Download The Functional Assessment Interview (FAI) is an important part of a functional behaviour assessment. The FAI consists of a series of questions designed to gather information about a child's behaviour. Unlike the Motivation. Assessmen
Download THE CONTENT OF THE FUNCTIONAL ASSESSMENT OBSERVATION FORM. This Functional Assessment Observation Form has eight major sections (see next page). A blank copy of the form is included on page 9. Each labeled section is described below. T
Download THE CONTENT OF THE FUNCTIONAL ASSESSMENT OBSERVATION FORM. This Functional Assessment Observation Form has eight major sections (see next page). A blank copy of the form is included on page 9. Each labeled section is described below. T
Download Do the different types of problem behavior tend to occur in bursts or clusters and/ or does any type of problem behavior typically precede another type of problem behavior (e.g., yells preceding hits)?. To determine the antecedent conditi
Appearance and behaviour • Physical characteristics- hair and eye colour, ethnic origin, stature and posture. • Facial characteristics- e.g. furrowing of brow
Download Student Functional Assessment. Interview and Reinforcement Survey. Student: School: Date of Birth: Age: Grade: Date Completed: Interviewer: Section A. Always. Sometimes. Never. 1. In general, is your work too hard for you? 2. In genera
Refer to Chapter 2 “Assessment,” p. 64: Care Plans Developed after using. Functional Health Patterns Assessment Model. Client's name: Mrs. Mary Acosta. Age: 55. Are there differences between the Body Systems Model and the Functional. Health Pattern M
Functional Skills Mathematics Level Sample Assessment Task 3 Step Total marks Marks Marks awarded for Task 3 step A 5 4 3 correct averages corresponding to their choice
Page 1 of 37 CHILDREN’S FUNCTIONAL ASSESSMENT RATING SCALE1 Department of Children and Families Substance Abuse and Mental Health Programs
Functional Behavioral Assessment: Part 1 (Description) Date: ___ 1/20/98 ____ Page ____ of ____ Student Name: _ Case One-SLD _____ ID: ____ 0001
GP MENTAL HEALTH TREATMENT PLAN PATIENT ASSESSMENT Patient’s Name Date of Birth Address Phone Carer details and/or emergency contact(s)
Download Terdapat hubungan antara bentuk tulang alveolus dengan retensi gigi tiruan penuh. Kata kunci: Tulang .... Gambar 5: Bentuk tulang alveolus klas III pada.
Download ing objectives: (a) explain the microfinance policy environment in the country;. (b) evaluate the institutional and financial capacity and performance of MFIs; (c) determine the issues and constraints affecting capacity and performance;
Download ing objectives: (a) explain the microfinance policy environment in the country;. (b) evaluate the institutional and financial capacity and performance of MFIs; (c) determine the issues and constraints affecting capacity and performance;
Download Terdapat hubungan antara bentuk tulang alveolus dengan retensi gigi tiruan penuh. Kata kunci: Tulang .... Gambar 5: Bentuk tulang alveolus klas III pada.
Download The maximum number of individuals that can be supported sustainably by a given environ- ment is known as its 'carrying capacity'. For most non-human species, the concept is quite simple. If carrying capacity is exceeded, the populati
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Download Carrying Capacity - An Old Concept: Significance for the Management of Urban Forest Resources. 1. Introduction. Human life depends on healthy ecosystems, which supply life-sustain- ing resources and absorb wastes. The industrial rev- o
Download Carrying Capacity - An Old Concept: Significance for the Management of Urban Forest Resources. 1. Introduction. Human life depends on healthy ecosystems, which supply life-sustain- ing resources and absorb wastes. The industrial rev- o
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Download The maximum number of individuals that can be supported sustainably by a given environ- ment is known as its 'carrying capacity'. For most non-human species, the concept is quite simple. If carrying capacity is exceeded, the populati
The Mental Health Screening and Assessment Tools for Primary Care table provides a listing of mental health screening and assessment tools, summarizing their
Items 7 - 25 ... SUMMARY OF FREE ASSESSMENT MEASURES ... measure. The measures can be accessed at: Child version http://www.childfirst.ucla.edu/Brief%20Problem %20Checklist%20-%20Child.pdf. Parent Version ... Impairment Rating Scale ( Narrative Descr
MENTAL RESIDUAL FUNCTIONAL CAPACITY ASSESSMENT PROVIDER’S NAME: _________________________ PROVIDER’S TELEPHONE: _________________________ PATIENT’S NAME: _________________________ PATIENT’S DATE OF BIRTH: _________________________ PATIENT’S SS#: _________________________ Please answer the following questions about your patient’s mental health impairment(s) and how his or her ability to perform certain job functions is affected by the impairment. Your answers should be based on the evidence in the patient’s file and on your personal contact with and observations of the patient. 1.
Date treatment began: ________________ Frequency of treatment (weekly / bi-weekly / monthly) ________________ Date of last appointment: ________________
2.
Current Diagnoses:
3.
Highest GAF this past year: ___________________________________
4.
Current GAF: ___________________________________
5.
Prognosis:
6.
Are you aware of any physical medical condition that may contribute to the patient’s mental impairment? yes / no If “yes,” please describe: _______________________________________________________________________ _______________________________________________________________________
7.
What treatments has the patient undergone? ________________________________________________________________________ ________________________________________________________________________
8.
Has the patient’s impairment lasted, or is it expected to last, at least 12 months? yes / no
9.
Do you believe the patient is a malingerer? yes / no
Is there evidence of current drug or alcohol abuse? yes / no If so, would the impairment exist in the absence of the drug or alcohol abuse? yes / no
11.
Is the patient compliant with treatment? yes / no
12.
Based on your personal assessment of the patient, please circle the word that best describes his or her functioning in the associated category, using the definitions provided below. Assume that these activities must be performed on a regular and sustained basis (40 hours per week). None: Mild: Moderate: Marked: Extreme: Not Ratable:
There are no limitations on the ability to function in this area. There are limitations on ability to function but they are mild or transient. The ability to function in this area is less than marked but more than mild. The ability to function in this area is seriously limited. The ability to function in this area is precluded. There is no evidence available to rate the ability to function in this area.
I.
UNDERSTANDING AND MEMORY
a.
The ability to remember locations and work-like procedures. None
b.
Moderate
Marked
Extreme
Not Ratable
The ability to understand and remember very short and simply instructions. None
c.
Mild
Mild
Moderate
Marked
Extreme
Not Ratable
The ability to understand and remember detailed instructions. None
Mild
Moderate
Marked
Extreme
Not Ratable
II.
SUSTAINED CONCENTRATION AND PERSISTENCE
a.
The ability to carry out very short and simple instructions. None
b.
Marked
Extreme
Not Ratable
Mild
Moderate
Marked
Extreme
Not Ratable
The ability to maintain attention and concentration for extended periods. None
d.
Moderate
The ability to carry out detailed instructions. None
c.
Mild
Mild
Moderate
Marked
Extreme
Not Ratable
The ability to perform activities within a schedule, maintain regular attendance, and be punctual within customary tolerances. None
The ability to sustain an ordinary routine without special supervision. None
f.
Mild
Moderate
Marked
Extreme
Not Ratable
The ability to work in coordination with or proximity to others without being distracted by them. None
g.
Moderate
Marked
Extreme
Not Ratable
The ability to make simple work-related decisions. None
h.
Mild
Mild
Moderate
Marked
Extreme
Not Ratable
The ability to complete a normal workday and workweek without interruptions from psychologically based symptoms and to perform at a consistent pace without an unreasonable number of and length of rest periods. None
Mild
Moderate
Marked
Extreme
Not Ratable
III.
SOCIAL INTERACTION
a.
The ability to interact appropriately with the general public. None
b.
Moderate
Marked
Extreme
Not Ratable
The ability to ask simple questions or request assistance. None
c.
Mild
Mild
Moderate
Marked
Extreme
Not Ratable
The ability to accept instructions and respond appropriately to criticism from supervisors. None
d.
Mild
Moderate
Marked
Extreme
Not Ratable
The ability to get along with coworkers or peers without distracting them or exhibiting behavioral extremes. None
f.
Mild
Moderate
Marked
Extreme
Not Ratable
The ability to maintain socially appropriate behavior and to adhere to basic standards of neatness and cleanliness. None
Mild
Moderate
Marked
Extreme
Not Ratable
IV.
ADAPTATION
a.
The ability to respond appropriately to changes in the work setting. None
The ability to be aware of normal hazards and take appropriate precautions. None
c.
Marked
Extreme
Not Ratable
Mild
Moderate
Marked
Extreme
Not Ratable
The ability to set realistic goals or make plans independently of others. None
e.
Moderate
The ability to travel in unfamiliar places or use public transportation. None
d.
Mild
Mild
Moderate
Marked
Extreme
Not Ratable
The ability to tolerate normal levels of stress None
Mild
Moderate
Marked
Extreme
Not Ratable
14.
Would your patient’s impairment substantially interfere with his or her ability to work on a regular and sustained basis at least 20% of the time? yes / no
15.
How often would your patient need to miss work each month because of his or her mental impairment or for treatment of the mental impairment? _______ days per month
16.
Do you believe that your patient can work on a regular and sustained basis in light of his or her mental impairment? yes / no Please explain: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
18.
Do you believe the patient can manage his or her own funds? yes / no Please explain: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________
