Initial assessment is undertaken across eight domains that aim to describe clinical severity and service needs using a 5-point scale, ranging from 0 to 4. Higher ratings indicate increased severity of problem and need for higher (more intensive) levels of care.
Within each domain, each rating is defined by one or more descriptors which are designated by alpha characters (a, b, c etc.). Only one of these descriptors need to be met for a rating to be assigned to the person.
Overarching Rules and Guides to Ratings¶
Within each domain, if more than one descriptor applies to the consumer, the descriptor with the highest rating should be selected.
- Example one: if 3-b, and 3-c apply, but 4-a is also present, the rating selected is 4.
- Example two: if 2-a and 2-b apply, but 3-c is also present, the rating selected is 3.
Unless stated otherwise, rate the person’s current situation, defined as their most typical over the past month. This recognises that personal and social circumstances can change.
Use all available information in making your rating. This may include clinical interview and information gathered from the person’s family, referrers, or other informants.
The coding of ratings as numerals is not intended to imply that an overall composite score can be used for making decisions about the person’s service needs. The numbers should be regarded as just shorthand for summarising severity.
Guidance is given for each domain on examples of problems that should be considered for specific ratings (the ‘descriptors’). Consider these as examples only rather than an exhaustive list of all factors relevant to the domain. Therefore, at times, referring to the underlying rating format may be helpful.
If there is uncertainty in the ratings, do not rate up. Seek additional information that will allow you to rate with certainty. Where uncertainty remains even after the additional information is obtained, the individual should be supported to access an appropriate clinician for a comprehensive assessment.
- This tool should not be used without clinical oversight.
- It should not be used as a screening tool because it cannot be used without some form of personalised assessment.
Primary Assessment vs. Contextual Domains¶
The eight domains fall into two categories:
- Primary Assessment Domains (Domains 1 to 4): These cover Symptom Severity and Distress, Risk of Harm, Functioning and Impact of Co-existing Conditions. Primary Assessment Domains represent the basic areas for initial assessment that have direct implications for decisions about assignment to a level of care.
- Contextual Domains (Domains 5 to 8): These cover Treatment and Recovery History, Social and Environmental Stressors, Family and Other Supports and Engagement and Motivation. Assessment on these domains provides essential context to moderate decisions indicated by the primary domains.
A rating system grades each Domain on a 5-point rating scale of severity. While terms vary, the rating scale for each domain follows the general format:
0 = No problem1 = Mild problem2 = Moderate problem3 = Severe problem4 = Very severe problem
Specific criteria are outlined for assessing each domain, designed to serve as a checklist of factors to consider when judging the extent to which a problem is present.