New Healthy Lives 5 Axis Scale Validated for People with Complex Health and Social Needs
Peer-reviewed study published in BMC Health Services Research demonstrates scale’s reliability, validity, and ease of use
(Brookline, MA) — The Brookline Center for Community Mental Health is pleased to announce the publication and validation of the Healthy Lives 5 Axis Scale (HL-5), a concise, multidimensional tool designed to help providers better assess and support individuals living with complex health and social challenges.
Published in BMC Health Services Research, the peer-reviewed study confirms the HL-5’s high levels of reliability and strong validity, filling a critical gap in the field of complex care management. While the field has grown rapidly in response to patients with urgent and overlapping medical, behavioral, and social needs, most existing measures were not designed for clinical settings serving these populations.
“Until now, there has been no practical tool that captures the realities of complexity in a way that clinical providers can actually use,” said Henry White, MD, Senior Innovation Advisor at The Brookline Center. “The Healthy Lives 5 Axis Scale bridges that gap. It takes a few minutes to complete, yielding actionable results that inform treatment planning, track progress, and ultimately help people build healthier, more stable lives.”
The HL-5 measures five key domains that together capture the multifaceted realities of complex care: health-related functioning, physical and social needs, capacity for self-care, access, and utilization. The study found that the HL-5 demonstrated very strong test–retest reliability with scores above 0.8 for four domains and above 0.75 for the fifth, and strong, statistically significant correlations with well-established measures of health and social needs.
Unlike many existing models that rely on a linear cause-and-effect framework, the HL-5 reflects the dynamic, interconnected factors that drive complexity—from chronic health conditions and social determinants to barriers in access and self-management. Developed with support from the Blue Cross Blue Shield of Massachusetts Foundation and Bowdoin Street Health Center, and in partnership with Beth Israel Deaconess Medical Center, the HL-5 was tested with adults in an urban community health setting.
Since the launch of the Healthy Lives program in 2010, the Center has helped hundreds of individuals manage serious medical, behavioral, and social-environmental challenges through integrated, person-centered care. The program has achieved remarkable results, including a 35% reduction in emergency department use and improved management of chronic conditions such as diabetes.
The full open access article can be viewed here: https://bmchealthservres.biomedcentral.com/articles/10.1186/s12913-025-13069-x
The Brookline Center invites healthcare providers, community health centers, and care management teams nationwide to explore the HL-5 and incorporate it into their own practices. If you are interested in learning more, please contact Dr. White at HenryWhite@BrooklineCenter.org