged. It was popularised in the 1960s with the release of Letraset sheets containing Lorem Ipsum passages, and more recently with desktop publishing software like Aldus PageMaker including

Health Related Needs Screening Tools and Resources

Screening for health related needs can help identify population needs and who may benefit from resources and efforts to improve health outcomes.

This list contains screening tools and other resources, screening tools are denoted with an (*) asterisk  for easy identification.

NCFH

NCFH has developed 3 tools to help health centers assess health related needs for MSAW populations and navigate health resources.

NACHC, AAPCHO, OPCA

Association of Asian Pacific Community Health Organizations (AAPCHO), and Oregon Primary Care Association (OPCA) developed this screening tool as a national effort to help health centers and other providers collect the data needed to better understand and act on their patients’ health related needs.

CENTERS FOR MEDICARE & MEDICAID SERVICES (CMS)
  • (*) Accountable Health Communities Screening Tool : a tool to assess patients’ needs on housing, food security, transportation, and economic stability used to inform treatment plans and make referrals to community services.
  • USING Z CODES: The Health Related Needs Data Journey to Better Outcomes: This infographic describes the journey that health related needs data takes from the individual through the health system to data reporting as ICD-10-CM Z codes. It discusses data collection, documentation, coding and reporting and contains resources to help implement programs to collect and report health related needs data in a manner that can lead to better health outcomes for individuals.
EVERYONE PROJECT BY AMERICAN ACADEMY OF FAMILY PHYSICIANS (AAFP)
  • (*) Health Related Needs Screening Tool: a questionnaire for screening core health-related social needs, which include housing, food, transportation, utilities, and personal safety, using validated screening questions.
    • Guide to Social Screening: a guide outlining the importance of screening for health related needs and the rationale for the questions included in the screening forms.
    • Neighborhood Navigator: a website that allows users to search by zip code for resources and programs in their neighborhood to address health related needs. It provides information on food, housing, goods, transportation, health, care, education, employment, and more.
    • Action Plan: a quick form to guide a discussion with your patients about their health related needs and document a plan to address them. The form is available in seven languages.
HEALTH BEGINS
BOSTON MEDICAL CENTER
  • (*)WE CARE Survey: an instrument designed to identify health related needs using self-report and a family-centered approach to determine a family’s need for assistance.
HEALTH LEADS
LOINC
  • (*) WellRx Questionnaire: a questionnaire form to assess economic stability, education, neighborhood and physical environment, and food.
CORPORATION OF SUPPORTIVE HOUSING (CSH)

AMERICAN HOSPITAL ASSOCIATION

AVAILABLE NATIONAL SERVICES FOR HEALTH RELATED NEEDS

Aunt Bertha (Findhelp): https://www.findhelp.org/

  • Find food assistance, help paying bills, and other free or reduced cost programs in the United States.

211: https://www.211.org/

  • The 211 network in the United States responds to more than 14 million requests for help every year. Most calls, web chats, and text messages are from people looking for help meeting basic needs like housing, food, transportation, and health care.

AAFP Neighborhood Navigator: https://navigator.aafp.org/

  • A tool to enable patients to locate services that meet their health related needs on their own. Neighborhood Navigator, which is powered by Aunt Bertha, is equipped to accommodate more than 100 languages and is integrated with Google Maps to offer users step-by-step directions to community resources.

Cap4Kids: https://cap4kids.org

  • CAP4Kids (The Children’s Advocacy Project) was developed in 2005 as a way for healthcare providers, social workers, child advocates and parents and teens to find reliable, up-to-date information on community resources to help improve and enhance the lives of children and families.

Feeding America: https://www.feedingamerica.org

  • The Feeding America network is the nation’s largest domestic hunger-relief organization, working to connect people with food and end hunger. Donors, staff, and volunteers all play an important role in our efforts to end hunger in the United States.

Supplemental Nutrition Assistance Program: https://www.fns.usda.gov/snap

  • SNAP provides nutrition benefits to supplement the food budget of needy families so they can purchase healthy food and move towards self-sufficiency.

Special Supplemental Nutrition Program for Women, Infants, and Children (WIC): https://www.fns.usda.gov/wic

  • The Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) provides federal grants to states for supplemental foods, health care referrals, and nutrition education for low-income pregnant, breastfeeding, and non-breastfeeding postpartum women, and to infants and children up to age five who are found to be at nutritional risk.

Public Housing and Voucher Program: https://www.hud.gov/topics/rental_assistance

  • Public housing was established to provide decent and safe rental housing for eligible low-income families, the elderly, and persons with disabilities. Public housing comes in all sizes and types, from scattered single-family houses to high rise apartments for elderly families. There are approximately 1.2 million households living in public housing units, managed by some 3300 PHAs.

    The housing choice voucher program is the federal government’s major program for assisting very low-income families, the elderly, and the disabled to afford decent, safe, and sanitary housing in the private market. Since housing assistance is provided on behalf of the family or individual, participants are able to find their own housing, including single-family homes, townhouses and apartments.

Benefit Finder questionnaire: https://www.benefits.gov/

  • The official benefits website of the U.S. government and includes information for citizens to identify benefits that they may be eligible to receive, and application information. Benefits address a variety of needs including food/nutrition, health care, housing and utilities, childcare, and tax assistance.

1Degree: https://www.1degree.org/

  • Free online tools to help you find low-cost or free resources in a variety of locations across the United States: Nine counties of the Bay Area, Los Angeles County, Southwest New Mexico (Grant, Hidalgo, and Catron Counties), Summit County Colorado, Detroit, Michigan, Gainesville, Florida and New York City, New York.

NowPow: https://www.nowpow.com/

  • NowPow is a personalized community referral platform for every need and every person. We build community referral networks that promote meaningful partnerships, drive impact, and data to bridge gaps in community care.
National Center for Farmworker Health
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