Social Functioning Questionnaire

Social Functioning Questionnaire
The Social Functioning Questionnaire is designed to enable a detailed assessment of an

individuals social functioning for both rehabilitation and research purposes. It is divided
into 5 sections, each containing 8 items to be completed for each person: Self-care Skills,
Domestic Skills, Community Skills, Social Skills and Responsibility.
In addition, there are ten Index Items which are asterisked and can be used to derive a
global measure of social functioning that enables comparison with populations which have
been assessed using the Community Placement Questionnaire (also available form RDP).
The questionnaire is to be completed by care staff on the basis of the persons observed
performance in the past month.
The abbreviation E? ask whether the patient /resident is expected to complete that task on
a regular basis. Circle Yes or No as appropriate.
All items are to be completed. If there has been no opportunity to observe, the answer is
not known or the item inapplicable enter 9 in the box next to the question.
The Summary Sheet enables quick identification of problem areas and also the production
of a social functioning profile. This is produced by summing the items for which a rating has
been made in each section and dividing that Total Score by the number of items completed.
This Mean Score can then be entered as a bar in the graph provided. In addition, the Global
Measure of Social Functioning may be derived similarly from the ten Index Items and
entered as a cross in the graph.
The Intervention Sheet is provided for staff to enter details of programmes decided upon on
the basis of the assessment and may be used to fill out details of the problems identified in
each area and to record progress etc.
A further questionnaire, the Problems Questionnaire, is available. This questionnaire

assesses behavioural and psychological problems and is designed to complement the Social
Functioning Questionnaire and the Community Placement Questionnaire to provide an
integrated set of schedules that may be used for individual programme planning, service
planning and research purposes.
Note: The Social Functioning Questionnaire is a modification by Paul Clifford and Isobel
Morris of the Adaptive Functioning Scale developed by Tilly Latimer-Sayer and Isobel Morris.
A. SELF-CARE SKILLS
*1 Personal Appearance
4 = Maintains a neat and tidy appearance without help or prompting from staff
3 = Maintains neat appearance but needs some supervision
2 = Maintains a neat appearance with close and regular supervision
1 = Does not maintain neat appearance, even with supervision. Major problems
with this item
2 Appropriate of Clothing
4= Dresses appropriately without prompting. Wear clothing appropriate to age, sex and
weather.
3= Dresses appropriately with occasional supervision or prompting.
2= Needs close supervision to ensure appropriateness of dress.
1= Rarely dresses appropriately, even with close supervision. Major problems with this
item.
3 Changing Clothing
4 = Changes clothing regularly and independently.
3 = Changes clothing with occasional prompting.
2 = Changes clothing with frequent prompting.
1 = Major problems with this item.
4 Washing Hands and Face

4 = Keeps hands and face clean independently.
3 = Needs occasional prompting.
2 = Needs frequent prompting.
5 Shaving
4 = Shaves independently.
3 = Needs occasional prompting or help.
2 = Needs frequent prompting or help.
6 Menstruation
4 = Manages menstruation adequately and independently.
3 = Manages menstruation with occasional prompting and help.
2 = Manages menstruation with frequent prompting and help.
7 Bathing/Hair Washing
4 = Does these tasks regularly and independently.
3 = Does these tasks with occasional prompting.
2 = Does these tasks with frequently prompting.
8 Toiletting
4 = Uses toilet appropriately and independently.
3 = Needs occasional help (e.g. not using toilet properly, poor cleanliness).
2 = Frequently needs help (e.g. poor habits in the use of toilet, occasional incontinence).
1 = Major problems with this item (e.g. frequent incontinence, severe problems with
cleanliness).
9 Teeth Cleaning/Dentures
4 = Cleans teeth independently/looks after dentures.
3 = Needs occasional prompting.
2 = Needs frequent prompting.
1 = Major problems with this item (e.g. no real or false teeth, refusal to attend to teeth).
B DOMESTIC SKILLS
10 Table Manners
4 = Table manners are acceptable to other residents/public.
3 = Table manners are usually acceptable but needs occasional prompting.
2 = Table manners need frequent prompting.
11 Table Setting and Clearing E? YES/NO

4 = Sets and clears table correctly and independently.
3 = Sets and clears table with occasional prompting.
2 = Sets and clears table with frequent prompting.
12 Washing Up E? YES/NO
4 = Washes up correctly and independently.
3 = Washes up with occasional prompting.
2 = Washes up with frequent prompting.
13 Cooking Simple Foods E? YES/NO
4 = Able to prepare a simple snack with little or no supervision.
3 = Able to prepare a snack with close supervision.
2 = Able to make tea or simple food requiring little cooking e.g. tea, sandwiches, toast,
boiled egg.
1 = Unable or resistant to cooking.
14 Preparing Complicated Food Items E? YES/NO

4 = Plans and prepares a main cooked meal independently.
3 = Plans and prepares a meal with occasional prompting.
2 = Prepares a meal with frequent prompting.
*15 Room Cleaning E? YES/NO

4 = Able to clean room/bed area well and spontaneously, e.g. sweeping, tidying etc.
3 = Needs occasional prompting to maintain adequate standard.
2 = Needs close supervision to maintain adequate standard.
1 = Unable or resistant to cleaning room.
16 Laundry E? YES/NO
4 = Does this independently.
3 = Does this with occasional prompting.
2 = Does this with frequent prompting.
17 Use of Telephone E? YES/NO

4 = Does this independently.
3 = Does this with occasional prompting.
2 = Does this with frequent prompting.
C COMMUNITY SKILLS
18 Knowledge of Location
4 = Knows complete address of home, so could report this if lost.
3 = Knows name of home and local area.
2 = Knows name of home.
1 = Does not report any parts of home address correctly.
19 Travelling on Foot E? YES/NO
4 = Can walk any distance independently (good traffic sense, can find way back etc.).
3 = Can walk a short distance, e.g. to a local shop, independently.
2 = Needs accompanying on local outings.
1 = Major problems with this item (e.g. physical inability, difficulty leaving place of
residence).
*20 Use of Public Transport E? YES/NO

4 = Able to use public transport alone and without supervision.
3 = Able to use some form of public transport with minimal guidance.
2 = Needs to be accompanied on public transport with supervision by staff, friends or
relatives.
1 = Major problems with use of public transport.
*21 Shopping E? YES/NO

4 = Able to purchase major items of clothing (shirt, shoes, etc.).
3 = Able to purchase minor items (cigarettes, sweets, etc) from a shop without help.
2 = Able to use shops with some supervision.
1 = Unable or resistant to using shops.
22 Vocational Activity E? YES/NO

(Sheltered work, industrial therapy etc.)
4 = Attends regularly with minimal prompting and works acceptably.
3 = Attends regularly with minimal prompting, works with little supervision, but needs
some reminding.
2 = Attends irregularly and/or needs close supervision.
1 = Major problems with this item (e.g. will not attend, work of poor standard, leaves
after a few minutes etc.).
23 Use of Public Eating/Drinking Facilities E? YES/NO

(Cafes, Restaurants, Public Houses.)
4 = Uses public eating and drinking facilities independently on a regular basis.
3 = Goes to public eating facilities accompanied and needs occasional prompting.
2 = Goes to public eating facilities accompanied and needs frequent prompting.
24 Use of Public Leisure Facilities E? YES/NO

4= Attends independently.
3= Attends with guidance given before leaving.
2= Attends accompanied by staff.
1= Major problems with this item.
25 Use of Public Office E? YES/NO

(Post Office, DHSS, Police Station)
4 = Uses one or more of the above regularly and independently (e.g. collect GIRO from
Post Office).
3 = Uses one of the above on occasional basis.
2 = Uses one of the above if accompanied and prompted.
1 = Does not use public offices.
D SOCIAL SKILLS
26 Speech
4 = Speech is comprehensible to public.
3 = Speech is comprehensible to those who know resident quite well.
2 = Speech is sometimes comprehensible.
*27 Conversation with Residents

4= Can initiate and sustain a conversation with other residents.
3= Can occasionally initiate and sustain a conversation but rarely involved in more than
a brief sequence of exchanges.
2= Rarely initiates but responds briefly to prompting (e.g. requests, jokes).
1= Minimal interaction, rarely more than single word prompted exchanges.
*28 Conversation with Staff

4 = Can initiate and sustain a conversation with member of staff.
3 = Can occasionally initiate and sustain a conversation but rarely involved in more than
a brief exchange
2 = Rarely initiates but responds briefly to prompting (e.g. requests, jokes).
1 = Minimal interaction, rarely more than single word prompted exchanges.
*29 Social Mixing

4= Mixes with others and forms friendships or attachments to particular individuals
(staff, patients or people outside hospital).
3= Mixes with others but does not seem to form particular attachments.
2= Mixes little with groups on the whole but enjoys participating in some social activities
(e.g. discussion groups, outings).
1= Minimal interaction, rarely more than single word prompted exchanges.
*30 Participation
4= Will participate in carrying out programmed activities regularly and with little or no
prompting.
3= Will participate in programme activities fairly regularly, but needs some prompting.
2= Requires consistent prompting, but even so, only carries out programmed activities
irregularly.
1= Rarely, or never, participates in programmed activities.
31 Leisure Activity
4= Will engage in leisure activities involving others with or without prompting (e.g.
chatting to others, card games etc.).
3= Will engage in organised leisure activities with some prompting.
2= Prefers to spend leisure time in activities not involving others, e.g. reading, watching
television.
1= Prefers to spend leisure time not involved in any activity.
32 Knowledge/Concern for Other Residents

4= Demonstrates having knowledge of other Residents situations, and/or shows concern
if another Resident has a problem.
3 = Sometimes demonstrates having knowledge and/or shows concern for other
Residents.
2 = Has been known to demonstrate having knowledge or show concern for other
Residents.
1 = Generally does not demonstrate knowledge and/or show concern for other Residents.
33 Sexual Relationships
4 = Has an established sexual relationship.
3 = Has occasional sexual relationships.
2 = Enjoys occasional social contact (e.g. discos, clubs).
1 = No active interest or engagement in sexual relationships.
E RESPONSIBILITY
*34 Getting Up in the Morning

4= Little or no difficulty in rising. Rises most mornings with no prompting.
3= Mild difficulty in rising. Wakes and gets out of bed with minimal prompting.
2= Moderate difficulty in rising. Needs regular and sometimes frequent prompting to
rise.
1= Severe difficulty in rising. Rises with difficulty only after regular and frequent
prompting, or requires physical assistance.
35 Meals
4 = Eats adequate regular meals independently.
3 = Eats adequate regular meals with occasional prompting.
2 = Eats adequate meals with frequent prompting.
36 Personal Possessions E? YES/NO

4= Is responsible for some items and cares for them independently, e.g. toiletries,
clothes, watch.
3= Is responsible for some items and cares for them but needs occasional prompting.
2= Is responsible for some items and cares for them but needs close supervision.
1= Major problems with this item, e.g. loses or gives them away.
37 Managing Weekly Allowance E? YES/NO

4 = Can manage weekly allowance independently.
3 = Needs help with budgeting weekly allowance.
2 = Can use money to buy one item, e.g. cigarettes.
38 Personal Finance E? YES/NO

4 = Cares for personal finance independently.
3 = Needs some guidance in caring for personal finance.
2 = Needs to have access to personal finance restricted.
39 Health
4 = Promptly reports injuries or illness symptoms/attends GP.
3 = Usually reports injuries or illnesses but has been known not to.
2 = Sometimes fails to report illnesses or injuries.
1 = Does not report injuries or illnesses to staff.
40 Medication E? YES/NO
4= Is responsible for own medication and administers it independently.
3= Medication administered by staff. Resident attends and accepts medication regularly.
2= Medication administered by staff. Resident attends and accepts medication with
prompting.
1= Major problems in administration, e.g. refuses or secretes medication.
41 Returning at Night
4 = Returns home at night by the set time. (Letting people know).
3 = Occasionally returns home after the set time but is not a problem to staff.
2 = Frequently returns after the set time and is a problem to staff.
Other comments:
Social Functioning Questionnaire
Name:
Ward/Setting:
Date:
Score Intervention
planned?
Self care
1 Appearance
2 Approp
3 Change
4 Washing
5 Shaving
6 Menst
7 Bathing
8 Toilet
9 Teeth
Domestic
10 Manners
11 Table
12 Washup
13 Simple*
14 Compli
15 Clean*
16 Laundry
17 Phone
Community
18 Location
19 Foot
20 Transport*
21 Shopping*
22 Vocation
23 Pub
24 Club
25 Office
Social
26 Speech
27 Con.Res.*
28 Con.Staff.*
29 Mixing*
30 Partic*
31 Leisure
32 Concern
33 Sex
Responsibility
34 Get up*
35 Meals
36 Possess
37 Allow
38 Finance
39 Health
40 Medic
41 Return
Total score Mean score

Self care
Domestic
Community
Social
Responsibility
Index items
E. items
Social Functioning Profile
4
3.8 High
3.6
3.4
3.2 Mod
2.8
2.8
2.6
2.4 Low
2.2
2.0
1.8
1.6
Poor
1.4
1.2 V. poor
Self care Domestic Communit Social Responsibil

y ity

Social Functioning Questionnaire

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Social Functioning Questionnaire

Transféré par

Droits d'auteur :

Formats disponibles

Social Functioning Questionnaire

The Social Functioning Questionnaire is designed to enable a detailed assessment of an

A further questionnaire, the Problems Questionnaire, is available. This questionnaire

4 Washing Hands and Face

11 Table Setting and Clearing E? YES/NO

14 Preparing Complicated Food Items E? YES/NO

*15 Room Cleaning E? YES/NO

17 Use of Telephone E? YES/NO

*20 Use of Public Transport E? YES/NO

*21 Shopping E? YES/NO

22 Vocational Activity E? YES/NO

23 Use of Public Eating/Drinking Facilities E? YES/NO

24 Use of Public Leisure Facilities E? YES/NO

25 Use of Public Office E? YES/NO

*27 Conversation with Residents

*28 Conversation with Staff

*29 Social Mixing

32 Knowledge/Concern for Other Residents

*34 Getting Up in the Morning

36 Personal Possessions E? YES/NO

37 Managing Weekly Allowance E? YES/NO

38 Personal Finance E? YES/NO

Social Functioning Questionnaire

Total score Mean score

Self care Domestic Communit Social Responsibil

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