CALAIM - HEALTH NEEDS/RISK ASSESSMENT_ENG

  • Health Needs/Risk Assessment

  • Introduction statement that highlights the importance of the patient's role in the benefit:

    By participating in the Enhanced Care Management (ECM) benefit, you are committing to partnering with me in your care. Our team is here to provide support to help you work towards your health and social goals; we will work with you to help you develop you own management of your health and daily life. 

    Today and over the next 1-3 visits, we will complete this assessment together, and from there develop goals and next steps that support your overall health and wellness.

    Engagement Questions: Ask 3 or more of these during or at the end of the assessment. 

    1. How strongly do you agree with this statement? I lead a purposeful and meaningful life.

    2. Strenghts: What is something that you are good at or really proud of? 

    3. Self-Efficacy: How confident are you in taking actions needed to maintain or improve your health?

    4. Coping Skills: When you feel sad or worried, what helps you feel better? What do you do for fun or relax? 

    5. Problem-Solving Skills: When you had a difficult situation in the past, what did you do? 

    6. Motivation: What do you want ot improve about your health? Why do you want to improve your health? 

  • Demographic Information

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  • Who can we contact in an emergency?

  • Culture

  • Health Literacy

    I would like to ask you about how you think you are managing your health conditions:

  • Physical Health

  • Preventative Care

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  • Medications

  • Pain Management

  • Activities of Daily Living (ADLs)

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  • Behavioral Health Assessment Questions

    Mental Health History

  • Mental Health Assessment Questions

    Depression - Patient Health Questionnaire (PHQ)

  • PHQ-2

    Plus Question 9

    Over the last two weeks, how often have you been bothered by any of the following:

  • Scoring: Not at all = 0, Several days = 1, More than half the days = 2, Nearly every day = 3
    • Score of 2 or greater AND/OR checks YES on Q.9 — Individual completes the PHQ-9
    (recommend self-administer). Printable PHQ-9 in multiple languages:
    https://www.phqscreeners.com/
    • If PHQ-9 score is >10 consult with clinical consultant and supervisor.
    • If PHQ-9 score is >15 or positive for Q.9 request immediate consultation

  • Anxiety

    Anxiety and Stress happens when someone feels tense, nervous, anxious, or can't sleep at night because their mind is troubled.

  • Trauma and Stressors

    Sometimes things happen to people that are unusually or especially frightening, horrible, or traumatic, such as being in a serious accident, physical/emotional abuse, sexual assault or abuse, being in a war, seeing someone killed or assaulted, having a loved one die by suicide, being bullied/discriminated against, or other events/experiences that were distressing or disturbing to you.

  • Cognitive Functioning

  • Scoring: If the patient checks yes to either box, consult with the clinical consultant and supervisor.

  • Developmental Factors

    Ask the following question only if this information is not already available to the ECM Provider Team.

  • Question for patient OR family/caregiver/case manager (depending on individual’s ability to answer)

  • Substance Use

  • I have some questions about your experience with alcohol, nicotine products, marijuana and other substances. Some of the substances we will talk about are prescribed by a doctor, but I will only be focusing on whether you have taken them for reasons other than prescribed or in doses other than prescribed.

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  • Social Determinants of Health (SDoH)

    Housing
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  • Safety

  • Food Security

  • Social Connections/Support

  • Family Member/Individual Supports (Including Caregiver Resources and involvement)

  • Benefits and Other Services

  • Legal Involvement

  • If yes, I would like to coordinate with anyone you are working with related to your stay in         so we can work together to support you and your goals.

  • End-of-life Planning

  • Member Priorities

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  • Should be Empty: