1. MENTAL STATUS: COGNITIVE FUNCTIONING: Consider the client’s level of hallucinations‚ delusions‚ disorientation‚ bizarre behavior or speech‚ memory problems‚ serious confusion‚ or other symptoms of serious cognitive impairment. How would you rate his/her overall mental status? RATING __________
2. MENTAL STATUS: EMOTIONAL STATE: Consider the client’s level of depression‚ anxiety‚ and overall emotional state. How would you rate your client’s overall emotional well-being? RATING __________
3. IMPULSE CONTROL: Think about your client’s overall behavior. Consider things such as their ability to express themselves effectively‚ ability to work at things patiently‚ tendency to verbally or physically lash out at others‚ run away‚ harm themselves‚ or proneness to impulsive‚ criminal‚ or drug-abusing behavior. How would you rate their overall impulse control? RATING __________
4. COPING SKILLS: Think about your client’s ability to cope with problems and everyday stresses. How would you rate their ability to assess problem situations‚ deal with “triggers‚” cope with stress‚ solve problems‚ perhaps reach out to others for help in order to deal effectively with their difficulties? RATING __________
5. IMMEDIATE SOCIAL NETWORK (close friends‚ spouse‚ family): Consider the quality of your client’s relationships with those available friends‚ family‚ spouse (as applicable). How would you rate the quality of the interaction overallbetween your client and them with respect to closeness‚ intimacy‚ general interpersonal satisfaction‚ effectivecommunications‚ degree of conflict‚ level of hostility‚ aggression‚ and abuse? RATING __________
6. EXTENDED SOCIAL RELATIONSHIPS/NETWORK (local community): Think about your client’s relationships with persons outside their immediate family and social group. Consider their relationship to others in the community‚their involvement in social groups‚ organizations‚ and general feeling of integration into the wider community inwhich they live. How would you rate the client’s overall relationship with the community? RATING __________
7. RECREATIONAL ACTIVITIES: Consider what the client does for fun (alone or social)‚ hobbies‚ relaxation (reading‚ TV‚ video games‚ playing cards‚ etc.)‚ and physical exercise (walking‚ jogging‚ biking‚ etc.). How would you rate theclient’s overall involvement in recreational activities? RATING __________
8. MATERIAL RESOURCES: Think about your client’s current or (if client is institutionalized) most recent living environment and their overall living situation. Consider such things as adequacy of food‚ clothing‚ shelter‚ and safety.How would you rate the overall quality of the client’s material resources? RATING __________
9. USE OF ALCOHOL AND OTHER DRUGS: Consider the client’s use of alcohol‚ illicit substances (cocaine‚ heroin‚ marijuana‚ hallucinogens‚ etc.)‚ and illicit use of prescription medication. Consider the following: how often dothey use them‚ in what quantity‚ and what are the psychological‚ physical‚ and social consequences associated withtheir use? How would you rate the client’s overall functioning with regard to the use of alcohol and other drugs?RATING __________
10.HEALTH: Consider the client’s overall health. Aside from normal‚ transient illnesses think about health habits‚ chronic primary health disorders‚ their own opinion of their health‚ ability to engage in their usual activities relatively free from discomfort‚ overall energy level‚ hospitalizations‚ and treatments for illness other than psychiatricdisorders. How would you rate their physical health overall? RATING __________
11.INDEPENDENT LIVING/SELF CARE: Rate how well your client manages their household‚ takes care of personal hygiene‚ eats‚ sleeps‚ and otherwise cares for basic needs. RATING __________
12.WORK (OR ROLE) SATISFACTION: If the client works outside the home‚ is a homemaker or student‚ think for a moment about their work (or role) productivity. Considering the type of work or role in which they are engaged‚how would you rate their overall work (role) productivity over the past 30 days? RATING __________
0=Poor‚ 1= Impaired‚ 2= Marginal‚ 3= Good‚ 4= Excellent
O’Hare‚ T.‚ Sherrer‚ M. V.‚ Cutler‚ J.‚ McCall‚ T.‚ Dominique‚ K.‚ & Garlick‚ K. (2002). Validating the psychosocial wellbeing scale among mentally ill clients with substance abuse problems.Social Work in Mental Health‚ 1‚ 15–30.
O’Hare‚ T.‚ Sherrer‚ M. V.‚ Connery‚ H. S.‚ Thornton ‚J.‚ LaButti‚ A.‚ Emrick‚ K. (2003). Further Validation of the Psycho-Social Well-Being Scale (PSWS) with Community Clients. Community Mental Health Journal‚ 39(2)‚ 115-129.
O’Hare‚ T.‚ Sherrer‚ M. V.‚ LaButti‚ A.‚ Emrick‚ K. (2004). Validating the Alcohol Use Disorders Identification Test With Persons WhoHave a Serious Mental Illness. Research on Social Work Practice‚ 14(1)‚ 36-42