Your loved one’s ability to manage activities of daily living (ADL) and the degree of their symptom severity can be essential to assessing the level of housing support they need. 

The first part of this worksheet explores ADLs such as regular routines, daily tasks, medication, cooking, and managing money. The second part of this worksheet helps understand the severity of positive symptoms (such as hallucinations or delusions), negative symptoms (such as social withdrawal or lack of motivation), and cognitive symptoms (such as difficulties with memory or focus). Together, it forms a picture of the kind of support they’ll need. 

When you've completed the worksheet, you can print the page to store in your records or save the form to your personal Jotform account. S&PAA does not keep documentation from completed worksheets.

For each symptom below, check the box if the statement is very challenging for your loved one. The more you select may indicate a more structured housing situation may be needed.

This portion assesses which housing features might be most helpful for these symptoms. Refer to “Part 1: Understanding Your Loved One” of the toolkit to learn more. 

Instructions: Use this section of the worksheet to assess the severity of symptoms your loved one may be experiencing. For each symptom below if applicable, mark how severely it occurs as well as its impact on daily living. 

Summary of Most Concerning Items Selected:

Activities of Daily Living:

{Home}

{Health}

{Finances}

{Routines}

{Relationships}

{Communication}

 

Symptom Severity:

Positive Symptoms: {typeA104}

{howCan}

Negative Symptoms: {howSevere}

{howCan107}

Cognitive Symptoms: {howSevere108}

{howCan109}

Other Symptoms: {howSevere110}

{howCan111}

Comorbidity Symptoms: {howSevere112}

{howCan113}

 

 

Refer to the worksheets for the “I’m Diagnosed. Now What?” toolkit to explore managing symptoms and overall recovery.


Next Steps 
Please transfer the most important concerns in the "Build Your Housing Plan” worksheet.