General Financial Hardship & Unemployment

COVID-related concerns:

  1. General financial hardship is impacted by, and in turn affects, each of the vulnerable groups noted above, exacerbated significantly by the virus and the measures taken by local and state governments to combat it

  2. We can expect significant increases in anxiety, depression, and likely suicide attempts and self-harming behaviors, in light of the increased financial burdens on individuals and families

General principles about screening for financial needs and unemployment:

  1. Questions about financial resource strain often produce a high false positive rate, as individuals and families at all incomes experience stress around money.

  2. The questions below provide a more targeted focus on health care access and poverty and are adapted from the Behavioral Risk Factor Survey, a validated questionnaire.

Scripts for Providers:

  1. Sometimes people find that their income does not quite cover their living costs. In the last 12 months, has this happened to you?

  2. During the last four weeks, have you been actively looking for work?

  3. What was your main activity during most of the last 12 months? Worked for pay, attended school, household duties, unemployed, permanently unable to work, other?

  4. In the last 12 months, did you skip medications to save money?


  1. If you are at U of M, contact the Social Worker serving your clinic and/or Department.

  2. Washtenaw County has several assistance program, including emergency financial aid. These resources are listed here:

Other Suggestions and Resources:

  1. Financial assistance information for military families:

  2. Information on unemployment insurance relief during/after COVID:

  3. Michigan Dept of Labor & Economic Activity assistance for low-income Michiganders:,5863,7-336-78421_97193_98753---,00.html

Food Insecurity

COVID-related concerns:

  1. Food insecurity and hunger are likely to persist long after the virus is controlled medically, as the stressors of financial hardship, social distancing, and school closures linger

  2. Additional illnesses and mental health problems related to hunger and poor nutrition are likely to rise, particularly among vulnerable individuals like children and seniors

  3. Federal and state assistance programs will require significant increases in funding to continue to provide for those in need, with possible lapses in such resources

General principles about screening for food insecurity:

  1. Providers across health care settings are screening patients for food insecurity, a practice recommended by numerous professional societies.

  2. Many screening interventions use the Hunger Vital Sign™, and are increasingly being incorporated into electronic medical record systems.

Scripts for Providers:

  1. I’m going to read you two statements that people have made about their food situation. For each statement, please tell me whether the statement was often true, sometimes true, or never true for your household in the last 12 months:

  2. “We worried whether our food would run out before we got money to buy more.” Was that often true, sometimes true, or never true for your household in the last 12 months?

  3. “The food we bought just didn’t last, and we didn’t have money to get more.” Was that often true, sometimes true, or never true for your household in the last 12 months?

  4. A response of “often true” or “sometimes true” to either question = positive screen for Food Insecurity.


  1. If you are at U of M, contact the Social Worker serving your clinic and/or Department.

  2. Washtenaw County has several food resources. You can provide your patient the following resource guide:

  3. Michigan Department of Health and Human Services Family Well-Being Guide:

Other Suggestions and Resources:

Housing Insecurity

COVID-related concerns:

  1. Housing instability, homelessness, and financial hardship are likely to persist after the virus is controlled medically

  2. Physical and mental health problems related to unstable housing and unsafe environments are likely to increase

General principles about screening for housing insecurity (adapted from Klein &Reddy 2015):

  1. Medical providers should devote significant attention to building rapport with homeless patients by expressing compassion through empathetic listening.

  2. Directly asking “Are you homeless?” does not effectively identify homelessness. People without homes may not identify themselves as “homeless” due to stigma, shame, or the thought that a temporary and tenuous living arrangement is “home.”

  3. There are many vulnerable subpopulations of homeless persons who may require targeted interventions.

Scripts for Providers:

  1. Where did you stay last night? How long have you stayed in the place you stayed last night? Are you able to stay in this housing for more than 90 days?

  2. Are you worried or concerned that in the next two months you may NOT have stable housing that you own, rent, or stay in as part of a household?

  3. Right now are you receiving help related to your housing needs from any other agency?


  1. If you are at U of M, contact the Social Worker serving your clinic and/or Department.

  2. Washtenaw County has several resources. They are listed on this site:

Other Suggestions and Resources:

Access to Critical Utilities

COVID-related concerns:

  1. Premorbid, underlying health conditions could be exacerbated by limited access to critical services like clean water and consistent electricity

  2. Households most vulnerable to poor water access will likely be at higher risk for continued infection with Covid-19

  3. Individuals not already connected with mental health care may require referrals, and frontline providers such as internists, family medicine practitioners, and OBGYNs may need to provide screening measures for mental illness and/or initial mental health care

General principles about screening for social needs, including access to critical utilities:

  1. Understanding a patient’s social needs can be challenging: your patients may not speak or read English well, or they may be concerned about divulging sensitive information such as immigration status.

  2. Patients may have previously had negative experiences in attempting to address their social needs.

Scripts for Providers:

  1. In the past year, has the utility company shut off your service for not paying your bills?

  2. Do you have trouble paying your heating bill for the winter?

  3. Since [name of current month] of last year, were there any days that your home was not heated because you couldn’t pay the bills?


  1. If you are at U of M, contact the Social Worker serving your clinic and/or Department.

  2. Washtenaw County has several resources for utility assistance. You can give your patient this information:

Other Suggestions and Resources:


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  • How will people react to the new financial crisis?