Community Occupational Therapy Initial Screening Tool COTIST

Transcription

1 1 Community Occupational Therapy Initial Screening Tool COTIST Name : Date : 1. Self Care Has there been a major change in your life recently affecting your ability? Is it important to you to be able to cook, shop and use public transport? Have you done these activities in the past? Is there a significant change when you are well and when you are unwell? Are You Able To: get up in the morning when you want sleep maintain personal hygiene to your satisfaction wash your clothes shop for food prepare and cook food use public transport Use the telephone 2. Living Situation Is where you live and your ability to look after your home important to you? Has anything changed with regards to your living situation? Is there a significant change when you are well and when you are unwell

2 2 Do You : have accommodation like where you live feel safe and secure in your own home live alone feel able to look after your home 3. Being with Others Has there been a major change in your life recently affecting your ability to socialise with others? Is it important to you to be able to socialise and be with others? What have you been like around others in the past? Do You : enjoy the company and socialising with other people enjoy your own company have any support from other people? prefer smaller groups Feel comfortable in larger groups Prefer individual activities Have any specific language needs YES/NO Comments

3 3 4. Employment and College Has there been a major change in your life recently affecting your ability to study/work? Is it important to you to be employed or involved in study? What have you done in the past? Are You: in employment involved in any voluntary work involved in any study or training Have difficulty reading /writing Have any conditions which impair your vision 5. Your Beliefs and Values Is it important to you to be able to practice your spiritual beliefs or be around others with similar beliefs? What have you done in the past? have religious /spiritual beliefs that are important to you do you like to be with others who have similar beliefs/values feel able to join others with similar beliefs

4 4 6. Finances Has there been a major change in your life recently affecting your ability to manage your finances? receive benefits have difficulty budgeting/managing your money/accessing your money? Have outstanding debts where you have difficulty meeting repayments 7. General Health and Well Being Has there been a major change in your life recently affecting your general health? have any physical problems feel happy with your general health think that there is any help you need in order to improve your general heath ie access to Health Screens

5 5 8. Activities You Enjoy Doing Has there been a major change in your life recently affecting your ability to do these activities? Is it important to you to be able to do these activities? Is there a significant change when you are well and when you are unwell Are you able to do the activities you enjoy doing/want to do: Recovery Plan What skills/strengths do you feel you have? Recovery Goals

6 6 Activities/Intervention Thank you for taking the time to fill in this questionnaire if it is assessed as being appropriate a Recovery Plan will now be completed and returned to you for agreement and signing Is there anyone in particular that you do not wish your Recovery Plan to be discussed with? YES/NO If Yes who?