LEVEL 4 LEVEL 3 LEVEL 2 1 Areas of Functioning (4 points) (3 points) (2 points) (1 point) TREATMENT ADHERENCE (continued) Client reports no support Client reports Client reports gaps in Client reports strong TREATMENT SUPPORT system (no family, friends inconsistent and/or no availability and adequacy support from family, or peers); dependable support of support system from friends and OR system; family and friends; AND Client is in imminent OR AND Client has disclosed HIV danger of being in crisis; Client is isolated from Client is requesting status to his/her support OR families, social groups, additional support; system. Client resists referrals and and/or may be new to AND assistance with taking area; Client has disclosed HIV medication. OR status to his/her support Client has not disclosed system. status to family members due to fear of stigma. Score: Details any emotional, cognitive, disordered and/or addictive behaviors diagnosed, displayed, or reported by the BEHAVIORAL HEALTH Client and the impact of these behaviors on the Client’s ability to collaborate with health care professionals and adhere to health care regimens. Client expresses or Client self-reports mental Client self-reports mental Client self-reports no exhibits behavior that illness or history of mental illness or history of mental history of mental illness MENTAL HEALTH indicates the Client is a illness and is in treatment illness and receives and does not exhibit any danger to self and/or but is non- compliant with treatment and/or is behavior that may need others; following treatment evaluated consistently; an assessment. OR prescribed. and condition is stable. Client has been diagnosed with mental illness and is not in Score: treatment.
Areas of Functioning LEVEL 4 (4 points) LEVEL 3 (3 points) LEVEL 2 (2 points) 1 (1 point) TREATMENT ADHERENCE (continued) TREATMENT SUPPORT Score: Client reports no support system (no family, friends or peers); OR Client is in imminent danger of being in crisis; OR Client resists referrals and assistance with taking medication. Client reports inconsistent and/or no dependable support system; OR Client is isolated from families, social groups, and/or may be new to area; OR Client has not disclosed status to family members due to fear of stigma. Client reports gaps in availability and adequacy of support system from family and friends; AND Client is requesting additional support; AND Client has disclosed HIV status to his/her support system. Client reports strong support from family, friends and AND Client has disclosed HIV status to his/her support system. BEHAVIORAL HEALTH Details any emotional, cognitive, disordered and/or addictive behaviors diagnosed, displayed, or reported by the Client and the impact of these behaviors on the Client’s ability to collaborate with health care professionals and adhere to health care regimens. MENTAL HEALTH Score: Client expresses or exhibits behavior that indicates the Client is a danger to self and/or others; OR Client has been diagnosed with mental illness and is not in treatment. Client self-reports mental illness or history of mental illness and is in treatment but is non- compliant with following treatment prescribed. Client self-reports mental illness or history of mental illness and receives treatment and/or is evaluated consistently; and condition is stable. Client self-reports no history of mental illness and does not exhibit any behavior that may need an assessment.
ELECTRONIC_Standardized_Michigan_HIV_MCM_Acuity_Pilot_Tool_2.2016_517969_7.docx