Health Practices: Rate independent self-care for physical and mental health, including managing moods, medications, illness management

Evidence of danger to self/others; No self-care; evidence of breaks in reality; requires pervasive interventions (e.g., multiple or lengthy stays in crisis, jail).

Marked limitations in self-care and may have physical complications; extensive help for very severe mental impairments; concern for danger to self/others.

Limited self-care and compliance; serious impairments in moods, symptoms, mental status; maybe physical issues promoting continuous help for health care.

Marginal self-care and compliance with health issues or prescriptions; managing moods is moderate problem; requires scheduled low level mental health assistance.

Moderately self-sufficient; manages moods but relies on some routine assistance or home visits by helping persons; in private or self-help residences.

Independent self-care, compliant with treatment, meds; minimal support- some assistance from family, friends, other helping persons.

Optimally independent in taking care of physical and mental status; makes good health care decisions; no assistance needed in self care.

Housing Maintenance: Rate self-sufficiency for living independent, maintaining/getting along in residence, management of household.

Health endangering threat; needs or relies on pervasive supervision in protective environment; dependent - does not manage household, not self-sufficient.

Marked limitations in keeping or maintaining stable housing e.g., sometimes on street, needs or uses constant assistance, likely in 24/7 supported or protective residences.

Dysfunctional in community housing; unstable; Limited self-sufficiency e.g., relies on respite, assistance, private or self-help home, may occasionally help in household maintenance.

Stable community housing but housing may be inadequate or s/he may be only marginally self-sufficient e.g., relies on regular assistance to maintain stable household.

Moderately self-sufficient in independent, private residence with routine, low level assistance e.g., home visits by helping persons; mostly maintains household by self.

Adequate independence: self-sufficient with minimal assistance in community based, independent housing e.g. intermittent support from family, friends, others.

Optimal independence: Self-sufficient in community based, independent living with no significant assistance or public support in housing.

Communication: Rate ongoing and effective verbal/ nonverbal communication.

Not effective: high risk threats or non-communicative; pervasive dependence.

Communication is dysfunctional, blunted, or antagonistic with others; dependent on assistance.

Limited verbal or nonverbal effectiveness in communicating with others & may rely on assistance.

Not clear about problems; marginal effectiveness in communicating with others; uses regular assistance.

Moderately effective in communicating with others; using routine assistance.

Adequately effective in communicating with others; minimal need for assistance.

Optimal effectiveness in communicating with others; no significant assistance needed..

Safety: Rate maintenance of personal safety, e.g. not suicidal, homicidal, etc.)

Unsafe; Imminent danger to self or others; needs or requires pervasive level of continuous supervision.

Marked limitations in safety around home, community; needs/has extensive level of continuous supervision.

Makes unsafe decisions; "at risk" e.g., abusive or abused, cognitive limitations, needs supervision.

Marginally safe, aware and self-protective, benefits from regular assistance or monitoring.

Moderately safe; good decisions; benefits from routine care-givers e.g., home visits by helping persons.

Safe decisions; Adequate self-protection with minimal assistance from family, neighbors, friends, and others.

Optimally safe; alert; takes care of self with no significant assistance from others.

Managing Time: Rate management of time, self-direction (e.g., a 7 = optimal sleep 7-9 hours average/night)

High risk; aberrant routines or MIA (missing); No management of time; pervasive direction of others.

Marked limitations in routine time management; needs or receives extensive direction by others.

Limited e.g., poor routine management of meds, sleep, mealtimes; might need/use constant direction.

Marginally effective; disruptions in routines; uses regular direction (e.g., prompts).

Moderately effective time management; benefits from routine direction of others.

Adequate time management; minimal prompts or reliance on direction of others.

Optimal routines for health and wellness; self-directive in managing sleep, meds, mealtimes.

Managing Money: Rate independent management of personal finances.

No income and no involvement in managing personal or public assisted finances; total dependence on public or institutional help.

Marked limitations in management of personal finances; often involves rep payees or total supervision; very limited money; minimal participation in spending or managing money.

Requires help to seek/manage public financial assistance (may have rep payee for rent); dependent or minimal participation in managing personal finances.

Marginally independent in managing personal income, benefits or public assisted finances; often uses help; moderately participates in paying day-to-day rent and expenses.

Moderately independent in managing personal finance (minimum public assistance); minimal, intermittent assistance from others; significant participation in managing money.

Adequately independent in managing independent, personal finances with minimal checks and balances or assistance of others.

Optimal independence in managing independent and personal finances.

Nutrition: Rate current report of consuming basic diet supporting prescription medications; WNL = independently shops, plans, cooks for nutritional needs. Rate independent management of nutritional needs. (*At least 2 meals/day.)

High risk dietary concerns; Does not manage nutritional needs; no participation in meal planning, shopping and preparation.

Very severe dietary limitations; substantial dependence on continuous assistance, often involves constant supervision; no nutritional meal plans, preparation.

Serious limitations; needs or depends on continuous assistance from others; may eat what is available, limited participation in meal plans, shopping and preparation.

Marginal independence managing nutritional needs 2x/day; often uses assistance; some participation in meal planning, shopping and preparation.

Moderately independent in meeting nutritional needs 2x/day; benefits from intermittent assistance, but participates in meal planning, shopping and preparation.

Adequately independent in managing nutritional needs with minimal assistance from others in meal planning, shopping and preparation.

Optimal independence in managing nutritional needs with no significant assistance from others needed for meal planning, shopping, and preparation.

Problem Solving: Rate independent management of problems of daily living.

No problem solving; pervasive dependence on others to handle daily living problems; threat of health endangering threat; no participation in problem solving.

Very severe limitations in problem solving, often involving constant supervision; minimal participation in problem solving.

Serious limitations in meeting day-to-day needs, problem solving; often needs or relies on assistance; limited participation in treatment-related problem solving.

Marginally self-sufficient in day to day problem solving; often needs or uses regular assistance, participates in treatment-related problem solving.

Moderately self-sufficient in problem solving with routine assistance from others; compliant in treatment-related decision making.

Adequately self-sufficient in day-to-day problem solving with minimal assistance from others.

Optimal and independent problem solving with no significant assistance from others.

Family Relationships: Rate family interactions (separate from friends) and quality of family relationship.

Dysfunctional relationships or deviant behaviors often leading to physical aggression or severe abuse, withdrawn, often rejected by others.

Very dysfunctional relationships within family (e.g., total withdrawal, unwanted dependency, destructive verbal or physical communication).

Dysfunctional family relationships ; often no positive communication or participation with family or significant others.

Marginally functional family relationships (e.g., relationships are often stressed or infrequent, superficial, unreliable).

Moderately effective continuing and close relationship with at least one family member or significant other.

Adequate personal relationship with one or more family members or with significant other.

Positive relationship with family/significant others; assertively contributes to these relationships.

Alcohol/Drug Use: Rate self-control with addictive drugs including cigarettes; or maintenance of alcohol/drug abstinence

Current abuse or dependence leading to imminent health and safety threats - pervasive substance abuse, no self-control; accepts or denies extremely severe status with substance abuse.

Current abuse or dependence; may deny substance abuse problem, does not participate in treatment; extremely limited self-control for abstinence or safe use.

Current abuse or dependence, acknowledges serious substance abuse problem but shows limited self-control, struggles with treatment plan.

Current moderate problem with use, dependence, compliant with treatment, moderate success over alcohol, cigarettes and drugs.

No current use but recent history of abuse/dependence; adequately aware of risks and seeking help, information, support, treatment to continuously sustain success.

Safe Use, not smoking or Abstinent with self help groups. May have had a history of substance abuse related issue.

No history of substance abuse-related problems and optimal self control with substances

Leisure: Rate independent participation in leisure activities.

Dependent - No independent participation in leisure activities.

Dependent - min. participation in leisure of any kind without help.

Limited interests or independent participation in leisure activities.

Marginally independent leisure activity participation.

Moderately independent leisure activity participation.

Adequately independent in at least one leisure activity.

Community Resources: Rate current independent use of health & social services, shopping, and transportation.

No independent use of community resources; chronic reliance on helpers to gain access OR adamantly refuses necessary help.

Inappropriate dependence OR unable to be independent with community resources, very reliant on helpers.

Does not seek appropriate supports services without help; limited independence with community resources, reliant on help to gain access.

Marginally independent, occasional reliance to gain access to recreational, educational and vocational resources.

Moderately independent in use of community resources, intermittent reliance gaining access.

Adequate independent use of community resources, minimal need for help in gaining access.

Optimal independent use of community resources, no significant need for help in gaining access.

Social Network: Rate quality of interactions with immediate social network (e.g. close friends not family)

Extremely dysfunctional in relationships (e.g., often imminent physical aggression, involves police or severely withdrawn)

Marked limitations in social network relationships (e.g., excessive dependency or destructive behaviors)

Limited interpersonally, often no significant friendships, socially isolated or avoids and withdraws.

Marginal functioning with others (e.g., friendships are often minimal, unreliable, strained).

Moderately effective continuing and close relationship with at least one friend.

Adequate interpersonal relationships with one or more friends.

Positive relationship with one or more friends; optimally independent with assertively contributions.

Sexuality: Rate mental & physical sexual health, sexually safe & appropriate behaviors

Severely dysfunctional, pervasive high risk; danger to self or others prompts continuous protective supervision.

Marked limitations in sexual health & self-care, likely prompts extensive level of protective interventions due to high risk to self or others.

Behaviors indicate limited sexual health self-care; risk concerns may prompt extra care, interventions, even supervision if risks appear imminent.

Marginally sufficient in self-care of sexual health; minimal understanding of personal or others sexual behavior, issues, inhibitions

Moderately sufficient in sexual health and self-care with routinely helpful education, guidance of others as age appropriate.

Adequate self-care around sexual self &health, self respect, asking only expected and minimal guidance from others.

Optimal sexual self-care., self respect and respect for partner, no guidance from others needed.

Productivity: Rate functioning primarily in the most appropriate expected role (e.g., wage earner, homemaker, employee, student).

Productivity severely limited; often unable to work or adapt to homemaking or school; virtually no attempt to be productive.

Occasional attempts at productivity unsuccessful; no routine or structure at home or in day activities.

Limited productivity; often with currently restricted capabilities for school, independent employment and home making.

Marginal productivity with mental distress (e.g. reduced ability to work in sheltered or independent setting.

Moderately functional working in independent job, at home or in school; fluctuates with the limited skills experience.

Adequate functioning; working in independent jobs, home or school; often not applying all available abilities.

Optimally performs employment-related functions, homemaking, or school tasks with ease and efficiency.

Coping skills: Rate knowledge and effective use of coping mechanisms.

Pervasive stresses, no mindful use of coping skills approach health endangering threat, needs/requires pervasive supervision.

Negative use of coping skills often leading to relapse, crises, involving constant interventions, in or out of protective environment.

Ineffective use of few coping skills prompting regular interventions (e.g., extra contacts, frequent use of over-the-counter medications).

Marginally effective knowledge and use of coping mechanisms; seeks assistance to create or initiate coping mechanisms.

Moderately effective range of coping mechanisms, WNL routine reminders, assistance to initiate coping mechanisms.

Effective use of coping mechanisms with only expected, minimal assistance, knows self, acts to reduce stressors and use options to restore confidence.

Optimally effective use of coping mechanisms under various stresses with no significant assistance from others.

Behavioral Norms: Rate extended community, social relationships, interaction within the community, e.g., court involvement rated <=4

Totally isolated from or evidences severely deviant behaviors (i.e., behavior is overtly disruptive or threatening, may involve criminal justice sanctions).

Often isolated or demonstrates deviant behaviors, e.g., rejected or belligerent to helpers, neighbors; may have serious restrictions by courts/parole.

Limited successful and appropriate interactions; minimal survival level interactions or seriously impaired behaviors, e.g., arrested, restricted by courts/parole

Marginally effective interactions; may be compliant with courts/parole; may receive multiple public system supports in accord with multiple needs.

Moderately effective and independent in community interactions; may receive some public support in accord with needs

Adequate positive interactions in resident neighborhood; in one community organization or recreational activity

Independently and Positively interacts in community, church or clubs, recreational activities, hobbies, or personal interests, often with other participants.

Personal Hygiene: Rate independent management of personal hygiene, dental and oral care.

No self care - no personal hygiene; evidence indicates health endangering threat, pervasive needs.

High risk or severe problems with teeth or in self-care, personal hygiene; health endangered.

Limited self-care of teeth, poor personal, oral hygiene; needs or dependent on assistance.

Marginally self-sufficient in maintaining adequate hygiene, dental - oral health; moderate support

Moderately self-sufficient in maintaining adequate hygiene with routine assistance.

Adequate self-care in maintaining good hygiene; minimal prompts or infrequent assistance.

Optimal hygiene functioning, self-sufficient around cleanliness; no issues.

Grooming: Rate independent care, groomed hair, hands, general appearance.

No personal grooming indicative of high risk, pervasive needs.

Marked limitations evident with poorly cleaned hair, hands, self-grooming, serious needs.

Limited self-care in grooming, general observations indicate serious impairments.

Marginally self-sufficient in maintaining adequate grooming - regular assistance.

Moderately self-sufficient in grooming with prompts or support - routine assistance.

Adequate self-sufficiency in grooming, minimal assistance needed.

Optimal self-sufficiency in grooming with no issues and no routine assistance.Unclean, undressed -high risk needs due to no self-care

Dress: Rate clean, weather appropriate w/o personal bias

Unclean, undressed -high risk needs due to no self-care

Severe impairment, wearing unclean & inappropriate dress for weather, tasks.

Insufficient clean dress or dress is in poor repair, ill fitting in all weather

Marginally self-sufficient in maintaining clean, appropriate dress

With periodic support or help, wears clean, appropriate dress

Adequate self-sufficiency in maintaining clean, appropriate dress

Optimal self-sufficiency in maintaining clean, appropriate dress;