Domains applicable to schizophrenia

.... ................... 1. Behaviour ....... .................................. 2. Cognition ..... ................................ 3. Psychogical/emotion ......... ............ 4. Comunication

P
S	S
H	H	H	H
M	M	M	M
L	L	L	L
N	N	N	N

A full assessment for NHS continuing healthcare is required if there are:
• two or more domains selected in column A;
• five or more domains selected in column B, or one selected in A and four in B; or
• one domain selected in column A in one of the boxes marked with an asterisk
(i.e. those domains that carry a priority [ P ] level in the Decision Support Tool),
with any number of selections in the other two columns.

The first four are the Domains that apply to schizophrenia.

Remembering also Domain twelve

[ 76. In certain cases, an individual may have particular needs that are not easily categorised by the care domains described here.
In such circumstances, it is the responsibility of the assessors to determine the extent and type of the need
and to take that need into account (and record it in the 12th care domain)
when deciding whether a person has a primary health need. ]

1. Enter below a brief description of the actual needs of the individual, including providing
the evidence why the level in the table overleaf has been chosen (referring to appropriate risk assessments),
and referring to the frequency and intensity of need, unpredictability, deterioration and any instability.
2. Circle the assessed level overleaf.

Name of patient		Date of completion
Please circle statement A, B or C in each domain	C	B	A	Evidence in records to support this level
Behaviour*	No evidence of ‘challenging’ behaviour. OR Some incidents of ‘challenging’ behaviour. A risk assessment indicates that the behaviour does not pose a risk to self or others or a barrier to intervention. The person is compliant with all aspects of their care.	‘Challenging’ behaviour that follows a predictable pattern. The risk assessment indicates a pattern of behaviour that can be managed by skilled carers or care workers who are able to maintain a level of behaviour that does not pose a risk to self or others. The person is nearly always compliant with care.	‘Challenging’ behaviour that poses a predictable risk to self or others. The risk assessment indicates that planned interventions are effective in minimising but not always eliminating risks. Compliance is variable but usually responsive to planned interventions.
Cognition	No evidence of impairment, confusion or disorientation. OR Cognitive impairment (for example, difficulties in retrieving short-term memory) which requires some supervision, prompting or assistance with more complex activities of daily living, such as finance and medication, but awareness of basic risks that affect their safety is evident. OR Occasional difficulty with memory and decisions/choices requiring support, prompting or assistance. However, the individual has insight into their impairment.	Cognitive impairment (which may include some memory issues) that requires some supervision, prompting and/or assistance with basic care needs and daily living activities. Some awareness of needs and basic risks is evident. The individual is usually able to make choices appropriate to needs with assistance. However, the individual has limited ability even with supervision, prompting or assistance to make decisions about some aspects of their lives, which consequently puts them at some risk of harm, neglect or health deterioration.	Cognitive impairment that could include marked short-term memory issues and maybe disorientation in time and place. The individual has awareness of only a limited range of needs and basic risks. Although they may be able to make choices appropriate to need on a limited range of issues, they are unable to do so on most issues, even with supervision, prompting or assistance. The individual finds it difficult, even with supervision, prompting or assistance, to make decisions about key aspects of their lives, which consequently puts them at high risk of harm, neglect or health deterioration.
Psychological/ Emotional	Psychological and emotional needs are not having an impact on their health and well-being. OR Mood disturbance or anxiety or periods of distress, which are having an impact on their health and/or well-being but respond to prompts and reassurance. OR Requires prompts to motivate self towards activity and to engage in care planning, support and/or daily activities.	Mood disturbance or anxiety symptoms or periods of distress which do not readily respond to prompts and reassurance and have an increasing impact on the individual’s health and/or well-being. OR Withdrawn from most attempts to engage them in support, care planning and/or daily activities.	Mood disturbance or anxiety symptoms or periods of distress that have a severe impact on the individual’s health and/or well-being. OR Withdrawn from any attempts to engage them in care planning, support and daily activities.
Communication	Able to communicate clearly, verbally or non-verbally. Has a good understanding of their primary language. May require translation if English is not their first language. OR Needs assistance to communicate their needs. Special effort may be needed to ensure accurate interpretation of needs or additional support may be needed either visually, through touch or with hearing.	Communication about needs is difficult to understand or interpret or the individual is sometimes unable to reliably communicate, even when assisted. Carers or care workers may be able to anticipate needs through non-verbal signs due to familiarity with the individual.	Unable to reliably communicate their needs at any time and in any way, even when all practicable steps to do so have been taken. The person has to have most of their needs anticipated because of their inability to communicate them.
Mobility	Independently mobile. OR Able to weight bear but needs some assistance and/or requires mobility equipment for daily living.	Not able to consistently weight bear. OR Completely unable to weight bear but is able to assist or cooperate with transfers and/or repositioning. OR In one position (bed or chair) for majority of the time but is able to cooperate and assist carers or care workers.	Completely unable to weight bear and is unable to assist or cooperate with transfers and/or repositioning. OR Due to risk of physical harm or loss of muscle tone or pain on movement needs careful positioning and is unable to cooperate. OR At a high risk of falls (as evidenced in a falls risk assessment). OR Involuntary spasms or contractures placing themselves and carers or care workers at risk.
Nutrition	Able to take adequate food and drink by mouth to meet all nutritional requirements. OR Needs supervision, prompting with meals, or may need feeding and/or a special diet. OR Able to take food and drink by mouth but requires additional/supplementary feeding.	Needs feeding to ensure adequate intake of food and takes a long time (half an hour or more), including liquidised feed. OR Unable to take any food and drink by mouth, but all nutritional requirements are being adequately maintained by artificial means, for example via a non-problematic PEG.	Dysphagia requiring skilled intervention to ensure adequate nutrition/hydration and minimise the risk of choking and aspiration to maintain airway. OR Subcutaneous fluids that are managed by the individual or specifically trained carers or care workers. OR Nutritional status ‘at risk’ and may be associated with unintended, significant weight loss. OR Significant weight loss or gain due to an identified eating disorder. OR Problems relating to a feeding device (e.g. PEG) that require skilled assessment and review.
Continence	Continent of urine and faeces. OR Continence care is routine on a day-to-day basis. OR Incontinence of urine managed through, for example, medication, regular toileting, use of penile sheaths, etc. AND Is able to maintain full control over bowel movements or has a stable stoma, or may have occasional faecal incontinence.	Continence care is routine but requires monitoring to minimise risks, for example those associated with urinary catheters, double incontinence, chronic urinary tract infections and/or the management of constipation.	Continence care is problematic and requires timely and skilled intervention, beyond routine care.
Skin integrity	No risk of pressure damage or skin condition. OR Risk of skin breakdown which requires preventative intervention once a day or less than daily, without which skin integrity would break down. OR Evidence of pressure damage and/or pressure ulcer(s) either with ‘discolouration of intact skin’ or a minor wound. OR A skin condition that requires monitoring or reassessment less than daily and that is responding to treatment or does not currently require treatment.	Risk of skin breakdown which requires preventative intervention several times each day, without which skin integrity would break down. OR Pressure damage or open wound(s), pressure ulcer(s) with ‘partial thickness skin loss involving epidermis and/or dermis’, which is responding to treatment. OR A skin condition that requires a minimum of daily treatment, or daily monitoring/reassessment to ensure that it is responding to treatment.	Pressure damage or open wound(s), pressure ulcer(s) with ‘partial thickness skin loss involving epidermis and/or dermis’, which is not responding to treatment. OR Pressure damage or open wound(s), pressure ulcer(s) with ‘full thickness skin loss involving damage or necrosis to subcutaneous tissue, but not extending to underlying bone, tendon or joint capsule’, which is responding to treatment. OR Specialist dressing regime in place which is responding to treatment.
Breathing*	Normal breathing, no issues with shortness of breath. OR Shortness of breath, which may require the use of inhalers or a nebuliser and has no impact on daily living activities. OR Episodes of breathlessness that readily respond to management and have no impact on daily living activities.	Shortness of breath, which may require the use of inhalers or a nebuliser and limit some daily living activities. OR Episodes of breathlessness that do not respond to management and limit some daily activities. OR Requires any of the following: low level oxygen therapy (24%); room air ventilators via a facial or nasal mask; other therapeutic appliances to maintain airflow. OR CPAP (Continuous Positive Airways Pressure).	Is able to breathe independently through a tracheotomy that they can manage themselves, or with the support of carers or care workers. OR Breathlessness due to a condition which is not responding to therapeutic treatment and limits all daily living activities.
Drug therapies and medication: symptom control*	Symptoms are managed effectively and without any problems, and medication is not resulting in any unmanageable side-effects. OR Requires supervision/administration of and/or prompting with medication or may have a physical, mental state or cognitive impairment requiring support to take medication, but shows compliance with medication regime. OR Mild pain that is predictable and/or is associated with certain activities of daily living; pain and other symptoms do not have an impact on the provision of care.	Requires the administration of medication due to: – non-concordance or non-compliance – type of medication (for example insulin); or – route of medication (for example PEG, liquid medication). OR Moderate pain which follows a predictable pattern; or other symptoms which are having a moderate effect on other domains or on the provision of care.	Requires administration and monitoring of medication regime by a registered nurse, carer or care worker specifically trained for this task because there are risks associated with the potential fluctuation of the medical condition or mental state, or risks regarding the effectiveness of the medication or the potential nature or severity of side-effects. However, with such monitoring the condition is usually non-problematic to manage. OR Moderate pain or other symptoms which is/are having a significant effect on other domains or on the provision of care.
Altered states of consciousness*	No evidence of altered states of consciousness (ASC). OR History of ASC but effectively managed and there is a low risk of harm.	Occasional episodes of ASC that require the supervision of a carer or care worker to minimise the risk of harm.	Frequent episodes of ASC that require the supervision of a carer or care worker to minimise the risk of harm. OR Occasional ASCs that require skilled intervention to reduce the risk of harm.
Total from all pages

Name of patient		Date of completion
Please circle statement A, B or C in each domain	C	B	A	Evidence in records to support this level
Behaviour*	No evidence of ‘challenging’ behaviour. OR Some incidents of ‘challenging’ behaviour. A risk assessment indicates that the behaviour does not pose a risk to self or others or a barrier to intervention. The person is compliant with all aspects of their care.	‘Challenging’ behaviour that follows a predictable pattern. The risk assessment indicates a pattern of behaviour that can be managed by skilled carers or care workers who are able to maintain a level of behaviour that does not pose a risk to self or others. The person is nearly always compliant with care.	‘Challenging’ behaviour that poses a predictable risk to self or others. The risk assessment indicates that planned interventions are effective in minimising but not always eliminating risks. Compliance is variable but usually responsive to planned interventions.
Cognition	No evidence of impairment, confusion or disorientation. OR Cognitive impairment (for example, difficulties in retrieving short-term memory) which requires some supervision, prompting or assistance with more complex activities of daily living, such as finance and medication, but awareness of basic risks that affect their safety is evident. OR Occasional difficulty with memory and decisions/choices requiring support, prompting or assistance. However, the individual has insight into their impairment.	Cognitive impairment (which may include some memory issues) that requires some supervision, prompting and/or assistance with basic care needs and daily living activities. Some awareness of needs and basic risks is evident. The individual is usually able to make choices appropriate to needs with assistance. However, the individual has limited ability even with supervision, prompting or assistance to make decisions about some aspects of their lives, which consequently puts them at some risk of harm, neglect or health deterioration.	Cognitive impairment that could include marked short-term memory issues and maybe disorientation in time and place. The individual has awareness of only a limited range of needs and basic risks. Although they may be able to make choices appropriate to need on a limited range of issues, they are unable to do so on most issues, even with supervision, prompting or assistance. The individual finds it difficult, even with supervision, prompting or assistance, to make decisions about key aspects of their lives, which consequently puts them at high risk of harm, neglect or health deterioration.
Psychological/ Emotional	Psychological and emotional needs are not having an impact on their health and well-being. OR Mood disturbance or anxiety or periods of distress, which are having an impact on their health and/or well-being but respond to prompts and reassurance. OR Requires prompts to motivate self towards activity and to engage in care planning, support and/or daily activities.	Mood disturbance or anxiety symptoms or periods of distress which do not readily respond to prompts and reassurance and have an increasing impact on the individual’s health and/or well-being. OR Withdrawn from most attempts to engage them in support, care planning and/or daily activities.	Mood disturbance or anxiety symptoms or periods of distress that have a severe impact on the individual’s health and/or well-being. OR Withdrawn from any attempts to engage them in care planning, support and daily activities.
Communication	Able to communicate clearly, verbally or non-verbally. Has a good understanding of their primary language. May require translation if English is not their first language. OR Needs assistance to communicate their needs. Special effort may be needed to ensure accurate interpretation of needs or additional support may be needed either visually, through touch or with hearing.	Communication about needs is difficult to understand or interpret or the individual is sometimes unable to reliably communicate, even when assisted. Carers or care workers may be able to anticipate needs through non-verbal signs due to familiarity with the individual.	Unable to reliably communicate their needs at any time and in any way, even when all practicable steps to do so have been taken. The person has to have most of their needs anticipated because of their inability to communicate them.
Mobility	Independently mobile. OR Able to weight bear but needs some assistance and/or requires mobility equipment for daily living.	Not able to consistently weight bear. OR Completely unable to weight bear but is able to assist or cooperate with transfers and/or repositioning. OR In one position (bed or chair) for majority of the time but is able to cooperate and assist carers or care workers.	Completely unable to weight bear and is unable to assist or cooperate with transfers and/or repositioning. OR Due to risk of physical harm or loss of muscle tone or pain on movement needs careful positioning and is unable to cooperate. OR At a high risk of falls (as evidenced in a falls risk assessment). OR Involuntary spasms or contractures placing themselves and carers or care workers at risk.
Nutrition	Able to take adequate food and drink by mouth to meet all nutritional requirements. OR Needs supervision, prompting with meals, or may need feeding and/or a special diet. OR Able to take food and drink by mouth but requires additional/supplementary feeding.	Needs feeding to ensure adequate intake of food and takes a long time (half an hour or more), including liquidised feed. OR Unable to take any food and drink by mouth, but all nutritional requirements are being adequately maintained by artificial means, for example via a non-problematic PEG.	Dysphagia requiring skilled intervention to ensure adequate nutrition/hydration and minimise the risk of choking and aspiration to maintain airway. OR Subcutaneous fluids that are managed by the individual or specifically trained carers or care workers. OR Nutritional status ‘at risk’ and may be associated with unintended, significant weight loss. OR Significant weight loss or gain due to an identified eating disorder. OR Problems relating to a feeding device (e.g. PEG) that require skilled assessment and review.
Continence	Continent of urine and faeces. OR Continence care is routine on a day-to-day basis. OR Incontinence of urine managed through, for example, medication, regular toileting, use of penile sheaths, etc. AND Is able to maintain full control over bowel movements or has a stable stoma, or may have occasional faecal incontinence.	Continence care is routine but requires monitoring to minimise risks, for example those associated with urinary catheters, double incontinence, chronic urinary tract infections and/or the management of constipation.	Continence care is problematic and requires timely and skilled intervention, beyond routine care.
Skin integrity	No risk of pressure damage or skin condition. OR Risk of skin breakdown which requires preventative intervention once a day or less than daily, without which skin integrity would break down. OR Evidence of pressure damage and/or pressure ulcer(s) either with ‘discolouration of intact skin’ or a minor wound. OR A skin condition that requires monitoring or reassessment less than daily and that is responding to treatment or does not currently require treatment.	Risk of skin breakdown which requires preventative intervention several times each day, without which skin integrity would break down. OR Pressure damage or open wound(s), pressure ulcer(s) with ‘partial thickness skin loss involving epidermis and/or dermis’, which is responding to treatment. OR A skin condition that requires a minimum of daily treatment, or daily monitoring/reassessment to ensure that it is responding to treatment.	Pressure damage or open wound(s), pressure ulcer(s) with ‘partial thickness skin loss involving epidermis and/or dermis’, which is not responding to treatment. OR Pressure damage or open wound(s), pressure ulcer(s) with ‘full thickness skin loss involving damage or necrosis to subcutaneous tissue, but not extending to underlying bone, tendon or joint capsule’, which is responding to treatment. OR Specialist dressing regime in place which is responding to treatment.
Breathing*	Normal breathing, no issues with shortness of breath. OR Shortness of breath, which may require the use of inhalers or a nebuliser and has no impact on daily living activities. OR Episodes of breathlessness that readily respond to management and have no impact on daily living activities.	Shortness of breath, which may require the use of inhalers or a nebuliser and limit some daily living activities. OR Episodes of breathlessness that do not respond to management and limit some daily activities. OR Requires any of the following: low level oxygen therapy (24%); room air ventilators via a facial or nasal mask; other therapeutic appliances to maintain airflow. OR CPAP (Continuous Positive Airways Pressure).	Is able to breathe independently through a tracheotomy that they can manage themselves, or with the support of carers or care workers. OR Breathlessness due to a condition which is not responding to therapeutic treatment and limits all daily living activities.
Drug therapies and medication: symptom control*	Symptoms are managed effectively and without any problems, and medication is not resulting in any unmanageable side-effects. OR Requires supervision/administration of and/or prompting with medication or may have a physical, mental state or cognitive impairment requiring support to take medication, but shows compliance with medication regime. OR Mild pain that is predictable and/or is associated with certain activities of daily living; pain and other symptoms do not have an impact on the provision of care.	Requires the administration of medication due to: – non-concordance or non-compliance – type of medication (for example insulin); or – route of medication (for example PEG, liquid medication). OR Moderate pain which follows a predictable pattern; or other symptoms which are having a moderate effect on other domains or on the provision of care.	Requires administration and monitoring of medication regime by a registered nurse, carer or care worker specifically trained for this task because there are risks associated with the potential fluctuation of the medical condition or mental state, or risks regarding the effectiveness of the medication or the potential nature or severity of side-effects. However, with such monitoring the condition is usually non-problematic to manage. OR Moderate pain or other symptoms which is/are having a significant effect on other domains or on the provision of care.
Altered states of consciousness*	No evidence of altered states of consciousness (ASC). OR History of ASC but effectively managed and there is a low risk of harm.	Occasional episodes of ASC that require the supervision of a carer or care worker to minimise the risk of harm.	Frequent episodes of ASC that require the supervision of a carer or care worker to minimise the risk of harm. OR Occasional ASCs that require skilled intervention to reduce the risk of harm.
Total from all pages

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