Behavior/Mood | and Status, Frequency & Alterability |
Assaultive (not during personal care) | Current behavior |
Combative during personal care | Current behavior |
Combative during personal care | Past behavior, addressed with current interventions |
Many incidences of uncontrollable crying tearfulness | Current behavior, frequency 4 or more days per week |
Delusions | Past behavior, addressed with current interventions |
Depression score of 14 or greater | N/A |
Inappropriate nakedness | Current behavior and not easily altered |
Easily irritable/agitated requiring intervention(s) | Current behavior and not easily altered |
Eats nonedible substances/objects (Pica)(persistent for at least a month) | Current behavior |
Eats nonedible substances/objects (Pica)(persistent for at least a month) | Past behavior, addressed with current interventions |
Hallucinations | Current behavior |
Hiding items | Past behavior, addressed with current interventions |
Hoarding | Past behavior, addressed with current interventions |
Mental health therapy/program | Needs |
Nonhealth related repetitive anxious complaints/questions | Current behavior, daily |
Nonhealth related repetitive complaints/questions | Past behavior, addressed with current interventions |
Repetitive movement/pacing, hand wringing, fidgeting | Current behavior, daily |
Resistive to care with words/gestures (does not include informed choice) | Current behavior |
Resistive to care with words/gestures (does not include informed choice) | Past behavior, addressed with current interventions |
Sexual acting out | Current behavior |
Sexual acting out | Past behavior, addressed with current interventions |
Inappropriate spitting | Current behavior and not easily altered |
Inappropriate spitting | Past behavior, addressed with current interventions |
Breaks/throws items | Current behavior |
Unsafe smoking | Current behavior and not easily altered |
Disturbs household at night when others are sleeping and requires intervention | Current behavior |
Wanders exit seeking | Current behavior |
Wanders exit seeking | Past behavior, addressed with current interventions |
Wanders not exit seeking | Current behavior |
Wanders not exit seeking | Past behavior, addressed with current interventions |
Yelling/screaming | Current behavior, frequency 4 or more days per week |
Status | Intervention | Frequency | Weight |
Past | No intervention | N/A | 0 |
Past | With intervention | N/A | 0.25 |
Current | N/A | 1-3 days per wk | 0.5 |
Current | N/A | 4-6 days per wk | 0.75 |
Current | N/A | Daily | 1 |
Behavior | Value | |
Easily Altered/Past | Not Easily Altered | |
1. Many incidences of uncontrollable crying, tearfulness | .5 | 1 |
2. Easily irritable/agitated | .5 | 1 |
3. Obsessive regarding own health or body functions | .5 | 1 |
4. Repetitive physical movement/pacing, hand wringing, fidgeting | .5 | 1 |
5. Hiding items | .5 | 1 |
6. Hoarding | .5 | 1 |
7. Inappropriate verbal noise | .5 | 1 |
8. Wanders, not exit seeking | .5 | 1 |
Maximum total points after adjusting for status for behaviors 1-8 = 2 | ||
9. Repetitive anxious complaints/questions | 1 | 2 |
10. Rummages/takes belongings of others | 1 | 2 |
11. Verbally abusive | 1 | 2 |
12. Yelling or screaming | 1 | 2 |
13. Inappropriate spitting | 1 | 2 |
14. Unrealistic fears and suspicions | 1 | 2 |
15. Accuses others of stealing | 1 | 2 |
Maximum total points after adjusting for status for behaviors 9-15 = 3 | ||
16. Resistive to care with words/gestures | 2 | 3 |
17. Disturbs household at night when others are sleeping, requires intervention | 2 | 3 |
18. Unsafe cooking | 2 | 3 |
19. Inappropriate toileting/menses activity | 2 | 3 |
20. Unsafe smoking | 2 | 3 |
21. Left home and gotten lost | 2 | 3 |
22. Inappropriate nakedness | 2 | 3 |
Maximum total points after adjusting for status for behaviors 16-22 = 4 | ||
23. Intentional self-injury | 4 | 5 |
24. Wanders/Exit seeking | 4 | 5 |
25. Sexual acting out | 4 | 5 |
26. Intimidating/threatening (no physical contact) | 4 | 5 |
27. Assaultive (not during personal care) | 4 | 5 |
28. Breaks, throws items | 4 | 5 |
Maximum total points after adjusting for status for behaviors 23-28 = 10 | ||
29. Deliberate fire setting behaviors | 5 | 6 |
30. Combative during care | 5 | 6 |
31. Eats nonedible substances/objects (Pica)(persistent for at least a month) | 5 | 6 |
32. Deliberate sexual violence | 5 | 6 |
Maximum total points after adjusting for status for behaviors 29-32 = 12 |