| Functioning | Generally |
| High functioning and independent | No impairments. Symptom impacts, environmental stresssors, health impacts and substance use impacts on functioning do not exist or individual has effective coping skills to prevent symptoms from impacting functioning. Or, the individual has developed and engaged with a highly effective natural support network to help as needed. |
| Functioning well with only slight impairments or occasional difficulties | Some mild infrequent impairments. Functioning only infrequently impacts functioning, less often than weekly, or less than 1/2 the time when action is needed in this domain. Individual uses coping skills to reduce symptom impacts and environmental stressors, or uses an effective support network to help as needed. Problems may still occur from time to time, but needs are generally met. |
| Significant impairment, difficulties occurring more than occasionally | Difficulties occur regularly, weekly or more often or more, as often as daily, or more than 1/2 the time when action is needed in a particular domain. Coping skills are often not consistently effective to prevent problems from occuring or to prevent failure to complete tasks in this domain. Needs are frequently unmet as a result of impaired functioning. |
| Severely impaired functioning, creating potential or frequent risk of harm | Experiences frequent mental health hospitalizations;
Frequently expresses suicidal ideation or threats of harm to others;
Reports daily impaired functioning across other domains as a result of symptom impacts. |
| Profoundly impaired functioning, creating imminent risk of harm and the need for immediate intervention | An imminent threat to personal safety, or the health and safety of others is evident and should be reported immediately, actions taken. |
| Functioning | Mental Health |
|---|
| High functioning and independent | Has reduced or eliminated symptoms, or as learned coping skills to respond successfully to eliminate distressing impacts consistently when symptoms occur. This does not mean the individual never has a bad day or stressful moment, rather has learned resiliance and recovers quickly without help from others, or with help from an effective natural support network. |
| Functioning well with only slight impairments or occasional difficulties | Has reduced or eliminated most symptoms, or as learned coping skills to respond successfully to eliminate distressing impacts consistently without help from others, or with help from an effective natural support network. . |
| Significant impairment, difficulties occurring more than occasionally | Reports symptoms occurring frequently, daily to several times weekly. Has not learned coping skills to reduce the emotional impact of symptoms, or is unsuccessful using them more than 1/2 the time. Symptoms are impacting daily basic functioning more than 1/2 the time and functioning in other domains. |
| Severely impaired functioning, creating potential or frequent risk of harm | Experiences frequent mental health hospitalizations;
Frequently expresses suicidal ideation or threats of harm to others;
Reports daily impaired functioning across other domains as a result of symptom impacts. |
| Profoundly impaired functioning, creating imminent risk of harm and the need for immediate intervention | Reports suicidal intention, or credibly threatens harm to others. This should be reported immediately, actions taken. Duty to warn may apply. |
| Functioning | Health |
|---|
| High functioning and independent | Is managing personal health care, scheduling and attending well-care and other needed health and dental care appointments, following physician orders, and taking medications (if applicable) independently or with help from an effective natural support network. |
| Functioning well with only slight impairments or occasional difficulties | Is managing personal health and personal care, scheduling and attending well-care and other needed health and dental care appointments, following physician orders, and taking medications (if applicable) with only occassional slip-ups that do not threaten health status. |
| Significant impairment, difficulties occurring more than occasionally | Has significant unmet personal care or healthcare needs. May not be scheduling or attending necessary health and dental care appointments. May not be taking medications as prescribed or following doctor's orders. |
| Severely impaired functioning, creating potential or frequent risk of harm | Is experiencing a decline in health or at risk of a a health care crisis related to failure to meet health care needs, follow physician orders, take medications as described. |
| Profoundly impaired functioning, creating imminent risk of harm and the need for immediate intervention | Reports or shows signs of a serious, perhaps life-threatening health condition is has not/is not taking action to treat it. This should be reported immediately, actions taken. A report of adult in need of protrection may be warranted. |
| Functioning | Home |
|---|
| High functioning and independent | Manages rent, finances, transportation and personal care needs independently wihout need for help or with help from an effective supportive natural support network.
Is up-to-date on rent and other bills, or paying off debts successfully. Uses preferred transportation without assistance. Has sufficient money for food, clothing and personal needs. Cooks, cleans, cares adequately for home/apartment pets, children, etc. based on personal preferences. |
| Functioning well with only slight impairments or occasional difficulties | With occassional slip-ups, manages rent, finances, transportation, cooks, cleans, cares adequately for home/apartment pets, children, etc. based on personal preferences. Has sufficient money for food, clothing and personal needs. Occassional errors do not threaten housing or independent living status. May reach out out for professional supports help as needed to solve infrequent problems. |
| Significant impairment, difficulties occurring more than occasionally | Is potentially or frequently at risk of eviction for non-payment of rent or apartment rule violations.
Fails more than 1/2 the time to complete regular household tasks (cleaning, laundry, billl-paying, shopping for basic needs).
Often falls short of money for bills, basic needs and food in a given month.
Struggles with transportation resources because of lack of skill, lack of money, or symptom impacts. |
| Severely impaired functioning, creating potential or frequent risk of harm |
At immediate risk of evicition for lease violations.
History of evictions for lease violations.
In serious debt or accumulating debt for unpaid bills.
Repeatedly falls short of money for basic needs, food, etc.
Consistenty not completing basic home care tasks (cleaning, laundry, billl-paying, shopping for basic needs). |
| Profoundly impaired functioning, creating imminent risk of harm and the need for immediate intervention | A life or health-threatening condition exists in the home and is not resolved. (Risk of fire, dangerous electrical conditions, violent neighbor, etc.) It is unreported or unresolved. This should be reported immediately, actions taken. |
| Functioning | Connection |
|---|
| High functioning and independent | Reports:
Satisfaction with current social circle and relationships at all levels (family, close friends, acquaintences, neighbors;
Has a safe and healthy recreational and social life;
Ability to resolve conflicts in each independently with help from effective natural supports;
A supportive social support network;
Confidence with ability to make and keep friends as desired |
| Functioning well with only slight impairments or occasional difficulties | Reports:
General satisfaction with current social circle and relationships at all levels (family, close friends, acquaintences, neighbors.
Has a generally safe and healthy recreational and social life.
May reach out for professional supports (e.g. psychotherapy) to help as needed to resolve occassional to infrequent conflicts in relationships |
| Significant impairment, difficulties occurring more than occasionally | Has frequent conflicts with family, friends, neighbors or acquaintences.
May have recent or pending legal charges resulting from conflicts.
Reports a lack of a sustained social network due to maladaptive social skills.
Has recently lost friends or family due to conflict.
Desires to, but has not successfully reconnected with family or friends due to past conflicts and inability to resolve them.
Is currently engaged in unhealthy or dangerous social and recreational activities. |
| Severely impaired functioning, creating potential or frequent risk of harm |
Remains in an abusive relationship.
Has no social support network as a result of conflicts or communication difficulties.
Has recently lost relationships with close friends or family as a result of conflicts or communication difficulties.
Frequent conflicts with housemantes, nieghbors or acquaintences could have safety, health or legal consequences |
| Profoundly impaired functioning, creating imminent risk of harm and the need for immediate intervention |
Ongoing domestic violence occurring in the home perpetrated by the individual, or of which the individual is a victim.
Credible threats of harm by the individual or by others toward the individual.
All of this without the individual's ability to respond/remediate and/or protect oneself or others.This should be reported immediately, actions taken. Duty to warn may apply. |
| Functioning | Purpose |
|---|
| High functioning and independent | Employed and satisfied, and or confident in ability to gain/change employment if needed;
A stay-at-home parent and functioning well in this role without intervention or with help from a natural support network;
Not working for reasons perhaps related to disability, but engaged in meaningful purposeful activity other than work;
Not working, but volunteering;
Or retired; and
Satisfied with current purpose/meaningful activity. |
| Functioning well with only slight impairments or occasional difficulties | Employed and not looking for work, or doing so independently;
A stay-at-home parent;
Not working for reasons perhaps related to disability, but engaged in meaningful purposeful activity other than work;
Not working, but volunteering;
Or retired; and
May reach out for professional supports help as needed to solve infrequent problems. |
| Significant impairment, difficulties occurring more than occasionally | Is unemployed and seeking, but unable to find work related to functioning.
Has frequently lost employment or is at risk of losing a job.
Has failed to engage or remain engaged in volunteering, civic involvement, even if desired, related to functioning.
Expresss dissatisfaction with current purposeful activity related to the above.
Avoids pursuit of purposeful, meaningful activity due to symptoms. |
| Severely impaired functioning, creating potential or frequent risk of harm | Unlikely to apply as a rating in this domain. Beng a victim of maltreatment or exploitation in a workplace may apply |
| Profoundly impaired functioning, creating imminent risk of harm and the need for immediate intervention | Unlikely to apply as a rating in this domain unless a life or health-threatening condition exists in the workplace/other activities and is not resolved. This should be reported immediately, actions taken. |
No additional guidance on these axes at this time, with the assumption that the descriptors in the selections are clear. If you believe more guidance here is necessary, please tap the feedback link below.
This guide is a living document. We want to improve it with your help. Do you have questions? Found a typo? Find yourself wanting more information? Please send us your thoughts about anything in this chapter by tapping on the link below.
If you have recently viewed this page and don't see changes you expect, consider a hard refresh to see recent changes. On Mac, that is Command+R.
