CLIENT 

ASSESSMENT RECORD (CAR) 

GENERAL INFORMATION

The purpose of the Client Assessment Record (CAR) is to give clinicians a tool to evaluate the
functioning level of their customers.

The clinician must have knowledge of the customer’s behavior and adjustment to his/her community
based on the assessment, and other information. The knowledge must be gained either through
direct contact (face-to-face interview) and experience with the customer, or by systematic review of
the customer’s functioning with individuals who have observed and are acquainted with the customer.

The CAR levels of functioning have been structured within a "normal curve" format, ranging from
Above Average Functioning (1-10) to Extreme Psychopathology (50). Pathology begins in the 20-29
range. The CAR format provides a broad spectrum of functioning and permits a range within which
customers can be described.

The clinician’s rating in each domain needs to based on assessment information: 1) the frequency of
the behavior (How often does the behavior occur?); 2) the intensity of the behavior (How severe is the
behavior?); 3) duration of the behavior (How long does the behavior last?); and 4) the impact the
symptoms/behaviors have on daily functioning, to establish the severity of the customer’s current
condition.

Only current information is to be rated, not historical information.

CAR DOMAIN DEFINITIONS

1. FEELING/MOOD/AFFECT: Measures the extent to which the person’s emotional life is well
moderated or out of control.
2. THINKING/MENTAL PROCESS: Measures the extent to which the person is capable of and
actually uses clear, well-oriented thought processes. Adequacy of memory and overall
intellectual functioning are also to be considered in this scale.
3. SUBSTANCE USE: Measures the extent to which a person’s current use of synthetic or
natural substances is controlled and adaptive for general well-being and functioning. Although
alcohol and illegal drugs are obvious substances of concern, any substance can be subjected
to maladaptive use or abuse, especially if compounded by special medical or social situations.
4. MEDICAL/PHYSICAL: Measures the extent to which a person is subject to illness, injury
and/or disabling physical conditions, regardless of causation. Demonstrable physical effects of
psychological processes are included, but not the effects of prescribed psychotropic
medications. Physical problems resulting from assault, rape, or abuse are included.
5. FAMILY: Measures the adequacy with which the customer functions within his/her family and
current living situation. Relationship issues with family members are included as well as the
adequacy of the family constellation to function as a unit.
6. INTERPERSONAL: Measures the adequacy with which the person is able to establish and
maintain interpersonal relationships. Relationships involving persons other than family
members should be compared to similar relationships by others of the same age, gender,
culture, and life circumstances.
 7. ROLE PERFORMANCE: Measures the effectiveness with which the person manages the role
most relevant to his or her contribution to society. The choice of whether job, school, or home
management (or some combination) is most relevant for the person being rated depends on
that person’s age, gender, culture and life circumstances. If disabled, intellectually, mentally or
physically, the client would be scored relative to others with the same disability and in the
same situation. Whichever role is chosen as most relevant, the scale is used to indicate the
effectiveness of functioning within the role at the present time.
8. SOCIO-LEGAL: Measures the extent and ease with which the person is able to maintain
conduct within the limits prescribed by societal rules and social mores. It may be helpful to
consider this scale as a continuum extending from pro-social to anti-social functioning.
***Other Behavioral Non-Chemical Addictions would be rated here: gambling, internet,
pornography, sexual, etc.
9. SELF CARE/BASIC NEEDS: Measures the adequacy with which the person is able to care for
him/herself and provide his/her own needs such as food, clothing, shelter and transportation.
If the customer lives in a supportive or dependent situation for reasons other than lack of ability
(e.g. confined on criminal sentence), estimate the ability to make arrangements independently
and freely. Children, the disabled and elderly persons who are cared for by others should also
be rated on their own ability to make arrangements compared to others their age.

LEVEL OF FUNCTIONING RATING SCALE

 1 - 9 (Above Average): Functioning in the particular domain is consistently better than that which
is typical for age, gender, and subculture, or consistently average with occasional prominent
episodes of superior, excellent functioning. Functioning is never below typical expectations for the
average person.
 10 - 19 (Average): Functioning in the particular domain as well as most people of same age,
gender, and subculture. Given the same environmental forces is able to meet usual expectations
consistently. Has the ability to manage life circumstances.
 20 - 29 (Mild to Moderate): Functioning in the particular domain falls short of average expectation
most of the time, but is not usually seen as seriously disrupted. Dysfunction may not be evident in
brief or casual observation and usually does not clearly influence other areas of functioning.
Problems require assistance and/or interfere with normal functioning.
 30 - 39 (Moderate to Severe): Functioning in the particular domain is clearly marginal or
inadequate, not meeting the usual expectations of current life circumstances. The dysfunction is
often disruptive and self-defeating with respect to other areas of functioning. Moderate
dysfunction may be apparent in brief or casual interview or observation. Serious dysfunction is
evident.
 40 - 49 (Incapacitating): Any attempts to function in the particular domain are marked by obvious
failures, usually disrupting the efforts of others or of the social context. Severe dysfunction in any
area usually involves some impairment in other areas. Hospitalization or other external control
may be required to avoid life-threatening consequences of the dysfunction. Out of control all or
most of the time.
 50 (EXTREME): The extreme rating for each scale, suggests behavior or situations totally out of
control, unacceptable, and potentially life threatening. This score indicates issues that are so
severe it would not be generally used with someone seeking outpatient care.

 
 
 CAR DOMAIN SCORING EXAMPLES 

FEELING / MOOD AFFECT

1 – 9 (ABOVE AVERAGE): Anxiety, depression, or disturbance of mood is absent or rare. The person’s
emotional life is characterized by appropriate cheer and optimism given a realistic assessment of his/her
situation. Emotional control is flexible, with both positive and negative feelings clearly recognized and viewed as
within his/her control. Reactions to stressful situations are clearly adaptive and time limited.
10 – 19 (AVERAGE): No disruption of daily life due to anxiety, depression or disturbance of mood. Emotional
control shows consistency and flexibility. A variety of feelings and moods occur, but generally the person is
comfortable, with some degree of pleasant or warm affect. When strong or persistent emotions occur, the object
and approximate causes are readily indentified.
ADULT: Able to cope, either alone or with the help of others, with stressful situations. Not overwhelmed when
circumstances seem to go against him/her. Doesn’t dwell on worries; tries to work out problems. Frustration,
anger, guilt, loneliness, and boredom are usually transient in nature and resolve quickly. Considers self a worthy
person.
CHILD: Not overwhelmed when circumstances seem to go against him/her. Frustration, anger, guilt, loneliness,
and boredom are usually transient in nature and resolve quickly. Reactions to stressful events are age
appropriate.
20 – 29 (Mild to Moderate): Occasional disruption due to intense feelings. Emotional life is occasionally
characterized by volatile moods or persistent intense feelings that tend not to respond to changes in situations.
Activity levels may occasionally be inappropriate or there may be disturbance in sleep patterns.
ADULT: Tends to worry or be slightly depressed most of the time. Feels responsible for circumstances but
helpless about changing them. Feels guilty, worthless and unloved, causing irritability, frustration and anger.
CHILD: Frustration, anger, loneliness’, and boredom persist beyond the precipitating situation. May be slightly
depressed and/or anxious MOST OF THE TIME.
30 – 39 (Moderate to Severe): Occasional major (severe) or frequent moderate disruptions of daily life due to
emotional state. Uncontrolled emotions are clearly disruptive, affecting other aspects of the person’s life. Person
does not feel capable of exerting consistent an effective control on own emotional life.
ADULT: The level of anxiety and tension (intense feelings) is frequently high. There are marked frequent,
volatile changes in mood. Depression is out of proportion to the situation, frequently incapacitation. Feels
worthless and rejected most of the time. Becomes easily frustrated and angry.
CHILD: Symptoms of distress are pervasive and do not respond to encouragement or reassurance.
May be moderately depressed and/or anxious most of the time or severely anxious/depressed occasionally.
40 – 49 (Incapacitating): Severe disruption or incapacitation by feelings of distress. Unable to control one’s
emotions, which affects all of the person’s behavior and communication. Lack of emotional control renders
communication difficult even if the person is intellectually intact.
ADULT: Emotional responses are highly inappropriate most of the time. Changes from high to low moods make
a person incapable of functioning. Constantly feels worthless with extreme guilt and anger. Depression and/or
anxiety incapacitate person to a significant degree most of the time.
CHILD: Emotional responses are highly inappropriate most of the time. Reactions display extreme guilt and
anger that is incapacitating.
50 (EXTREME): Emotional reactions or their absence appears wholly controlled by forces outside the individual
and bears no relationship to the situation.

Scoring Tips:
 When determining if a person scores in the 40-49 range, remember that symptoms must be at a level that
is “incapacitating”. A good guide for this is “Unable to control one’s emotions, which affects all of the
person’s behavior and communication.”
THINKING/MENTAL PROCESS
This domain refers to the person’s intellectual functioning and thought processes only. If there is a lowering of
functioning level in either one, please rate the more severe of the two.
1 – 9 (ABOVE AVERAGE): Superior intellectual capacity and functioning. Thinking seems consistently clear,
well organized, rational and realistic. The person may indulge in irrational or unrealistic thinking, or fantasy,
but is always able to identify it as such, clearly distinguishing it from more rational realistic thought.
10 – 19 (AVERAGE): No evidence of disruption of daily life due to thought and thinking difficulties. Person
has at least average intellectual capacity. Thinking is generally accurate and realistic. Judgment is
characteristically adequate. Thinking is rarely distorted by beliefs with no objective basis.
ADULT: Capable of rational thinking and logical thought processes. Oriented in all spheres. No memory
loss.
CHILD: Intellectual capacity and logical thinking are developed appropriately for age.
20 – 29 (Mild to Moderate): Occasional disruption of daily life due to impaired thought and thinking
processes. Intellectual capacity slightly below average (“Dull Normal” to Borderline) and/or thinking
occasionally distorted by defensive, emotional factors and other personal features. Poor judgment may occur
often, but is not characteristic of the person. Communications may involve misunderstandings due to mild
thought disorders. Includes specific impairments of learning or attention and the ability to generalize from
acquired knowledge.
ADULT: Borderline retardation; but can function well in many areas. Peculiar beliefs or perceptions may
occasionally impair functioning. Occasionally forgetful, but is able to compensate.
CHILD: Bordering retardation or developmentally delayed, but can function well in many areas. Inability to
distinguish between fantasy and reality may, on occasion, impair functioning.
30 – 39 (Moderate to Severe): Frequent or consistent interference with daily life due to impaired thinking.
Mild to moderate mental retardation and/or frequent distortion of thinking due to emotional and/or other
personal factors may occur Frequent substitution of fantasy for reality, isolated delusions, or infrequent
hallucinations may be present. Poor judgment is characteristic at this level.
ADULT: Mild to moderate retardation, but can function with supervision. Delusions and/or hallucinations
interfere with normal daily functioning. Frequently disoriented as to time, place, or person. Person is unable to
remember recent or past events.
CHILD: Mild to moderate retardation. May be preoccupied by unusual thoughts of attachments.
40 – 49 (Incapacitating): Incapacitated due to impaired thought and thinking processes. Severe to profound
mental retardation and/or extreme disruption or absence of rational thinking may exist. Delusions or frequent
hallucination that the person cannot distinguish from reality may occur. Communication is extremely difficult
ADULT: Unable to function independently. Severely disoriented most of the time. Significant loss of memory.
CHILD: Severely disoriented most of the time. Loss of memory. If speech is present, it may manifest itself in
peculiar patterns.
50 (EXTREME): Profound retardation, comatose, or vegetative. No process that would ordinarily be
considered “thinking” can be detected, although person may appear to be conscious. Communication is
virtually impossible. Extreme catatonia.

NOTE: A score of 40 or more in this domain must include a statement indication the customer’s ability to
participate in treatment planning and benefit from the OP services requested.
Scoring Tips:
 When determining if a person scored in the 40-49 range, remember that symptoms must be at a level
that is “incapacitating”. A good guide for this is “Severely disoriented most of the time”
SUBSTANCE USE
1 – 9 (ABOVE AVERAGE): All substances are used adaptively with good control. Substances known to be
harmful are used sparingly, if at all.
10 – 19 (AVERAGE): No impairment of functioning due to substance use. Substance use is controlled so that
it is not apparently detrimental to the person’s over-all functioning or well-being. Substances used and amount
of use are within commonly accepted range of the person’s subculture. Infrequent excesses may occur in
situations where such indulges have no serious consequences.
ADULT: No functional impairment noted from any substance use. Reports occasional use of alcohol with no
adverse effects.
CHILD: No effects from intake of alcohol drugs, or tobacco other than possible one occurrence of
experimentation.
20 – 29 (Mild to Moderate): Occasional or mild difficulties in functioning due to substance use. Weak control
with respect to one or more substances. May depend on maladaptive substance use to escape stress or avoid
direct resolution of problems, occasionally resulting in increased impairment and/or financial problems.
ADULT: Occasional apathy and/or hostility due to substance use. Occasional difficulty at work due to
hangover or using on the job.
CHILD: Occasional incidence of experimentation with alcohol, drugs or other substance with potential adverse
effects.
30 – 39 (Moderate to Severe): Frequent difficulties in functioning due to substance use. Has little control over
substance use. Lifestyle revolves around acquisition and abuse of one or more substances. Has difficulty on
the job, at home and /or in other situations.
ADULT: Needs alcohol, drugs or other substances to cope much of the time, without them, feels upset and
irritable. Frequent hangovers/highs or other effects of substance abuse that are causing difficulty on the job, at
home and/or other situations.
CHILD: Repeated use of alcohol, drugs, or other substances causing difficulty at home and/or school.
40 – 49 (Incapacitating): Disabled or incapacitated due to substance use. Substance abuse dominates the
person’s life to the almost total exclusion of other aspects. Serious medical and/or social consequences are
accepted as necessary inconveniences. Control is absent, except as necessary to avoid detection of an illegal
substance.
ADULT: Major focus on obtaining desired substance. Other functions ignored. Unable to hold job due to use
of alcohol, drugs or other substances
CHILD: Unable to function at home or in school due to substance use. Life revolves around obtaining desired
substance.
50 (EXTREME): Constantly high or intoxicated with no regard for basic needs or elemental personal safety.
May include extreme vegetative existence.

NOTE: The use of substances by family members is recorded in domain #5, as it relates to the family’s ability
to operate as a functional unit.
Scoring Tips:
 When determining if a person scored in the 40-49 range, remember that symptoms must be at a level
that is “incapacitating”. A good guide for this is “Substance abuse dominated the person’s life to the
almost total exclusion of other aspects”.
 In addition to scoring substance use in this domain, you can also score substance dependence for
someone who is not using at this time. Example of this would be- how frequently is someone thinking
of using and how does that impact their daily functioning (i.e. if someone is thinking of using all the
time, and is participating in 5 AA meetings daily to keep from using- this may be impacting their ability
to hold down a job, etc.).
MEDICAL/PHYSICAL
1 – 9 (ABOVE AVERAGE): Consistently enjoys excellent health. Infrequent minor ills cause little discomfort,
and are marked by rapid recovery. Physical injury is rare and healing is rapid. Not ill or injured at this time of
rating and in good physical condition.
10 – 19 (AVERAGE): No physical problems that interfere with daily life. Generally good health without undue
distress or disruption due to common ailments and minor injuries. Any chronic medical/physical condition is
sufficiently controlled or compensated for as to cause no more discomfort or inconvenience than is typical for
the age. No life-threatening conditions are present.
ADULT: Occasional common colds, fatigue, headaches, gastrointestinal upsets, and common ailments that is
endemic in the community. No sensory aids required. No medications.
CHILD: Occasional common ailments. Rapid recovery with no long-term effects. No sensory aids required.
No medications.
20 – 29 (Mild to Moderate): Occasional or mild physical problems that interfere with daily living. Physical
condition worse than what is typical of age, sex, and culture and life circumstances; manifested by mild chronic
disability, illness or injury, or common illness more frequent than most. Includes most persons without specific
disability, but frequent undiagnosed physical complaints. Disorders in this range could become life threatening
only with protracted lack of care.
ADULT: Controlled allergies. Needs glasses, hearing aid, or other prostheses, but can function without them.
Needs medication on a regular basis to control chronic medical problem.
CHILD: Illnesses more frequent than average. Controlled allergies. Needs glasses, hearing aid, or other
prostheses, etc.
30 – 39 (Moderate to Severe): Frequent and/or chronic problems with health. Person suffers from serious
injury, illness or other physical condition that definitely limits physical functioning (though it may not impair
psychological functioning or productivity in appropriately selected roles). Includes conditions that would be life
threatening without appropriate daily care. Cases requiring hospitalization or daily nursing care should be
rated 30 or above, but many less critical cases may be in this range also.
ADULT: Diabetes, asthma, moderate over/underweight or other evidence of eating disorder. Cannot function
without function without glasses, hearing aid or other prostheses. Heavy dependence on medications to
alleviate symptoms of chronic illness.
CHILD: Diabetes, asthma, moderate over/underweight or other evidence of eating disorder. Cannot function
without glasses, hearing aid, or other prostheses. Physical problems secondary to abuse. Heavy dependence
on medication.
40 – 49 (Incapacitating): Incapacitated due to medical/physical health. The person is physically
incapacitated by injury, illness, or other physical co9ndition. Condition may be temporary, permanent or
progressive, but all cases in this range require at least regular nursing-type care.
ADULT: Medical/physical problems are irreversible and incapacitating. Must have special medication in order
to survive.
CHILD: Medical/physical problems are irreversible and incapacitating.
50 (EXTREME): Critical medical/physical condition requiring constant professional attention to maintain life.
Include all persons in a general hospital intensive care unit.
NOTE: Include how the medical condition limits the customer’s day-to-day function for score of 20 and above.
Scoring Tips:
 When determining if a person scored in the 40-49 range, remember that symptoms must be at a level that is
“incapacitating”. A good guide for this is “but all cases in this range require at least regular nursing-type care”.
 When determining if a person scored in the 30-39 range, please note that just having Diabetes, Asthma, etc. does
not automatically equate a score in this range. In addition, symptoms/condition “definitely limits physical
functioning”.
FAMILY
1 – 9 (ABOVE AVERAGE): Family unit functions cohesively with strong mutual support for its members.
Individual differences are valued.
10 – 19 (AVERAGE): Major conflicts are rare or resolved without great difficulty. Relationships with other
family members are usually mutually satisfying.
*****DEFAULT TO AVERAGE RATING IF ADULT HAS NO FAMILY OR LACK OF FAMILY CONTACT.
Feelings about lack of contact would be noted in domain #1*****
ADULT: Primary relationships are good with normal amount of difficulties. Feels good with family relationships
and secure in parent role. Destructive behavior among family members is rare.
CHILD: Conflicts with parents or siblings are transient; family is able to resolve most differences promptly.
Parenting is supportive and family is stable.
20 – 29 (Mild to Moderate): Relationships within the family are mildly unsatisfactory. May include evidence of
occasional violence among family members. Family disruption is evident. Significant friction and turmoil
evidenced, on some consistent basis, which is not easily resolved.
ADULT: Family difficulties such that client occasionally thinks of leaving. Some strife with children.
CHILD: Problems with parents or other family members are persistent, leading to generally unsatisfactory
family life. Evidence of recurring conflict or even violence involving adults and children.
30 – 39 (Moderate to Severe): Occasional major or frequent minor disruption of family relationships. Family
does not function as a unit. Frequent turbulence and occasional violence involving adults and children.
ADULT: Turbulent primary relationship or especially disturbing break-up. Adult rage and/or violence directed
toward each other or children.
CHILD: Family inadequately supportive of child. Constant turmoil and friction. Family unit is disintegrating.
40- 49 (Incapacitating): Extensive disruption of family unit. Relationships within family are either extremely
tenuous or extremely destructive.
ADULT: Not capable of forming primary relationships. Unable to function in parenting role. Abusive or
abused.
CHILD: Isolated. Lacking family support. Abused or neglected.
50 (EXTREME): Total breakdown in relationships within family. Relationships that exist are physically
dangerous or psychologically devastating.

NOTE: For adults, note and score current, ACTIVE family problems only. For children report and score the
behavior of the current family as it affects the child.
Scoring Tips:
 When determining if a person scored in the 40-49 range, remember that symptoms must be at a level
that is “incapacitating”. A good guide for this is “Abusive or abused” for adults, and “Abused or
neglected” for children.
 Score only the current family system (in the last 30 days). Family system can include anyone that the
person identifies as family (ex: common law husband/wife might be scored here). Please note that if
someone is identified and scored as family, they should not be included and scored again under
domain 6. Interpersonal.

 
INTERPERSONAL
1 – 9 (ABOVE AVERAGE): Relationships are smooth and mutually satisfying. Conflicts that develop are
easily resolved. Person is able to choose among response styles to capably fit into a variety of relationships.
Social skills are highly developed.
ADULT: Has wide variety of social relationships and is sought out by others.
CHILD: Social skills highly developed for age.
10 – 19 (AVERAGE): Interpersonal relationships are mostly fruitful and mutually satisfying. Major conflicts are
rare or resolved without great difficulty. The person appears to be held in esteem within his or her culture.
ADULT: Good relationship with friends. Forms good working relationships with co-worker.
CHILD: Client is able to relate well to peers or adults without persistent difficulty.
20 – 29 (Mild to Moderate): Occasional or mild disruption of relationships with others. Relationships are
mildly unsatisfactory although generally adequate. May appear lonely or alienated although general
functioning is mostly appropriate.
ADULT: Some difficulty in developing or keeping friends. Problems with co-workers occasionally interfere with
getting work done.
CHILD: Some difficulty in forming or keeping friendships. May seem lonely or shy.
30 – 39 (Moderate to Severe): Occasional major or frequent disruption of interpersonal relationships. May be
actively disliked or virtually unknown by many with whom there is daily contact. Relationships are usually
fraught with difficulty.
ADULT: Has difficulty making and keeping friends such that the relationships are strained or tenuous.
Generally rejects or is rejected by co-workers; tenuous job relationships.
CHILD: Unable to attract friendships. Persistent quarreling or social withdrawal. Has not developed age
social skills.
40 – 49 (Incapacitating): Serious disruption of interpersonal relationships or incapacitation of ability to form
relationships. No close relationships; few, if any, casual associations which are satisfying.
ADULT: Socially extremely isolated. Argumentative style or extremely dependent style makes work
relationships virtually impossible.
CHILD: Socially extremely isolated. Rejected, unable to attach to peers appropriately.
50 (EXTEME): Relationship formation does not appear possible at the time of the rating.

NOTE: Relationships with family members are reported in domain #5.

Scoring Tips:
 When determining if a person scored in the 40-49 range, remember that symptoms must be at a level
that is “incapacitating”. A good guide for this is “No close relationships”.
 This domain scores only the person’s ability to make and maintain relationships outside of the family
system- not the type of people they choose to have relationships with. If they are maintaining
relationships with people who are getting them into trouble/putting them at risk, this may be a
consideration for poor judgment when scoring in domain #2.
ROLE PERFORMANCE
1 – 9 (ABOVE AVERAGE): The relevant role is managed in a superior manner. All tasks are done effectively
at or before the time expected. The efficiency of function is such that most of the tasks appear easier than for
others of the same age, sex, culture, and role choice.
10 – 19 (AVERAGE): Reasonably comfortable and competent in relevant roles. The necessary tasks are
accomplished adequately and usually within the expected time. There are occasional problems, but these are
resolved and satisfaction is derived from the chosen role.
ADULT: Holds a job for several years, without major difficulty. Student maintains acceptable grades with
minimum of difficulty. Shares responsibility in childcare. Home chores accomplished.
CHILD: Maintains acceptable grades and attendance. No evidence of behavior problems.
20 – 29 (Mild to Moderate): Occasional or mild disruption of role performance. Dysfunction may take the
form of chronic, mild overall inadequacy or sporadic failures of a more dramatic sort. In any case, performance
often falls short of expectation because of lack of ability or appropriate motivation.
ADULT: Unstable work history. Home chores frequently left undone; bills paid late.
CHILD: Poor grades in school. Frequent absences. Occasional disruptive behavior at school.
30 – 39 (Moderate to Severe): Occasional major or frequent disruption of role performance. Contribution in
the most relevant role is clearly marginal. Client seldom meets usual expectations and there is a high
frequency of significant consequences, i.e. firing, suspension.
ADULT: Frequently in trouble at work, or frequently fired. Home chores ignored; some bills defaulted.
CHILD: Expelled from school. Constantly disruptive and unable to function in school.
40 – 49 (Incapacitating): Severe disruption of role performance due to serious incapacity or absent
motivation. Attempts, if any, at productive functioning are ineffective and marked by clear failure.
ADULT: Client not employable. Is unable to comply with rules and regulations or fulfill ANY of the
expectations of the client’s current life circumstance.
CHILD: Expelled from school. Constantly disruptive and unable to function in school.
50 (EXTREME): Productive functioning of any kind is not only absent, but also inconceivable at the time of
rating.

NOTE: Identify and assess only the customer’s primary role. Family role would be described in domain #5. If
residing in an RCF, RCF resident would be considered the primary role. Score functioning relative to others in
the same life circumstance.
Scoring Tips:
 When determining if a person scored in the 40-49 range, remember that symptoms must be at a level
that is “incapacitating”. A good guide for this is “Attempts, if any, at productive functioning are
ineffective and marked by clear failure”.
SOCIO-LEGAL
1 – 9 (ABOVE AVERAGE): Almost conforms to rules and laws with ease, abiding by the “spirit” as well as the
“letter” of the law. Any rate deviations from rules or regulations are for altruistic purposes.
10 – 19 (AVERAGE): No disruption of socio-legal functioning problems. Basically a law-abiding person. Not
deliberately dishonest, conforms to most standards of relevant culture. Occasional breaking or bending of
rules with no harm to others.
ADULT: No encounters with the law, other than minor traffic violations.
CHILD: Generally conforms to rules. Misbehavior is non-repetitive, exploratory or mischievous.
20- 29 (Mild to Moderate): Occasional or mild disruption of socio-legal functioning. Occasionally bends or
violates rules or laws for personal gain, or convenience, when detection is unlikely and personal harm to others
is not obvious. Cannot always be relied on; may be in some trouble with the law or other authority more
frequently than most peers; has no conscious desire to harm others.
ADULT: Many traffic tickets. Creates hazard to others through disregard of normal safety practices.
CHILD: Disregards rules. May cheat or deceive for own gain
30 – 39 (Moderate to Severe): Occasional major or frequent disruption of socio-legal functioning. Conforms
to rules only when more convenient or profitable than violation. Personal gain outweighs concern for others
leading to frequent and/or serious violation of laws and other codes. May be seen as dangerous as well as
unreliable.
ADULT: Frequent contacts with the law, on probation, or paroled after being incarcerated for a felony.
Criminal involvement. Disregard for safety of others.
CHILD: Unable to consider rights of others at age appropriate level. Shows little concern for consequences of
actions. Frequent contact with the law. Delinquent type behaviors.
40 – 49 (Incapacitating): Serious disruption of socio-legal functioning. Actions are out of control without
regard for rules and law. Seriously disruptive to society and/or pervasively dangerous to the safety of others.
ADULT: In confinement or imminent risk of confinement due to illegal activities. Imminent danger to others or
property.
CHILD: In confinement or imminent risk of confinement due to delinquent acts.
50 (EXTREME): Total uncontrolled or antisocial behavior. Socially destructive and personally dangerous to
almost all unguarded persons.

NOTE: Since danger to others is a clear component of scores of 30 and over, a clear statement as to the
customer’s danger to others must be included in the request.

Scoring Tips:
 When determining if a person scored in the 40-49 range, remember that symptoms must be at a level
that is “incapacitating”. A good guide for this is “In confinement or imminent risk of confinement” due to
illegal activities/ delinquent acts.
SELF CARE/BASIC NEEDS
1 – 9 (ABOVE AVERAGE): Due to the fundamental nature of this realm of behavior, “above average” may be
rated only where needs can be adequately and independently obtained in spite of some serious obstacle such
as extreme age, serious physical handicap, severe poverty or social ostracism.
10 – 19 (AVERAGE): Customer is able to care for self and obtain or arrange for adequate meeting of all basic
needs without undue effort.
ADULT: Able to obtain or arrange for adequate housing, food, clothing and money without significant difficulty.
Has arranged dependable transportation.
CHILD: Able to care for self as well as most children of same age and developmental level.
20 – 29 (Mild to Moderate): Occasional or mild disruption of ability to obtain or arrange for adequate basic
needs. Disruption is not life threatening, even if continued indefinitely. Needs can be adequately met only with
partial dependence on illegitimate means, such as stealing, begging, coercion or fraudulent manipulation.
ADULT: Occasional assistance required in order to obtain housing, food and/or clothing. Frequently has
difficulty securing own transportation. Frequently short of funds.
CHILD: More dependent upon family or others for self care than would be developmentally appropriate for
age.
30 – 39 (Moderate to Severe): Occasional major or frequent disruption of ability to obtain or arrange for at
least some basic needs. Include denial of need for assistance or support, meeting needs wholly through
illegitimate means. Unable to maintain hygiene, diet, clothing and/or prepare food.
ADULT: Considerable assistance required in order to obtain housing, food and/or clothing. Consistent difficulty
in arranging for adequate finances. Usually depends on others for transportation. May need assistance in
caring for self.
CHILD: Ability to care for self considerably below age and developmental expectation.
40 – 49 (Incapacitating): Severe disruption of ability to independently meet or arrange for the majority of
basic needs by legitimate or illegitimate means. Unable to care for self in a safe and sanitary manner.
ADULT: Housing, food and/or clothing must be provided or arranged for by others. Incapable of obtaining any
means of financial support. Totally dependent on others for transportation.
CHILD: Cannot care for self. Extremely dependent for age and developmental level.
50 (EXTREME): Person totally unable to meet or arrange for any basic needs. Would soon die without
complete supportive care.

NOTE: When rating a child in this domain, rate on child’s functioning only, without regard to adequacy of
parent’s provisions for basic needs. The developmental level of the child must also be considered.

Scoring Tips:
 When determining if a person scored in the 40-49 range, remember that symptoms must be at a level
that is “incapacitating”. A good guide for this is “Severe disruption of ability to independently meet or
arrange for the majority of basic needs by legitimate or illegitimate means”.