Intensive Need Moderate Need Need Self Management Area of Functioning (3) (2) (1) (0) Relationships and Support Systems Reports feeling isolated or Reports no close relationships, Reports having a support system, unsupported in current family, or supportive but identified need for regular Has satisfactory social support relationships (e.g. family and relationships check-ins from MCM friends) Has not disclosed HIV status to Support Systems and any members of social support Has disclosed HIV status to some Relationships system due to stigma, language members of support system which Has disclosed HIV status to most Has disclosed HIV status to all barriers, cultural beliefs around moderately impacts social members of support system members of support system HIV, etc. directly impacts isolation social interactions Relies on MCM, peer, or other program staff for social support Has experienced intimate partner Reports current or potential Past experience with intimate violence in the past that impacts Acuity Score: intimate partner violence and partner violence does not impact current relationships, financial needs immediate intervention present care situation, housing status, etc. Comments (include referrals needed): Intensive Need Moderate Need Basic Need Self Management Area of Functioning (3) (2) (1) (0) Income
Area of Functioning Intensive Need (3) Moderate Need (2) Need (1) Self Management (0) Relationships and Support Systems Support Systems and Relationships Reports no close relationships, family, or supportive relationships Reports feeling isolated or unsupported in current relationships (e.g. family and friends) Reports having a support system, but identified need for regular check-ins from MCM Has satisfactory social support Has not disclosed HIV status to any members of social support system due to stigma, language barriers, cultural beliefs around HIV, etc. directly impacts social interactions Has disclosed HIV status to some members of support system which moderately impacts social isolation Has disclosed HIV status to most members of support system Has disclosed HIV status to all members of support system Relies on MCM, peer, or other program staff for social support Acuity Score: Reports current or potential intimate partner violence and needs immediate intervention Has experienced intimate partner violence in the past that impacts current relationships, financial situation, housing status, etc. Past experience with intimate partner violence does not impact present care Comments (include referrals needed): Area of Functioning Intensive Need (3) Moderate Need (2) Basic Need (1) Self Management (0) Income