Adapted from Brookvale Living Skills Centre, Manly Warringah Area Health Service, Northern Metropolitan Region, Department of Health, N.S.W., 1987. Brookvale Living Skills Assessment Instructions for Completing Each item is scored as follows: 1 - if satisfactory 2 - if the behavior needs attention The behavior or the performance tasks is defined as "satisfactory" if either the clients or persons in significant contact with the client state that they are fairly satisfied with it. "Persons in significant contact" include those living with the client, in the family home, boarding house, etc., relatives or friends in frequent contact, the councilor or case manager, supervisor of a hostel etc. If any of these persons or the client states that the behavior or skill-deficit is causing significant problems for the client or others, then this item should be marked needs attention. This assessment is intended to be used for. Goal-setting. Discuss with the client and place a colored spot against -items the client wishes to work on - an appropriate training-programme can then be planned. Review and Measuring Change. At the time of review (preferably 6 months after initial assessment) items can be ticked in the same way. Collecting basic information about the functioning and needs of the client population. Research into the effects of programmes.
Brookvale Living Skills Assessment S Satisfactory N Needs attention Please tick appropriate column. Specify behaviors that need attention Place red spot against those behaviors that client wishes to work on. A. Self Care Cleanliness and grooming of: 1. Body 2. Hair 3. Teeth 4. Nails 5. Face 6. State of Clothing Clients name: Rater Dates; 1 st assess: Review: REVIEW S N Needs Attention S N B. Health Care 7. Nutrition awareness 8. Eating adequately 9. Fitness 10. Medication 11. Early 12. Appropriate use of health facilities C. Home Maintenance 13. Disposal of rubbish 14. Changing linen 15. Kitchen clean and tidy 16. Bathroom / Toilet clean and tidy 17. Bedroom clean and tidy D. Cooking and Meals 18. Planning 19. Shopping 20. Preparation 21. Timing 22. Sequence E. Money management 23. Awareness of entitlements 24. Using of Bank 25. Money transactions 26. Budgeting F. Time Management 27. Punctually at groups 28. Attendance at groups 29. Planning and organising 30. Satisfaction with use of time (refer to time pie)
G. Social Awareness 31. Politeness 32. Respect for other property 33. Habits and mannerisms 34. Table manners REVIEW S N Needs Attention S N H. Use of Communities Facilitates 35. Transport (can use adequately) 36. Transport ( can get information) 37. Shopping facilities 38. Community social groups, clubs 39. Others (eg phone) I. Social Networks (incl. relatives) 40. Satisfaction with degree of contact with close friends / relatives 41. Satisfaction with a number of friends / relatives 42. Satisfaction with a number of social contacts 43. Social supports in community practice 44. Social supports in community emotional 45 Communication with family (satisfaction) J. Social Skills 46. Withdrawn vs Outgoing 47. Appropriate vs Disturbing 48. Conventional needs 49. Self assertion skills K. Self Esteem 50. Friends and Relatives 51. Activities at work 52. Self liking (negative vs positive image L. Work Skills 53. Following instruction on tasks / initiatives 54. Co-operation with others 55. Attitude at work (motivation) 56. Persistence / Concentration M. Unacceptable Behavior 57. Violet / Destructive 58. Drug / Alcohol abuse 59. Inappropriate sexual behavior 60 66 Test Questions Scoring Total Score Other Comments:......
Use of Time Clients estimate of proportion of time spent on activities Staff draw Time Pie into 7 categories: 1. Self Care and Health 2. House hold tasks, cooking, shopping 3. Work 4. Solitary passive leisure (eg reading, TV) 5. Solitary Activities Leisure (including group) 6. Social Activities (including group sports) 7. Non Active or non constructive (sleeping, sitting, worrying, inappropriate behavior) Test Questions (Score 1 point for each correct answer) 60. What would you do if there was an error on your Social Security payments? Who would you contact? A Telephone or go to the Social Security in your area: Contact the relevant person, explain the situation, state your wishes. 61. If you were in urgent need of accommodation and could not afford flats/rooms etc. in the paper, what could you do? Who would you contact? A Salvation Army, Youth & Community Services, Women's Refuge, Housing Commission, Emergency Accommodation Scheme, Sydney City Mission. 62. If you had a legal problem and you.could not afford to have a lawyer, what would you do? A Contact Legal Aid. 63. If you noticed your symptoms getting worse, who could you contact for help? A. Contact your doctor, Case Manager/Occupational Therapist or local hospital casualty department 64. If you were feeling a need for more social contact /ways to fill in your time, name at least one organisation you could contact? A eg Living Skills Center, Parents without Partners, YMCA/YWCA, Women's Health Centers, Church, W.E.A. 65. If you didn't have enough clothes when Summer/Winter arrived, what would you do? A. Shop at inexpensive clothes store, St Vincent de Paul's fete, swap clothes with friends. 66. *If you had problems with your landlord, who could you contact for advice? A Tenants Union, Tenants Advice Bureau, Community Advice Bureau. INDIVIDUAL MANAGEMENT PLAN
Objectives / Goals Steps Date Achieved