Scoring and Next Steps
This questionnaire is meant to serve as a guide only, to assist physicians to help family members providing ongoing care to the chronically ill and disabled. To start, download and print a version of the questionnaire below and give it to your patient/caregiver to fill out.
Determining the score
- Reverse score questions 5 and 15. (For example, a "No" response should be counted as "Yes" and a "Yes" response should be counted as "No".)
- Total the number of "yes" responses.
Interpreting the score
A high degree of distress is likely:
- If the total "Yes" score = 10 or more.
- If the score on Question 17 (perceived stress) is 6 or higher.
- If the score on Question 18 (perceived health) is 6 or higher.
- If the answers are "Yes" to any of the following: Q1 (distractibility), Q4 (overwhelmed), Q9 (irritability), Q10 (sleeplessness), Q11 (crying spells), Q13 (back pain), Q14 (illness).
Any "Yes" responses to the questions on the Caregiver Self-assessment Questionnaire suggest that:
- The caregiver needs further assessment to determine the need for counseling/intervention.
- The caregiver might benefit from a medical check-up or referral to their personal physician (suggest they take the questionnaire to show).
- The caregiver might benefit from joining a support group.
- The caregiver be encouraged to arrange some relief from caregiving.
- The physician discuss available community resources and refer as appropriate.
- The physician consider a referral to social services.