Thank you for taking the Social Determinants Assessment. The purpose of this assessment is to help identify areas where you need assistance as well as help your Navigator determine how they can best help you secure the necessary resources and services to make your transition a success.
Please answer each question with respect to how often you feel your specific needs are being met in the past 30 days.
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Thank you for completing the Social Determinants Assessment. The purpose of this assessment is to help identify areas where you need assistance as well as help your Navigator determine how they can best help you secure the necessary resources and services to make your transition a success.
Your results for this assessment have been sent to the email address you registered with on PRISM. As we stated earlier, the information learned from this assessment is yours to share.
We advise you to forward this email to your Navigator. If you are uncomfortable forwarding this email, please be as open as possible with your Navigator about what you learned from this assessment.
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Question 1 of 19
1. Question
With respect to my health, in the past month how often have you felt your Physical Needs are being met?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 2 of 19
2. Question
With respect to my health, in the past month how often have you felt your mental health needs are being met?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 3 of 19
3. Question
With respect to my health, in the past month how often have you felt your nutritional needs are being met?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 4 of 19
4. Question
With respect to my health, in the past month how often have you found time for leisure and recreational activities?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 5 of 19
5. Question
With Respect to your Physical environment, in the past month how often have you felt safe?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 6 of 19
6. Question
With Respect to your Physical environment, In the past month my housing “needs” are being met?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 7 of 19
7. Question
With Respect to your Physical environment, In the past month my housing “goals” are being met?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 8 of 19
8. Question
With Respect to your Physical environment, In the past month my transportation “needs” are being met?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 9 of 19
9. Question
With Respect to your Economic Stability, In the past month I feel satisfied with my employment?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 10 of 19
10. Question
With Respect to your Economic Stability, In the past month I can meet my financial obligations?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 11 of 19
11. Question
With Respect to your Economic Stability, In the past month my dependent or elder care needs are being met?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 12 of 19
12. Question
With Respect to your Social Connections, In the past month I have family support?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 13 of 19
13. Question
With respect to your social connections, In the past month I have social support?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 14 of 19
14. Question
With respect to your social connections, In the past month I have community/cultural/spiritual support?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 15 of 19
15. Question
With Respect to your education In the past two weeks my education goals are being met?
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 16 of 19
16. Question
With respect to education, within the past two weeks I have access to educational, training, and development opportunities.
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 17 of 19
17. Question
With respect to my legal needs, within the past two weeks I have the legal support I need.
Never[1], Rarely [2], Sometimes [3], Often [4], Always [5]
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Never Always
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Question 18 of 19
18. Question
Have you applied for Military/Veteran benefits?
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Yes No
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Question 19 of 19
19. Question
Have you enrolled in the Veterans Health Administration?
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Yes No
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