Protocol - Social and Role Dysfunction in Psychosis and Schizophrenia

Current _________

Lowest Past Year___________

Highest Past Year___________

Superior social/interpersonal functioning

10

Superior functioning in a wide range of social and interpersonal activities. Frequently seeks out others and has multiple satisfying interpersonal relationships, including multiple close and casual friends. Is sought out by others because of his or her many positive qualities. Age-appropriate involvement in intimate relationships.

Above average social/interpersonal functioning

9

Good functioning in all social areas, and interpersonally effective.

Interested and involved in a wide range of social and interpersonal activities, including both close and casual friends. Age-appropriate involvement in intimate relationships. No more than everyday interpersonal problems or concerns (e.g., an occasional argument with spouse, girlfriend/boyfriend, friends, coworkers, or classmates). Able to resolve such conflicts appropriately.

Good social/interpersonal functioning

8

Some transient mild impairment in social functioning.

Mild social impairment is present, but transient and expectable reactions to psychosocial stressors (e.g., after minor arguments with spouse, girlfriend/boyfriend, friends, coworkers, or classmates). Has some meaningful interpersonal relationships with peers (casual and close friends), and/or age-appropriate intimate relationships. Infrequent interpersonal conflict with peers.

Mild problems in social/interpersonal functioning

7

Some persistent mild difficulty in social functioning.

Mild impairment present that is NOT just expectable reaction to psychosocial stressors (e.g., mild conflicts with peers, coworkers or classmates; difficulty resolving conflicts appropriately). Has some meaningful interpersonal relationships with peers (casual and/or close friends). Some difficulty developing or maintaining age-appropriate intimate relationships (e.g., multiple short-term relationships).

Moderate impairment in social/interpersonal functioning

6

Moderate impairment in social functioning.

Moderate impairment present (e.g., few close friends; significant but intermittent conflicts with peers, coworkers, or classmates). Moderate difficulty developing age-appropriate intimate relationships (e.g., infrequent dating). Occasionally seeks out others but will respond if invited by others to participate in an activity.

Serious impairment in social/interpersonal functioning

5

Serious impairment in social functioning.

No close friends or intimate partner but has some casual social contacts (e.g., acquaintances, school/work friends only). Rarely seeks out others. Occasional combative or verbally argumentative behavior with peers. Beginning to withdraw from family members (e.g., does not initiate conversation with family, but will respond if addressed).

Major impairment in social and interpersonal functioning

4

Major impairment in social functioning.

Serious impairment in relationships with friends or peers (e.g., very few or no friends, frequent conflicts with friends, or frequently avoids friends). Frequent combative or verbally argumentative behavior with peers. Infrequent contact with family members (e.g., sometimes does not respond to family or avoids family members).

Marginal ability to function socially

3

Marginal ability to function socially or maintain interpersonal relationships.

Frequently alone and socially isolated. Serious impairment in relationships with all peers, including acquaintances. Few interactions with family members (e.g., often alone in room). Serious impairment in communication with others (e.g., avoids participating in most social activities).

Inability to function socially

2

Unable to function socially or to maintain any interpersonal relationships.

Typically alone and socially isolated. Rarely leaves home. Rarely answers the phone or the door. Rarely participates in interactions with others at home or in other settings (e.g., work, school).

Extreme social isolation

1

Extreme social isolation.

No social or family member contact at all. Does not leave home. Refuses to answer the phone or door.

Current _________

Lowest Past Year___________

Highest Past Year___________

Superior role functioning

10

Independently maintains superior functioning in demanding roles. Obtains only superior performance evaluations at competitive work placement. Obtains all A’s in mainstream school. Generates, organizes, and completes all homemaking tasks with ease.

Above-average role functioning

9

Independently maintains very good functioning in demanding roles. Rarely absent or unable to perform. Obtains good-to-superior performance evaluations at competitive work placement. Obtains grades in A and B range in all courses in mainstream school. Generates, organizes, and completes all homemaking tasks.

Good role functioning

8

Independently maintains good role functioning in demanding roles. Occasionally falls behind on tasks but always catches up; obtains satisfactory performance evaluations at competitive work placement; obtains grades of C and above in mainstream school; occasional difficulty generating or organizing homemaking tasks; or maintains above-average performance with minimal support (e.g., tutoring, reduced academic course load at 4-year university, attends community college, may receive additional guidance at work less than 1-2 times a week). Receives A’s and B’s, good work/school evaluations, and completes all tasks with this level of support.

Mild impairment in role functioning

7

Mildly impaired functioning in demanding roles independently. Frequently behind on tasks or unable to perform; frequently obtains poor performance evaluations at competitive work placement or grades of D’s or better in mainstream school; frequent difficulty generating or organizing homemaking tasks; or maintains good performance with minimal support (e.g., minimal accommodations in general education classroom, receives additional guidance/support at work 1-2 times a week). Receives C’s or higher, satisfactory work/school evaluations, and completes most homemaking tasks with this level of support.

Moderate impairment in role functioning

6

Moderate impairment independently. May receive occasional F in mainstream courses, persistently poor performance evaluations at competitive work placement; may change jobs because of poor performance, persistent difficulty generating, or organizing homemaking tasks; or requires partial support (some resource or special education courses, receives guidance/support at work 2 times per week). May require less demanding or part-time jobs and/or some supervision in home environment but functions well or adequately given these supports (may fall behind but eventually completes assigned tasks, obtains satisfactory evaluations at work or passing grades in school).

Serious Impairment in Role Functioning

5

Serious impairment independently. Failing multiple courses in mainstream school, may lose job, or unable to complete most homemaking tasks independently; or in entirely special education classes, requires less demanding job/daily support or guidance, may require vocational rehabilitation, and/or some supervision in home environment but maintains ‘‘above average’’ performance-receives A’s and B’s, good evaluations at work/school, completes all tasks.

Major impairment in social and interpersonal functioning

4

Very serious impairment independently. All F’s in mainstream school or failing out of school; cannot obtain or hold independent job or unable to complete virtually any homemaking tasks independently; or adequate to good functioning with major support. Requires assisted work environment, entirely special education classes, nonpublic or psychiatric school, home schooling for the purpose of a supportive school environment, and/or supported home environment but functions adequately given these supports (may fall behind but completes assigned tasks, obtains satisfactory performance evaluations at work or passing grades).

Marginal ability to function

3

Impaired functioning with major support. Requires supported work environment, entirely special education classes, nonpublic or psychiatric school, home schooling for the purpose of a supportive school environment, and/or supported home environment but functions poorly despite these supports (persistently behind on tasks, frequently unable to perform, obtains poor performance evaluations at work or fails courses at school).

Inability to function

2

Disabled but participates in structured activities. On disability or equivalent nonindependent status. Not working for pay, attending classes for grades, or living independently. Spends 5 or more hours a week in structured role-related activities (e.g., residential treatment, volunteering, tutoring, sheltered work programs).

Extreme role dysfunction

1

Severely disabled. On disability or equivalent nonindependent status. Not working for pay, attending classes for grades, or living independently. Spends fewer than 5 hours a week in structured role-related activities.