Domain 3 - Functioning (Primary Domain)

Overview

This domain considers functional impairment associated with or exacerbated by mental health issues. While some types of illnesses, disabilities and developmental delays being experienced by the child may play a role in determining what types of support services may be required, they should generally not be considered in determining mental health service intensity within a stepped care continuum.

Assessment of a child on this domain should consider the impact of the mental health issues on:

  • The child’s ability to fulfil usual roles/responsibilities appropriate to their age, developmental level, capability, and cultural background.

  • The child’s functioning within the family or home environment, in educational settings, with friends and peers, at play and in the community.

  • The child’s ability to undertake basic activities of daily living appropriate to their age, capability, and developmental level (e.g., self-care, mobility, toileting, nutrition, and personal hygiene).

Scoring

0 = No problem in this domain

1 = Mild impact

  1. Mildly diminished ability to function in one or more of their usual roles (e.g., at home, in educational settings, with friends and peers, at play and in the community), but without significant or adverse consequences.

  2. Mental health issues contribute to brief and transient disruptions in one or more areas of functioning.

2 = Moderate impact

  1. Moderate functional impairment in more than one of their usual roles (e.g., at home, in educational settings, with friends and peers, at play and in the community) to the extent that they are reasonably frequently unable to meet the requirements of those roles, but without significant or adverse consequences.

  2. Mental health issues contribute to occasional difficulties with basic activities of daily living (e.g., eating, mobility, bathing, getting dressed, and toileting) or instrumental activities of daily living (e.g., preparing food, tidying up, completing tasks) but without threat to health.

3 = Severe impact

  1. Significant difficulties with functioning, resulting in disruption to many areas of the child’s life most of the time (e.g., limited participation in educational or recreational activities, deterioration in or some withdrawal from relationships with friends and peers), but the child can function independently with adequate treatment, family, and community support.

  2. Mental health issues frequently contribute to difficulties with basic activities of daily living (e.g., eating, mobility, bathing, getting dressed, and toileting) or instrumental activities of daily living (e.g., preparing food, tidying up, completing tasks) on a consistent basis but without threat to health.

4 = Very severe to extreme impact

  1. Profound difficulties with functioning, resulting in significant disruption to virtually all areas of the child’s life (e.g., unable to participate in educational activities, complete withdrawal from friends and peers).

  2. Mental health issues contribute to severe and persistent self-neglect that poses a threat to health.