Omaha System KBS Rating Supplement
October 2010
Income……………………………..………….…………

4-5

Residence………………………………………………

6-7



Neighborhood/Workplace Safety…………………….

8-9Communication with Community Resources………..

10-11



Interpersonal Relationships…………………….........

12-13



Mental Health…………………………………………..

14-15



Caretaking/ Parenting……………………….…………

16-17



Neglect………………….………………………..

18-19



Abuse ...…………………………………………………

20-21



Growth and Development……………………………..

22-23



Cognition………………………………………………..

24-25



Pregnancy………………………………………………

26-27



Postpartum……………………………………………...

28-29



Nutrition …………………………………………………

30-31



Physical Activity ……………………………………….

32-33



Substance Use ………………………………………..

34-35



Family Planning………………………………………..

36-37



Health care supervision……………………………….

38-39



Problem Classification Scheme……………….…….

40-41



Intervention Scheme………………………….……….

42-43



Problem Modifiers Guide………………………………

44-45

1

2

Omaha System KBS Rating Supplement
Introduction
This guide originated in St-Paul Ramsey County Public Health as an effort to improve consistentuse of the Omaha System; working with colleagues from Dakota County Public Health
Department, Scott County Human Services, and Washington County Public Health andEnvironment.
The booklet has been updated annually, and many more stakeholders have contributed to
improving it. In 2010, the effort has become international. We believe in the power ofcollaboration and appreciate the willingness to partner in data & practice quality improvement.
Why the Rating Supplement was developed
The KBS rating examples in the Omaha System book are sometimes difficult to apply to clients
because of the general scope of the examples. The examples in this supplement have beendeveloped to be consistent with the 2005 Omaha System definitions, symptoms and ratings, andat the same time are relevant for specific Public Health populations and work.
In the process of developing examples, we discovered that having additional areas of client
assessment to consider within knowledge, behavior and status provided a framework fordetermining ratings.
How the Rating Supplement is organized
Each problem includes the Omaha System definition, signs & symptoms and Consider
Statements for knowledge, behavior and status on the left side of the page. There are also
guidelines or notes that provide further clarification & direction. The corresponding KBS rating
guide with examples is on the right side of the page.
Use of the Rating Supplement
We welcome feedback on this document. You may contact us at mosug@omahasystemmn.org .

Copyright 2010 Minnesota Omaha System Users GroupMay be used without permission. Please acknowledge authors when used.

3

Income (pg 169):
Money from wages, pensions, subsidies, interest, dividends, or other sources available forliving and health care expenses
Signs/ Symptoms:Low/ no income
Uninsured medical expenses
Difficulty with money managementAble to buy only necessities
Difficulty buying necessities
Other

Assessment

Health Promotion

Adequate

Definition

Client status characterized by interest inincreasing knowledge, behavior,and health expectations, as well as developing
strengths and resources to enhance well-being in
the absence of risk factors, signs, or symptoms

Not an Omaha System definition.
It means the problem wasassessed, no signs/ symptoms orrisk factors are present and it will
not go on the client careplan

When to selectWhen the client wishes to learn about something
we don't normally address and there are nosigns/ symptoms or risk factors present

When you have assessed a
problem and determine that the
problem is neither Actual or
Potential and you will not be
addressing it

When to put it on
the client’s
careplan

It should be used rarely or never. Do you havetime to address issues not normally on your plate?

Never

When not to put iton the client’s
careplan

When it's something the PHN won't be
addressing. You should then select one of theoptions: low priority, self-care, other provider

Admission Status
RatingAdmission status rating must be 5. This ratingmeans no signs/ symptoms are present.

Other

If Health Promotion is selected, the problem must
go on the client careplan. It implies you aredoing something about it

Example:Substance Use

Client wants to know how to prevent osteoporosis

KBS rating considerations:
Knowledge(What client knows)
Consider knowledge of: community
resources forfinancial assistance money management
 importance of
education

Behavior(What client does)
Consider if client is: spending for needs
vs. wants
 living within means

Status(How client is)
Consider: essentials vs. extras,
 amount of debt,
 health insurance,
 employment status
 education status

Guidelines & Notes:
 By definition, a client utilizing state assistance programs would have “low/no income”
and could not have a status of a 5.
 The symptom “difficulty with money management” is about the client’s ability to prioritize
spending. A low-income client who cannot always make ends meet but can prioritize themoney she has would not have this as a symptom.
 It’s important to distinguish Behavior and Status. A low-income client may spend
appropriately and still not be able to make ends meet. In a case like this her Behavior
rating may be relatively high and her Status rating may be relatively low.
 When a client has a protective payee, there is an actual problem.
 Transportation, food, clothing, rent and other financial needs can be included under the
Income problem as well as any problems where money alone would solve the problem.
 Income may come from a variety of sources. The source may indicate a problem (stateassistance) or may be irrelevant as long as income is adequate (parental support for aminor).
 Self-sufficiency can be considered in the Income problem, if this is a goal for theparticular client. Measure the income aspect of that goal in this problem.

445

No history of substance use or hashistory but appears stable and not
at risk for relapse.

Assessment

ActualPotential

Definition

Client problem status characterized by theexistence of one or more signs and symptoms

Client status characterized by theabsence of signs and symptoms
and the presence of patterns,
practices, behaviors, or risk
factors that may preclude optimal
healthWhen risk factors are present

When to selectWhen signs/ symptoms are present

When to put iton the client’s
careplan

When the PHN will be addressing the issue insome way

When the PHN will be addressing
the issue in some way

When not to put
it on the client’s
careplan

When it's something the PHN won't be
addressing. You should then select one of theoptions: low priority, self-care, other provider

When it's something the PHN won't
be addressing. You should thenselect one of the options: low
priority, self-care, other provider

Admission
Status Rating

Admission status rating must be 1,2,3, or 4. These
ratings mean signs/ symptoms are present

Admission status rating must be 5.
This rating means no signs/
symptoms are present

Signs: Objective evidence about a client’s
problem.
Symptoms: Subjective evidence about a client’s
problem

Example:Substance Use

Client is currently using drugs, alcohol or smoking

Has a history of substance use, is
not currently using but is
experiencing stressful events thatput her at risk

Knowledge

3
Basic

4
Adequate

5Superior

No knowledge of:● sources ofincome/expenses● resources andhow to access● relationshipbetween educationand future earnings● budgeting

Minimalknowledge of:● sources ofincome/expenses●resources andhow to access● relationshipbetweeneducation andfuture earnings●budgeting

Basic knowledgeof:●sources ofincome/expenses● resources andhow to access● relationshipbetween educationand future earnings●budgeting

Adequateknowledge of:● sources ofincome/expenses● resources andhow to access● relationshipbetween educationand future earnings●budgeting

Superior
knowledge of:●sources ofincome/expenses●resources andhow to access●relationshipbetween educationand future earnings●budgeting

Not
Appropriate

RarelyAppropriate

Inconsistently
Appropriate

Usually
Appropriate

Consistently
Appropriate

Does not:●pay rent/mortgage●prioritize expenses● attend school orjob●manage income●budget●complete financial
paperwork●seek employment

Rarely:●pays
rent/mortgage●prioritizes
expenses●attends school orjob●manages income●budgets●completes
financialpaperwork●seeksemployment

Inconsistently:● paysrent/mortgage●prioritizes
expenses●attends school orjob●manages income●budgets●completes
financial paperwork●seeksemployment

Usually:● paysrent/mortgage●prioritizes
expenses●attends school orjob●manages income●budgets●completes
financial paperwork●seeksemployment or abetter job

Consistently:●pays
rent/mortgage●prioritizes
expenses●attends school orjob●manages income●budgets●completes
financial paperwork

Extreme S/S

Severe S/SModerate S/S

Minimal S/S

No S/S

Homeless due tolack of income

Has housing but
utilities
disconnected
due tononpayment

Inconsistently
has enoughmoney month tomonth

Decreasing debt

Expenses met

Income meets
most expenses

Has consistentsource of income

Some health careexpenses coveredor paid for

Most health careexpenses
covered or paid
forHealth careexpenses arecovered or paidforGambles orspendsexcessively/
impulsively

StatusOther

2
MinimalUnrealistic
expectations about
winnings fromgambling/lottery

Behavior

Omaha System Problem Modifiers Guide

1
None

Income doesn'tcover all basic
necessities
Unable to pay forany health careexpenses

Rarely hasenough moneyfor basic
necessities*Remember for all ratings, if you are trying to decide between 2 ratings, select the lower
rating as a rule of thumb.
44

5Residence (pg 175):
Living area
Signs/ Symptoms:
 Structurally unsound Inadequate heating/ cooling Steep unsafe stairs
 Inadequate/ obstructed exits/
entries Cluttered living space Unsafe storage of dangerous
objects/ substances Unsafe mats/ throw rugs










Inadequate safety devices
Presence of lead-based paintUnsafe appliances/ equipment
Inadequate/ crowded living space
Exposed wiring
Structural barriers
HomelessOther

KBS rating considerations:
Knowledge(What client knows)
Consider Knowledge of: basic home safety
 community resources
for home
repair/safety needs

Behavior(What client does)
Consider if client is: willing to make thehome safe

Status(How client is)
Consider: presence of home safety
hazards and risks for injury

Guidelines & Notes:• By definition, the problem of Residence encompasses both the issues of homesafety and homelessness.
• Status of a 5 may be appropriate for non-independent living situations, such as
minors, elderly in need of assistance, or those with disabilities.

6

Targets (continued)
end-of-life careenvironment
exercisesfamily planning carefeeding procedures
finances
foodgait training
genetics
growth/ development carehomehomemaking
homemaking/ housekeeping
infection precautions
interaction
interpreter/ translator services
laboratory findings
legal system
medical/ dental care
medication action/ side effects
medication administration
medication coordination/ ordering
medication prescription
medication set-up
mobility transfers
nursing care, supplemental
nursing carenutrition
nutritionist careoccupational therapy careostomy careother communication resources
paraprofessional/ aide carepersonal hygeine

43

physical therapy carepositioning
recreational therapy carerehabilitation
relaxation/ breathing techniques
respiratory care
respiratory therapy care
rest/ sleep
safetyscreening procedures
sickness/ injury caresigns/ symptoms-mental/ emotionalsigns/ symptoms-physicalskin caresocial work/ counseling carespecimen collection
speech and language pathology carespiritual carestimulation/ nurturance
stress management
substance use
substance use cessation
supplies
support groupsupport systemtransportationwellnessotherBehavior

Targets
This is a complete list of targets from the old and revised Omaha
System. Discontinued targets are crossed out. New targets areunderlined. Changes to existing targets are indicated by italics.
Definitions of all currently used targets can be found on pages 374376 in The Omaha System: A Key to Practice, Documentation, andInformation Management.
anatomy/ physiology
anger management
behavior modification
bladder carebonding/ attachment
bowel carebronchial hygiene
cardiac care
caretaking/ parenting skills
cast care
communication
community outreach worker services
continuity of carecoping skills
day care/ respite
dietary management
discipline
dressing change/ wound caredurable medical equipment
education
employment

StatusCategories
Category definitions can be found on page 373 in The Omaha
System: A Key to Practice, Documentation, and Information
Management.
01. Teaching, Guidance, and Counseling
02. Treatments and Procedures
03. Case Management
04. Surveillance

Knowledge

Intervention Scheme

1
None

2
Minimal3
Basic4Adequate

5Superior

No knowledgeof:● housing● resources andhow to access●tenant rights● hazards inliving area

Minimalknowledge of:●housing● resources andhow to access● tenant rights● hazards inliving areaBasicknowledge of:● housing● resources andhow to access●tenant rights
hazards inliving area

Adequateknowledge of:● housing● resources andhow to access●tenant rights● hazards inliving area

Superior
knowledge of:● housing●resources andhow to access● tenant rights● hazards inliving area

Not
Appropriate

RarelyAppropriate

Inconsistently
Appropriate

Usually
Appropriate

Consistently
Appropriate

Does not:●de-clutter●childproof●makerecommended
safety changes●seek affordable/stable housing●perform routinehomemaintenanceRarely:●de-clutters●childproofs●makesrecommended
safety changes●seeksaffordable/stable housing●performs
routine home
maintenance

Inconsistently:●de-clutters●childproofs●makesrecommended
safety changes●seeksaffordable/stable housing●performs
routine home
maintenance

Usually:●de-clutters●childproofs●makesrecommended
safety changes●performs
routine home
maintenanceConsistently:●de-clutters●childproofs●makesrecommended
safety changes●performs
routine home
maintenance

Extreme S/S

Severe S/SModerate S/S

Minimal S/S

No S/S

Extreme:●clutter●crowding●home repairsneeded●safety/
structural
hazards

Severe:●clutterand/or crowding●home repairsneeded●safety/
structural
hazards

Moderate:●clutter and/or
crowding●home repairsneeded●safety/
structural
hazards

Minimal:● clutter and/or
crowding●safety/
structural
hazards

No:●clutter and/or
crowding●safety/
structural
hazards

Homeless

Living in a
shelter or
unstable
temporarysituation

Living in
temporarysituation

Living in stablehousing

Livingindependently
in stable
housing

No heat/coolingfor current
weather
conditions
Unsafe storageof hazardous
materials

42

Deteriorating
lead paint7

Neighborhood/Workplace Safety (pg 178):
Freedom from illness, injury, or loss in the community or place of employment.
Signs/ Symptoms:
 High crime rate
 High pollution level Uncontrolled/dangerous/infectedanimals Inadequate space/resources tofoster health Inadequate/ unsafe play/exercisearea Threats/reports of violence







Physical hazards
Vehicle/traffic hazards
Chemical hazards
Radiological hazards
Other

KBS rating considerations:
Knowledge(What client knows)
Consider Knowledge of: situations requiring
emergency action
 workplace safety
regulations andpolicies

Behavior(What client does)
Consider if client is: practicing
preparedness(exercises)

Status(How client is)
Consider: presence of crosswalks
 disposal of Household
Hazardous Waste emergency shelter frequent emergency
calls (police/fire) neighborhood watch
groups recycling and clean up
efforts
 community resources
such as police, healthdept.
 high drug or crime area

Physiological Domain
Hearing………………………………………
Vision………………………………………...
Speech and Language………………………
Oral Health………………………………….
Cognition…………………………………….
Pain………………………………………….
Consciousness………………………………...
Skin…………………………………………..
Neuro-Musculo-Skeletal Function…………….
Respiration…………………………………...
Circulation……………………………………
Digestion-Hydration…………………………
Bowel Function……………………………….
Urinary Function……………………………...
Reproductive Function………………………..
Pregnancy……………………………………
Postpartum…………………………………...
Communicable/ Infectious Condition…………

230-233
233-237237-241
241-244245-250250-254254-258258-262263-270270-277277-284284-290290-295295-300
300-304304-310310-315315-322

Health-Related Behaviors Domain
Nutrition……………………………………...
Sleep and Rest Patterns……………………...
Physical Activity……………………………...
Personal Care……………………………….
Substance Use………………………………..
Family Planning………………………………
Health Care Supervision……………………..
Medication Regimen…………………………

323-328328-331331-334
334-337
337-342343-346346-350
350-356

Guidelines & Notes:

841

Following is a list of all the problems in the Problem Classification Scheme and the page numbers they181-185
185-187
187-190
190-193193-196
196-199
199-204205-208
208-214214-219219-223
223-229

2
Minimal3
Basic4Adequate

5Superior

No knowledgeof:● hazards incommunity,neighborhood orworkplace● possible
solutions or
resources●emergency
preparedness

Minimalknowledge of:● hazards incommunity,neighborhood orworkplace● possible
solutions or
resources●emergency
preparedness

Basic knowledgeof:● hazards incommunity,neighborhood orworkplace● possible
solutions andresources●emergency
preparedness

Adequateknowledge of:● hazards incommunity,neighborhood orworkplace● solutions andresources●emergency
preparedness

Superior
knowledge of:● hazards incommunity,neighborhood orworkplace● solutions andprevention
measures●emergency
preparedness

Not
Appropriate

RarelyAppropriate

Inconsistently
Appropriate

Usually
Appropriate

Consistently
Appropriate

Does not:● protect
employees orcommunity
members fromhazards● follow safety
regulations● plan for
emergencies

Rarely:● protect s
employees orcommunity
members fromhazards● follows safety
regulations● plans for
emergencies

Inconsistently:● protects
employees orcommunity
members fromhazards● follows safety
regulations● plans for
emergencies

Usually:● protectsemployees orcommunity
members fromhazards● follows safety
regulations● plans for
emergencies

Consistently:● protects
employees orcommunity
members fromhazards● follows safety
regulations● plans for
emergencies

Extreme S/S

Severe S/SModerate S/S

Minimal S/S

Assesses andresponds toworkplace orcommunity forrisks andhazards
No S/S

Extreme:● safety hazards
and violations

Severe:● safety hazards

Moderate:● safety hazards

Minimal:● safety hazards

No:● safety hazards

Limitedresources

Some resources

Adequateresources

Contributes tophysical hazards
or behaviors thatlead to illness or
injuryStatusPsychosocial Domain
Communication with Community
Resources…….
Social Contact…………………………………
Role Change…………………………………...
Interpersonal Relationship……………………..
Spirituality……………………………………..
Grief…………………………………………...
Mental Health…………………………………
Sexuality………………………………………
Caretaking/ Parenting………………………...
Neglect………………………………………..
Abuse………………………………………….
Growth and Development……………………

169-171
171-175
175-178
178-180

Behavior

Environmental Domain
Income……………………………..…………...
Sanitation………………………...…………….
Residence………………………….…………...
Neighborhood/ Workplace Safety

Knowledge

Problem Classification Scheme

1None

No resourcesHigh crime rate

Safety plan indevelopment

Safety plan inplace

No safety plan40

Adequate andaccessible
resources9

Signs/ Symptoms:
 Unfamiliar with options/ proceduresfor obtaining services
 Difficulty understanding roles/
regulations of service providers
 Unable to communicate concerns toprovider Dissatisfaction with services
 Inadequate/ unavailable resources Language barrier









Cultural barrier
Educational barrier
Transportation barrier
Limited access to care/ services/
goods
Unable to use/ has inadequate
communication devices/ equipment
Other

KBS rating considerations:
Knowledge(What client knows)
Consider:Behavior(What client does)
Consider: does client ask forassistance whenneeded level of difficulty inutilizing resources

Status(How client is)
Consider:2Minimal3
Basic4Adequate

5Superior

No knowledge of:● resources andhow to access● when to seek
health care for acute& chronic healthconditions● preventative/
wellness health carepractices/ treatment
plan

Minimalknowledge of:● resources andhow to access● when to seek
health care for
acute & chronic
health conditions● preventative/
wellness healthcare practices/
treatment plan

Basic knowledgeof:● resources andhow to access● when to seek
health care for
acute & chronic
health conditions● preventative/
wellness healthcare practices/
treatment plan

Adequateknowledge of:● resources andhow to access● when to seek
health care for
acute & chronic
health conditions● preventative/
wellness healthcare practices/
treatment plan

Superior knowledgeof:● resources and how toaccess● when to seek healthcare for acute & chronic
health conditions● preventative/
wellness health carepractices/ treatment
plan

RarelyAppropriate

Inconsistently
Appropriate

Usually
Appropriate

Consistently
Appropriate

Rarely:● makes/ follows
up on scheduled
health careappointments forillness, injuries orchronic healthconditions● follows plan ofcare● obtainspreventive/
wellness healthcare
Severe S/SInconsistently:● makes/ follows
up on scheduled
health careappointments forillness, injuries orchronic healthconditions● follows plan ofcare● obtainspreventive/
wellness healthcareModerate S/S

Usually:● makes/ follows
up on scheduled
health careappointments forillness, injuries orchronic healthconditions● follows plan ofcare● obtainspreventive/
wellness healthcare
Minimal S/S

Consistently:● makes/ follows up onscheduled health careappointments forillness, injuries orchronic healthconditions● follows plan of care
● obtains preventive/
wellness health care

Obvious untreatedhealth issues

Rarely receives
appropriate,
timely health care

Sometimes
receives
appropriate,
timely health care

Usually receives
appropriate,
timely healthcareConsistently receives
appropriate, timely
health care.

Does not have aplan of care with ahealth careproviderMinimal follow up
on plan of carefrom health careproviderDoes not:● make/follow up onscheduled healthcare appointments
for illness, injuries orchronic healthconditions● follow plan of care
● obtainpreventive/
wellness healthcareExtreme S/S

Client Status

Guidelines & Notes:• Consider the definition of this problem, and the fact that it reflectsinteraction between the individual, family or community andcommunity resources. This goes beyond just communication.

Has no access to a
medical home andno consistentsource of health
care

10

Fully understands theimportance of healthcare practices andaccessBelieves in myths
or inaccurate
health practices
Mistrust ofproviders thatprevents usage ofhealth careservices
Not Appropriate

Client/Caregiver Behavior

Interaction between the individual/ family/ community and social service
organizations, schools, and businesses in regard to services, information, and goods/
supplies.

Client/Caregiver Knowledge

Communication with Community Resources ( pg 181):

1None

No S/S

Follows up withplans of carefrom health careproviderInconsistentaccess to or
source of health
care

39

Has a medical homeand consistent accessto health careprovidersHealthcare Supervision (pg 346):

Signs/ Symptoms:
 Fails to obtainroutine/preventative health care
 Fails to seek care for symptoms
requiring evaluation/treatment
 Fails to return as requested tohealth care provider







Inability to coordinate multiple
appointments/treatment plans
Inconsistent source of health care
Inadequate source of health care
Inadequate treatment plan
Other

Knowledge

Management of the health care treatment plan by health care providers

KBS rating considerations:
Status(How client is)
Consider: state of disease
process
 history of medicalcare behavior andcurrent challenges
 access to primaryand specialty healthcare and medicalhome immunization andwell-child exam
statusGuidelines & Notes:
 Consider the use of other appropriate problems. If income is impacting the difficultyin accessing care, the Income problem should also be assessed.
 For children (minors), rate the caregiver’s knowledge and behavior, and the child’s
status.

38

Behavior

Behavior(What client or caregiver
does)
Consider: use of ER, preventive
care visits andchoices of providers
 history of medicalcare behavior andcurrent challenges
 if caregiver arranges
and follows throughwith plan of care, andappointments
independently

StatusKnowledge(What client or caregiverknows)
Consider knowledge of:• health, wellness, disease
process• health care beliefs andaccuracy of medical
information• how to use emergency
care, primary care, andspecialty care resources

1
None

2
Minimal3
Basic4Adequate

5Superior

No knowledgeof:● resources
and how toaccessMinimalknowledge of:● resources
and how toaccessBasic knowledgeof:● resources andhow to access

Adequateknowledge of:● resources
and how toaccessSuperior
knowledge of:● resources
and how toaccessNot
Appropriate

RarelyAppropriate

Inconsistently
Appropriate

Usually
Appropriate

Consistently
Appropriate

Does not:●use beneficial
community
resources

Rarely:● usesbeneficial
community
resources● accesses
resources
independently● fulfills
resource
requirements

Inconsistently:● uses beneficial
community
resources● accesses
resources
independently● fulfills resource
requirements

Usually:● usesbeneficial
community
resources● accesses
resources
independently● fulfills
resource
requirements

Consistently:● uses beneficial
community
resources● accesses
resources
independently● fulfills resource
requirements

Extreme S/S

Severe S/SModerate S/S

Minimal S/S

No S/S

Minimal:●barriers toconnecting tocommunity
resourcesNo:●barriers toconnecting tocommunity
resources

Extreme:●barriers toconnecting tocommunity
resources

Severe:●barriers toconnecting tocommunity
resources

Moderate:●barriers toconnecting tocommunity
resources

Not receiving
benefits ofresources

Receiving
benefits ofresources11

Signs/ Symptoms:
 Difficulty establishing/maintaining
relationships
 Minimal shared activities
 Incongruent
values/goals/expectations/schedules
 Inadequate interpersonalcommunication skills
 Prolonged, unrelieved tension






Inappropriate
suspicion/manipulation/control
Physically/emotionally abusive topartner
Difficulty problem solving without
conflict
Other

Knowledge

Interpersonal Relationships (pg. 190):
Association or bonds between the individual/family/community and others.

Behavior(What client does)
Consider client’s:
 interpersonalboundaries
 readiness to seek help openness toaccepting/seeking
information to modify
behaviors past history of abusive
behavior
 past history of treatment
for abusive behavior

Status(How client is)
Consider: stressors
 coping skills
 danger to others support system forindividual/family
 current ability to interact
positively with others
 positive conflict resolution

Guidelines & Notes:
 Include all relationships
 Interpersonal Relationships is intended to be used with clients who ARE abusive,
not the abuse victim. (use the abuse problem for victim)
 Interpersonal Relationships may be appropriate for a victim of abuse if being use toreflect the relationship skills, not the abuse itself.
 Be careful not to cross over into Mental Health. If there is a diagnosis that impacts
the relationship skills or communication, it may not be a relationship issue.

12

StatusKnowledge(What client knows)
Consider Knowledge of: behaviors that are
abusive, controlling,
manipulative impact of abusive,
controlling, manipulative
behaviors in own family
history

Behavior

KBS rating considerations:

1None
No knowledgeof:● methods● preconception
health●benefits of childspacing●resources andhow to access

2
MinimalMinimalknowledge of:● methods● preconception
health●benefits of childspacing●resources andhow to access

3
Basic
Basic
knowledge of:● methods● preconception
health●benefits of childspacing●resources andhow to access

4
Adequate
Adequateknowledge of:● methods● preconception
health●benefits of childspacing●resources andhow to access

5
Superior
Superior
knowledge of:● methods● preconception
health●benefits of childspacing●resources andhow to access

Believes
folklore/myths

Knows one
methodInconsistently
Appropriate
Inconsistently:● accesses
preconception or
family planningcare●uses familyplanning method● follows throughwith self-care

Knows morethan one
methodUsually
Appropriate
Usually:● accesses
preconception or
family planningcare●uses familyplanning method● follows throughwith self-care

Knows methods,
side effects, andcontraindications

Not
Appropriate
Does not:● accesspreconception or
family planningcare●use familyplanning method● follow throughwith self-care

Incomplete
information
about methods
RarelyAppropriate
Rarely:● accesses
preconception or
family planningcare●uses familyplanning method● follows throughwith self-care

Consistently
Appropriate
Consistently:● accesses
preconception or
family planningcare●uses familyplanning method● follows throughwith self-carerecommendations

recommendations

recommendations

recommendations

recommendations

Pregnant woman
does not intend
to use familyplanning
method(s) after
pregnancy

Pregnant
woman has notconsideredfamily planning
method(s) after
pregnancy

Pregnant
woman is not
sure aboutfamily planning
method(s) after
pregnancy

Pregnant
woman
considering
several familyplanning
method(s) after
pregnancy

Pregnant
woman hasdecided on andplans to use afamily planning
method(s) after
pregnancy

Extreme S/SExtreme:● risk forunintended
pregnancy

Severe S/S
Severe:●risk forunintended
pregnancy

Moderate S/SModerate:● risk forunintended
pregnancy

Minimal S/S
Minimal:● risk for an
unintended
pregnancy

No S/SNo:● risk for an
unintended
pregnancy

Interference withfamily planningplans by other(s)37Signs/ Symptoms:Inappropriate/ insufficient knowledge
about family planning methods
Inappropriate/ insufficient knowledge
about preconceptual health practices
Inaccurate/ inconsistent use of familyplanning methods






Dissatisfied with present familyplanning method
Fears others’ reactions
regarding family planning
choices
Difficulty obtaining familyplanning choices
Other

Knowledge

Family Planning (343):
Practices designed to plan and space pregnancy within the context of values,
attitudes, and beliefs.

Behavior(What client does)
Consider: client’s planning andreceptiveness if theclient doesn’t want to
get pregnant again.

Status(How client is)
Consider: ability to obtainfamily planning social/ cultural
stigma appropriateness of
method chosen hx of STIs
 hx of previous
unintended
pregnancy
 congruency of client
wants/ plans vs.
behaviors.

Guidelines & Notes:• Pregnant Clients: A pregnant client can't become pregnant. However, being
pregnant does not necessarily warrant a status rating of 5. Consider theclient's known risk factors for unintended pregnancy and determine ratings
based on those risk factors.
• Consider the relationship to the Health Care Supervision problem if the familyplanning problem relates to accessing birth control.

362Minimal3
Basic4Adequate

5Superior

No knowledgeof:●the difference
between positive
and negative
communication● the need forhelp/counseling● positive conflict
resolution
methods●resources andhow to access

Minimalknowledge of:●the difference
between positive
and negative
communication●need forhelp/counseling● positive conflict
resolution
methods●resources andhow to accessBasicknowledge of:●the difference
between positive
and negative
communication●need forhelp/counseling●positive conflict
resolution
methods●resources andhow to access

Adequateknowledge of:●the difference
between positive
and negative
communication●need for help/
counseling●positive conflict
resolution
methods●resources andhow to accessSuperior
knowledge of:●the difference
between positive
and negative
communication●need for help/
counseling●positive conflict
resolution
methods●resources andhow to access

Not
Appropriate

RarelyAppropriate

Inconsistently
Appropriate

Usually
Appropriate

Consistently
Appropriate

Does not:●form/maintainrelationships●admit to abusive
behaviors●communicate
appropriately in
relationships● problem solve
without conflict

Rarely:●forms/maintainsrelationships●admits toabusivebehaviors but
blames others●communicatesappropriately in
relationships● problem solves
without conflict

Inconsistently:●forms/maintains
relationships●admits toabusive behaviors
but not remorseful●communicatesappropriately in
relationships● problem solves
without conflict

Usually:●forms/maintainsrelationships●admits pastabusive behavior
but not currently
occurring●communicatesappropriately in
relationships● problem solves
without conflict

Consistently:● forms/
maintainsrelationships●communicatesappropriately in
relationships● problem solves
without conflict

Physical/emotional harm
directed towards
othersJailed for
abusivebehavior

Negative
emotional
expressions
towards others

No history ofabusivebehavior

Has begun
treatment/
counseling for
abusive behavior

Negative
physical
expressions notdirected toward
peopleStatusKnowledge(What client knows)
Consider knowledge of: methods available
 use, efficacy, side
effects of methods appropriateness forself resources to obtain reasons for spacing
or delaying
pregnancy
 family planning
topics, including:-contraceptive
methods-preconception health-benefits of childspacing

Behavior

KBS rating considerations:1
None

Extreme S/SExtreme:●controlling,
manipulativeenvironment/
Relationship● conflict inrelationship

Severe S/S
Severe:●controlling,
manipulativeenvironment/
relationship● conflict inrelationship

Current
restraining order

Past restraining
ordersModerate S/SModerate:●controlling,
manipulativeenvironment/
relationship● conflict inrelationship

13

Minimal S/S
Minimal:●controlling,
manipulativeenvironment/
relationship● conflict inrelationship

No S/S
No:●controlling,
manipulativeenvironment/
relationship● conflict inrelationship











Somatic complaints/ fatigue
Delusions
Hallucinations/ illusions
Expresses suicidal/ homicidal
thoughts
Attempts suicide/ homicide
Self-mutilation
Mood swings
Flash-backs
Other

KBS rating considerations:
Status(How client is)
Consider: effectiveness oftreatment/self-care

Knowledge
Alcohol/Drug
Behavior

Behavior(What client does)
Consider: help seeking
behavior
 self-monitoring

Guidelines & Notes:• Self-care may include sleep, exercise, stress management, meditation, herbs,
etc.
• Assess as actual if: current signs and symptoms of mental health problems
exist, not effectively coping with mental health issues, not effectively copingwith significant stress, or postpartum depression/psychosis• Assess as potential if: past personal history, current diagnosis that is
appropriately managed, coping well with high level of stress and/or difficult life
circumstances, significant family history of mental illness/suicide. (Riskfactors, but no current signs/symptoms)• Note: significant stress in itself, is not a Mental Health problem, and should
not be assessed unless signs or symptoms are present

14

StatusKnowledge(What client knows)
Consider knowledge of: own mental healthneeds/concerns available resources or
options fortreatment/management
 knowledge ofappropriate self-care

Stage
of
changeSigns/ Symptoms:
 Sadness/ hopelessness/decreased self-esteem
 Apprehension/ undefined fear
 Loss of interest/ involvement in
activities/ self-care Narrowed to scattered attention/focus
 Flat affect Irritable/ agitated/ aggressive
 Purposeless/ compulsive activity
 Difficulty managing stress Difficulty managing anger

Tobacco Behavior

Mental Health (pg 199):
Development and use of mental/emotional abilities to adjust to life situations, interact
with others, and engage in activities.

1None
No knowledge of:● negative effectsof substance use on
self or others● negative effects
of 2nd hand smoke●resources andhow to access●benefits of cutting
down and quitting

2
MinimalMinimalknowledge of:● negative effectsof substance useon self or others● negative effects
of 2nd hand smoke●resources andhow to access●benefits of cutting
down and quitting

Not
Appropriate
Not interested inchanging behavior

RarelyAppropriate
Considerschanging
behavior

Smokes more than
2 ppd

Smokes at least 1
but less than 2
ppd

Frequently uses
tobacco products
Does not avoid 2nd
hand smoke

Often uses
tobacco products

3
Basic
Basic knowledgeof:● negative effectsof substance useon self or others● negative effects
of 2nd hand smoke●resources andhow to access●benefits of
cutting down andquitting
Inconsistently
Appropriate
Prepares tochange behavior

Smokes lessthan 1 ppd
Sometimes uses
tobaccoproducts

4
Adequate
Adequateknowledge of:● negative effectsof substance useon self or others● negative effects
of 2nd hand smoke●resources andhow to access●benefits of
cutting down andquitting
Usually
Appropriate
Takingappropriate
action to change
behavior
Smokes a few
cigarettes perday
Rarely uses
tobaccoproducts

5Superior
Superior knowledgeof:● negative effects ofsubstance use on self
or others● negative effects of
2nd hand smoke●resources and how toaccess●benefits of cutting
down and quitting
Consistently
Appropriate
No use or stopped
using

Does not use tobacco
products
Does not expose self
to 2nd hand smoke.

Rarely avoids
exposure to 2nd
hand smoke

Occasionally
avoids exposure
to 2nd handsmoke

Often abuses
legal or illegal
substances

Occasionallyabuses legal or
illegalsubstances

Rarely abuses
legal or illegal
substances

Does not abuse legal
or illegal substances.

Extreme S/SExtreme issues
with:●physical/emotional
health●legal system●finances●employment●relationships

Severe S/S
Severe issues
with:●physical/emotion
al health●legal system●finances●employment●relationships

Moderate S/SModerate issues
with:●physical/emotion
al health●legal system●finances●employment●relationships

Minimal S/S
Minimal issues
with:●physical/emotion
al health●legal system●finances●employment●relationships

No S/S
No issues with:●physical/emotional
health●legal system●finances●employment●relationships

Needs
commitment

Multipleconvictions

Any tobacco use
by a woman who
knows she ispregnant
Frequently abuses
legal or illegal
substances

Usually avoids
exposure to 2nd
hand smoke

Any drug or
alcohol use by
woman who
knows she ispregnant, or by arecovering addict

35

Substance Use (337):
Consumption of medicines, recreational drugs, or other materials likely to cause moodchanges and/ or psychological/ physical dependence, illness, and disease.







Abuses over-the-counter/ prescription
medications
Uses “street”-recreational drugs
Abuses alcohol
Smokes/ uses tobacco products
Difficulty performing normal routines







Reflex disturbances
Behavior change
Exposure to cigarette/ cigar smoke
Buys/ sells illegal substances
Other

Knowledge

Signs/ Symptoms:

Behavior(What client does)
Consider: frequency/amount ofuse Implementing selfhelp behaviors
 binge drinking
 choice/ability to
avoid substancessuch as 2nd handsmoke

Status(How client is)
Consider:• s/s of health status
impairment• s/s of ADL/ relationship/law
problems r/t use• finances and health of family• acceptance of personal
responsibility• affects of use is under status

Guidelines & Notes:
Substance use refers to the loss of control with substance usage and consequences fromsubstance use
Rating Status at Admission (Pregnant Client):
 A woman who knowingly used drugs or alcohol during pregnancy should have astatus rating of 1 at admission. This applies even if the use occurred prior toadmission.
 A pregnant woman who never used drugs, alcohol or tobacco or stopped once she
found out she was pregnant should have a status rating of 5 at admission.
 Risk for relapse: A woman who quit using once she found out she was pregnant
should have a status rating of 5 regardless of her risk. If she relapses the problem
must be reassessed.
Rating Status at Discharge:
 A woman who knowingly used drugs or alcohol during pregnancy and quits shouldhave a discharge status rating of 5.
When client uses more than one type of substance, the behavior and status ratings
should reflect the most serious concern.

34

2
Minimal3
Basic4Adequate

5Superior

No knowledgeof:● symptoms thatare unusual or
could be a sign ofmental illness● treatment
needs/options● impact of illness
symptoms on life
● healthy coping
skills that can
reduce or manage
symptoms

Minimalknowledge of:● symptoms thatare unusual or
could be a sign ofmental illness● treatment
needs/options● impact of illness
symptoms on life
● healthy coping
skills that can
reduce or manage
symptoms

Basic knowledgeof:● symptoms thatare unusual or
could be a sign ofmental illness● treatment
needs/options● impact of illness
symptoms on life
● healthy coping
skills that can
reduce or manage
symptoms

Adequateknowledge of:● symptoms thatare unusual or
could be a sign ofmental illness● treatment
needs/options● impact of illness
symptoms on life
● healthy coping
skills that can
reduce or manage
symptoms

Superior
knowledge of:● symptoms thatare unusual or
could be a sign ofmental illness● treatment
needs/options● impact of illness
symptoms on life
● healthy coping
skills that can
reduce or manage
symptoms

Not
Appropriate

RarelyAppropriate

Inconsistently
Appropriate

Usually
Appropriate

Consistently
Appropriate

Does not:● take medication● attend therapy● access mental
health careRarely:● takes
medication● attends therapy● accesses mental
health care

Inconsistently:● takes
medication● attends therapy● accesses mental
health care

Usually:● takes
medication● attends therapy● accesses mental
health care

Consistently:● takes
medication● attends therapy● accesses mental
health care

Usually engages
in behavior thatexacerbates
symptoms/uses
ineffective selfcare

Inconsistently
engages inbehavior thatexacerbates
symptoms/ somepositive self-care

Usually engages
in behavior/selfcare thatstabilizes or
improves
symptoms.

Maintains
lifestyle topromotewellness

Extreme S/S

Severe S/SModerate S/S

Minimal S/S

Extreme:● agitation● depression● psychosis● anxiety● suicidal
thoughts with asuicide plan

Severe:● agitation● depression● psychosis● anxiety● suicidal
thoughts with nosuicide plan

Moderate:● agitation● depression● anxiety

Minimal:● agitation● depression● anxiety

Unable to copeat all.

Minimal coping
ability.

Moderate coping
skillsUsually coping

Harmful to self orothers.

Severe impact onlife

Moderate impact
on life

Minimal impact
on lifeNeeds
hospitalization.

Needs outpatientcare

Self diagnoses
and/or self
medicates
mental healthsymptoms.
Consistently
engages inbehavior thatexacerbates
symptoms

StatusKnowledge(What client knows)
Consider knowledge of:• harm to self/others• treatment options• relationshipbetween substanceuse and high risk
behaviors

Behavior

KBS rating considerations:

1
None

No S/S

Consistently
coping with dailystressors.
Positive social
functioning.
No impact on life

15







Dissatisfaction/ difficulty withresponsibilities
Difficulty interpreting or responding
to verbal/ non verbal communication
Neglectful
AbusiveOther

KBS rating considerations:
Knowledge(What client knows)
Consider knowledge of: infant/child cues
 fostering social
emotional andcognitive growth physical care needs

Behavior(What client does)
Consider: providing structure(routines)
 engages in stimulating,nurturing interaction
 physically/emotionallyabusive behavior
 prioritization of needs

MinimalBasic

Adequate

Superior

Minimalknowledge of:• reasons toparticipate inphysical activity

Basicknowledge of:• reasons toparticipate inphysical activity

Adequateknowledge of:• reasons toparticipate inphysical activity

Superior knowledgeof:• reasons toparticipate in physicalactivity

Not Appropriate

Rarely Appropriate

Inconsistently
Appropriate

Usually
Appropriate

Consistently Appropriate

Does not:• engage inregular physicalactivity• consider
changing behavior

Rarely:• engages inregular physicalactivity• considers
changing
behavior

Inconsistently:• engages inregular physicalactivity• considers
changing
behavior

Usually:• engages inregular physicalactivity• takes action tochange behavior

Consistently:• engages in regularphysical activity• maintains behavior
changes

No knowledgeof:• reasons toparticipate inphysical activity

Extreme S/S

Status(How client is)
Consider: child protection, court,or legal conditions on
caregiver physical condition andhygiene of dependent
child/adult meets physical,
developmental,
emotional, behavior &safety needs

Client Status

Signs/ Symptoms:
 Difficulty providing physical care/safety Difficulty providing emotional
nurturance Difficulty providing cognitive
learning experiences and activities Difficulty providing preventive andtherapeutic health care
 Expectations incongruent with stageof growth and development

Client/Caregiver
Behavior

Providing support, nurturance, stimulation, and physical care for dependent child or
adult

Client/Caregiver
Knowledge

None

Caretaking/ Parenting (pg 208):

Never Exercises

Severe S/S

Exercises
1x/week

Moderate S/S

Occasionallyexercises

Guidelines & Notes:• Child’s behavior and status is charted under Abuse, Neglect, and/or
Growth/Development

16

33

Minimal S/S

No S/SHas exercise
routine, butmaintains it
inconsistently

Consistently
exercises 5x/week

Physical Activity (331):
State or quality of body movements during daily living

Sedentary lifestyle
Inadequate/inconsistent exercise routineInappropriate type/amount of exercise
for age/physical condition
Other

KBS rating considerations:Behavior(What client does)
Consider if client is: implementing selfhelp readiness to change

Status(How client is)
Consider: acceptance of personal
responsibility

Behavior

Knowledge(What client knows)
Consider knowledge of: benefits of exercise
management
 exercise options
 how to accesssupport services

Knowledge

Signs/ Symptoms:

Guidelines & Notes:

1None
No knowledgeof:
age anddevelopmentally
specific● caregiving● health care● safety
practices● attachment● growth anddevelopment
Believes
inaccurate
information thatposes risk tochild/adult
Not
Appropriate
Does not:● provide forhealth and safety
needs● provide
physical care
● respond tocues● soothe●use discipline
methods
consistent withage/
development● engage instimulating/nurturinginteraction

2
MinimalMinimalknowledge of:age anddevelopmentally
specific● caregiving● health care● safety practices● attachment● growth anddevelopment

3
Basic
Basic
knowledge of:age anddevelopmentally

specific● caregiving● health care● safety practices● attachment● growth anddevelopment.

4
Adequate
Adequateknowledge of:age anddevelopmentally
specific● caregiving● health care● safety
practices● attachment● growth anddevelopment

5
Superior
Superior
knowledge of:age anddevelopmentally
specific● caregiving● health care● safety
practices● attachment● growth anddevelopment

RarelyAppropriate
Rarely:● provides forhealth and safety
needs● provides
physical care
● responds tocues● soothes●uses discipline
methods
consistent withage/
development● engages instimulating/nurturinginteraction

Inconsistently
Appropriate
Inconsistently:● provides forhealth and safety
needs● provides
physical care
● responds tocues● soothes●uses discipline
methods
consistent withage/
development● engages instimulating/nurturinginteraction

Usually
Appropriate
Usually:● provides forhealth andsafety needs● provides
physical care
● responds tocues● soothes●uses discipline
methods
consistent withage/
development● engages instimulating/nurturinginteraction

Consistently
Appropriate
Consistently:● provides forhealth andsafety needs● provides
physical care
● responds tocues● soothes●uses discipline
methods
consistent withage/
development● engages instimulating/nurturinginteraction

Extreme S/SConsistently
anxious/negative aboutcaregiving
responsibilities

Severe S/SFrequently
anxious/negative
about caregiving
responsibilities

Moderate S/SExpresses
some positive
feelings aboutcaregiving
responsibilities

Minimal S/S
Usually
positive aboutcaregiving
responsibilities

No S/S
Enjoyscaregiving

Expectations
not appropriate
for age anddevelopment

Expectations
rarelyappropriate forage anddevelopment

Expectations
sometimes
appropriate forage anddevelopment

Expectations
usuallyappropriate forage anddevelopment

Expectations
appropriate forage

StatusRelates in an
indifferent/
hostile manner

Active courtcase (e.g. riskof termination)
due to abuse orneglect

32

17

None

Neglect (pg 214):

Signs/ Symptoms:
 Lacks adequate physical care
 Lacks emotional nurturance/
support Lacks appropriate stimulation/
cognitive experiences






Inappropriately left alone
Lacks necessary supervision
Inadequate/ delayed medical care
Other

Client/Caregiver Knowledge

Child or adult deprived of minimally accepted standards of food, shelter, clothing, or
care.

Behavior(What child/adult does)
Consider: behaviors that may be
red flags for neglect

Status(How child/adult is)
Consider: affect and appearance
 medical care needs
 illness/treatment follow
up growth & development
 injuries
 safety/protection fromharm

Guidelines & Notes:
 Place the Child Neglect Problem in the child’s chart not the parent’s chart.
When victim of neglect is a child or vulnerable adult, rate caregiver’s knowledge
and child’s behavior and status.



Reflect caregiver behavior in Caregiver/Parenting problem.



Reference local/state laws and statutes regarding definition of neglect andmandated report guidelines.

18

Client Status

Caregiver’s Knowledge(What caregiver knows)
Consider knowledge of:

Client/Caregiver Behavior

KBS rating considerations:No knowledge of:• negative effects
of diet on healthstatus• suggested dietfor health status(dietary
guidelines andfood pyramid
recommendations)• current weight &weight history• role of fruits,
vegetables, sugar
and fats in dietmanagement• resources andhow to access

MinimalBasic

Adequate

Superior

Minimalknowledge of:Basic knowledgeof:

Adequateknowledge of:Superior
knowledge of:• negative effects
of diet on healthstatus• suggested dietfor health status(dietary
guidelines andfood pyramid• negative effects
of diet on healthstatus• suggested dietfor health status(dietary
guidelines andfood pyramid• negative effects
of diet on healthstatus• suggested dietfor health status(dietary
guidelines andfood pyramid• negative effects
of diet on healthstatus• suggested dietfor health status(dietary
guidelines andfood pyramid
recommendations)recommendations)recommendations)recommendations)• current weight &weight history• role of fruits,
vegetables, sugar
and fats in dietmanagement• resources andhow to access• current weight &weight history• role of fruits,
vegetables, sugar
and fats in dietmanagement• resources andhow to access• current weight &weight history• role of fruits,
vegetables, sugar
and fats in dietmanagement• resources andhow to access• current weight &weight history• role of fruits,
vegetables,
sugar and fats indietmanagement• resources andhow to access

Not Appropriate

Rarely Appropriate

Inconsistently
Appropriate

Usually Appropriate

Consistently
Appropriate

Does not:• eat fruits &vegetables• limit fat and/or
sugar intake• limit portions• track weight or
blood sugar• consider
changing behavior

Rarely:• eats fruits &vegetables• limits fat and/or
sugar intake• limits portions• tracks weight or
blood sugar• considers
changing behavior

Inconsistently:• eats fruits &vegetables• limits fat and/or
sugar intake• limits portions• tracks weight or
blood sugar• considers
changing behavior

Usually:• eats fruits &vegetables• limits fat and/or
sugar intake• limits portions• tracks weight or
blood sugar• takes action tochange behavior

Consistently:• eats fruits &vegetables• limits fat and/or
sugar intake• limits portions• tracks weight or
blood sugar• maintains
behavior changes

Extreme S/S

Severe S/SModerate S/S

Minimal S/S

No S/S

Blood sugar/lipid
levelsBlood sugar/lipid
levelsdecreasing withmedications

Blood sugar/lipid
levels controlledwith medications
and diet

Blood sugar/lipid
levels controlledwith dietBloodsugar/lipid
levels withinrecommended
ranges

Weight notwithinrecommended
ranges

Weightdecreasing

31

Weight withinrecommended
range






Overweight: adult BMI 25.0 or morechild BMI 95th percentile or more
Underweight: adult BMI 18.5 or less;child BMI 5th percentile or lessLacks established standards for daily
caloric/fluid intake
Exceeds established standards fordaily caloric/fluid intake
Unbalanced diet









Improper feeding schedule for age
Does not follow recommended
nutrition plan
Unexplained/progressive weight loss
Unable to obtain/prepare food
Hypoglycemia
Hyperglycemia
Other

KBS rating considerations:
Knowledge(What client knows)
Consider knowledge of: Benefits of weight
management
 Treatment options
 How to accesssupport services

Behavior(What client does)
Consider if client is: Implementing selfhelp strategies

4
Adequate
Adequateknowledge of:standards forproviding●physical care●stimulation,●supervision,●nurturance●health care

5Superior
Superior
knowledge of:standards andrationale forproviding●physical care●stimulation,●supervision,●nurturance●health care

Not
Appropriate
Does not:● engage withcaregiver● exhibit typicalbehavior forage/condition

RarelyAppropriate
Rarely:● engages withcaregiver● exhibits typicalbehavior forage/condition

Inconsistently
Appropriate
Inconsistently:● engages withcaregiver● exhibits
typical behavior
forage/condition

Usually
Appropriate
Usually:● engages withcaregiver● exhibits typicalbehavior forage/condition

Consistently
Appropriate
Consistently:● engages withcaregiver● exhibits typicalbehavior forage/condition

Extreme S/SExtreme:Unmet needs for●physical care●stimulation,●supervision,●nurturance● health care

Severe S/S
Severe:Unmet needs for●physical care●stimulation,●supervision,●nurturance● health care

Moderate S/SModerate:
Unmet needsfor●physical care●stimulation,●supervision,●nurturance● health care

Minimal S/S
Minimal:Unmet needs for●physical care●stimulation,●supervision,●nurturance● health care

No S/SNo:
Unmet needs for●physical care●stimulation,●supervision,●nurturance● health care

Caregiver’s Knowledge



3
Basic
Basic
knowledge of:standards forproviding●physical care●stimulation,●supervision,●nurturance●health care

Behavior

Signs/ Symptoms:

2
MinimalMinimalknowledge of:standards forproviding●physical care●stimulation,●supervision,●nurturance●health care

StatusNutrition (323):
Select, consume, and use food and fluids for energy, maintenance, growth and health1None
No knowledgeof:standards forproviding●physical care●stimulation,●supervision,●nurturance● health care

Status(How client is)
Consider: Acceptance of personal
responsibilty

Guidelines & Notes:

30

19

Abuse (pg 219):

Fearful/ hypervigilant behavior
Violent environment
Consistent negative messages
Assaulted sexually
Other

KBS rating considerations:
Knowledge(What client knows)
Consider knowledge of: cycle of abuse, power,& control effects of abuse on
self and others; legal /order forprotection;
 awareness of own
history & how history
affects the presentWith children, consider
parent’s knowledge of: what abuse is what appropriate
discipline is effects of a violent
environment

Behavior(What client does)
Consider: unusual responses
to partner
 accepting/seeking of
information;
 readiness to takeaction; acknowledgment of
abuse(What child does)child behaviors that may
be red flags, such as :
 unusual responses
to caregiver indiscriminantfriendliness watchfulness guardedness
 sexual actions
 affect sudden onset of
bedwetting

Status(How client is)
Consider: all types of abuse visible injuries
 level of isolation
 emotional status client/family safety reports by client orobservations by careprovider

Guidelines & Notes:
 When Abuse is used in an adult client’s chart means the client is experiencing
or is at risk of experiencing abuse.
 When the client is abusing or at risk of abusing a child, the problem Abuse
belongs in the child’s chart. Documentation in the adult’s chart will be in the
Caretaking/ Parenting problem.
 Reference local/state laws and statutes regarding definition of neglect andmandated report guidelines.
 Do not rate the abusers behavior or status, but rather consider the impact ofthat behavior on client status.
 Always relate to clients with respect and concern for their wellbeing. Refrainfrom making judgments about clients based on their abuse history orsigns/symptoms. The behaviors must be observed, not interpreted. Omaha
System terms are meant to be objective, although they may sound judgmental
in the context of ratings.

20

1
None
No knowledgeof:●physical/
emotional
postpartum
changes●breastfeeding●self care●resources andhow to access

2
MinimalMinimalknowledge of:●physical/
emotional
postpartum
changes●breastfeeding●self care●resources andhow to access

3
Basic
Basic
knowledge of:●physical/
emotional
postpartum
changes●breastfeeding●self care●resources andhow to access

4
Adequate
Adequateknowledge of:●physical/
emotional
postpartum
changes●breastfeeding●self care●resources andhow to access

5
Superior
Superior
knowledge of:●physical/
emotional
postpartum
changes●breastfeeding●self care●resources andhow to access

Not
Appropriate
Does not:●access
postpartum care●seek
information●follow throughwith self-careRarelyAppropriate
Rarely:●accesses
postpartum care●seeksinformation●follows throughwith self-careInconsistently
Appropriate
Inconsistently:●accesses
postpartum care●seeksinformation●follows throughwith self-care

Usually
Appropriate
Usually:●accesses
postpartum care●seeksinformation●follows throughwith self-care

Consistently
Appropriate
Consistently:●accesses
postpartum care●seeksinformation●follows throughwith self-carerecommendations

recommendations

recommendations

recommendations

recommendations●cope with
postpartum
changes/stressors●copes with
postpartum
changes/stressors●copes with
postpartum
changes/stressors●copes with
postpartum
changes/stressors●copes with
postpartum
changes/stressors

Extreme S/S
Unable to carefor self or infant

Severe S/S
Needs
assistance tocare for self
and infantModerate S/S
Needs daily
assistance tocare for self
and infant

Minimal S/S
Able to provide
most care forself and baby

No S/S
Able to careconsistently for
self and baby

At home withcomplications;condition
warrants closemonitoring

Complications
interfere withdaily activity
and require
moderate
restrictions or
health careintervention

Minimalcomplications
addressedusing self caremeasures

Healthy
postpartumwith mild
discomforts

Believes
inaccurate
information/
myths.

Behavior







Needs ED or
hospitalizationforcomplications
StatusSigns/ Symptoms:
 Harsh/ excessive discipline Welts/ bruises/ burns/ otherinjuries Questionable explanation of injury
 Attacked verbally

Knowledge

Child or adult subjected to non-accidental physical, emotional, or sexual violence or
injuryNo support
person(s)Minimalsupport(s)infrequently
available,
sometimes
unwilling toassistHas support(s)person who
assists whenavailable

29

Has a support
person(s) whenneededSupportperson(s)present andcontributing
meaningfulsupportPostpartum (pg 310):
Six-week period following childbirthSigns/ Symptoms:
Postpartum complications
Abnormal depressed feelings
Other
KnowledgeKBS rating considerations:
Knowledge(What client knows)
Consider knowledge of: emotional andphysiological changes
 danger signs
 Self care, including:management oflochia, perineal or
incision care,afterpains, emotionalswings, breast/nipple
discomforts, diet,rest/sleep, exercise.
 understanding ofmaternal benefits ofbreastfeeding for PP
recovery

Behavior(What client does)
Consider: willingness to learn
 behaviors related toself-care adherence to plan ofcare

Status(How client is)
Consider: physical symptoms of potential
postpartum complications
including: infection, severe pain,
bleeding, vaginal discharge,
hemorrhoids, engorgement, nipple
discomfort, c-section, perineum
problems, pour wound healing,
diabetes, hypertension,
thrombophlebitis
 severity and level of control ofphysical symptoms (above) emotional recovery
 ability to care for self and infant the impact of birth outcomes on
postpartum recovery

StatusGuidelines & Notes:
 Status in this problem refers to ability to care for self and infant as a result of pp course ofrecovery. If there are other problems contributing to the inability to care for infant and self, theyshould be opened.
 Mental Health: If S/S of postpartum psychosis, postpartum depression or other mental healthproblems are present, the Mental Health problem should be assessed, with appropriate S/S
indicated.
 Substance Use: If a postpartum woman is using drugs, alcohol or tobacco, the Substance Use
problem should be assessed, with appropriate S/S indicated.

28

2
MinimalMinimalknowledge of:● difference
between healthy
and abusive
relationship● physical,
emotional, sexualaspects of abuse● negative
impacts on childwell being● need for help
or counseling● resources andhow to access● how to protect
self anddependents● legal rights

3
Basic
Basic
knowledge of:● difference
between healthy
and abusive
relationship● physical,
emotional, sexualaspects of abuse● negative
impacts on childwell being● need for help
or counseling● resources andhow to access● how to protect
self anddependents

4Adequate
Adequateknowledge of:● difference
between healthy
and abusive
relationship● physical,
emotional, sexualaspects of abuse● negative
impacts on childwell being● need for help
or counseling● resources andhow to access●how to protect
self anddependents

Not
Appropriate
Does not:● have or follow
safety plan

RarelyAppropriate
Rarely:● follows safety
planInconsistently
Appropriate
Inconsistently:● follows safety
plan

Usually
Appropriate
Usually:● follows safetyplan

Behavior

Difficulty breast-feeding
Difficulty coping with postpartum changes
Difficulty with postpartum exercise/ diet/behaviors
Abnormal bleeding/ vaginal dischargeChild’s behavior





1
None
No knowledgeof:● difference
between healthy
and abusive
relationship● physical,
emotional,
sexual aspectsof abuse● negative
impacts on childwell being● need for help
or counseling● resources andhow to access● how to protect
self anddependents● legal rights

5Superior
Superior
knowledge of:● difference
betweenhealthy andabusiverelationship● physical,
emotional,
sexual aspectsof abuse● negative
impacts onchild well being● need for help
or counseling● resources
and how toaccess● how toprotect self anddependents
Consistently
Appropriate
Consistently:● follows safety
plan
Establishes
and maintains
safe living
conditions forself and others

Consistently
exhibits
extremeatypicalbehavior that
could indicate
abuse

Usually exhibits
atypicalbehavior that
could indicate
abuse

Inconsistently
exhibits atypicalbehavior that
could indicate
abuse

Rarely exhibits
atypicalbehaviors that
could indicate
abuse

Exhibits
typicalbehaviors

Extreme S/SExtreme abuse:● physical● emotional● sexual● domestic
abuse exposure● harsh/corporalpunishment

Severe S/S
Severe abuse:● physical● emotional● sexual● domestic
abuse exposure

Moderate S/SModerateabuse:● inconsistently
receives negative
messages

Minimal S/S
Minimal abuse:● rarely receives
negative
messages

No S/SNo abuse.

Inconsistently
safe in homeenvironment
and/or withcaregivers/
significant other

Usually safe inhomeenvironment
and/or withcaregiver/significant otherIs not safe inhomeenvironment
and/or withcaregivers/
significant
otherRarely safe inhomeenvironment
and/or withcaregivers/
significant other21

Ageappropriate
behavior
management
or disciplinethat is freefrom abuse
Safe in homeenvironment
and/or withcaregivers/
significant
other





Age-inappropriate behavior
Inadequate achievement/
maintenance of developmental
tasks
Other

KBS rating considerations:
Knowledge(What caregiver/individual knows)
Consider knowledge of: infant/child cues
 fostering social,emotional &cognitive growth physical care, safety
 positive/effective
discipline practices

Behavior(What child/individual
does)
Consider: how individual
responds toenvironment
 interaction withothersStatus(How child/individual is)
Consider: eligibility for services
 height/weight/headcircumference impact of delays on
areas of life such ascommunication,
mobility, self care

Guidelines & Notes:
 Obesity in Infants CDC Growth charts and Wt. Gain norm charts are used todetermine growth status
 Assess and document child’s behavior and status and caregiver’s knowledge in
growth/development problem in child’s chart.
 Assess and document caregiver’s knowledge, behavior and status in
Caretaking/Parenting problem in caregiver’s chart.

Behavior

Signs/ Symptoms:
 Abnormal results of developmental
screening tests
 Abnormal weight/ height/ headcircumference in relation to growth/age standards

Knowledge

Growth and Development (pg 223):
Progressive physical, emotional, and social maturation along the age continuum frombirth to death.

1None
No knowledge of:●appropriate rest,
exercise, and dietpatterns.
●pregnancy topics●the impact of highrisk behaviors on
fetal development●when to call the
doctor2
MinimalMinimal knowledgeof:●appropriate rest,
exercise, and dietpatterns.
●pregnancy topics●the impact of highrisk behaviors on
fetal development●when to call the
doctor3
Basic
Basic knowledgeof:●appropriate rest,
exercise, and dietpatterns.
●pregnancy topics●the impact of highrisk behaviors on
fetal development●when to call the
doctor4
Adequate
Adequateknowledge of:●appropriate rest,
exercise, and dietpatterns.
●pregnancy topics●the impact of highrisk behaviors on
fetal development●when to call the
doctor.

5
Superior
Superior
knowledge of:●appropriate rest,
exercise, and dietpatterns.
●pregnancy topics●the impact of highrisk behaviors on
fetal development●when to call the
doctorNot
Appropriate
Does not:●access prenatalcare●seek information●follow through with
self-carerecommendations●plan for baby
●cope withpregnancy changes/
stressors

Rarely Appropriate
Rarely:●accesses prenatalcare●seeks information●follows throughwith self-carerecommendations●plans for baby
●copes withpregnancy changes/
stressors

Inconsistently
Appropriate
Inconsistently:●accesses prenatalcare●seeks information●follows throughwith self-carerecommendations●plans for baby
●copes withpregnancy changes/
stressors

Usually
Appropriate
Usually:●accesses
prenatal care●seeks information●follows throughwith self-carerecommendations●plans for baby
●copes withpregnancychanges/ stressors

Consistently
Appropriate
Consistently:●accesses prenatalcare●seeks information●follows throughwith self-carerecommendations●plans for baby
●copes withpregnancy changes/
stressors

Severe S/SModerate S/S

Minimal S/S

No S/S

Mostly apathetic or
negative about
pregnancy

Some ambivalence
about pregnancy

Mostly positive
about pregnancy

Complications
interfere with daily
activity and require
moderate
restrictions or
health careintervention

Minimalcomplications
addressed using
self caremeasuresEngages in highrisk behaviors.
Reacts negatively
to references topregnancy/fetus
Extreme S/S

StatusUnwantedpregnancy
Hospitalized or ED
Visit for pregnancy
complications
Maternal or fetal
death

22

At home withcomplications;condition warrants
close monitoring
or bedrest

27

Consistently
positive about
pregnancy
Healthy pregnancy
with mild
discomforts that
do not interferewith daily
activities

Pregnancy (pg 304):
Period from conception to childbirth

Fears delivery procedure
Prenatal complications/ preterm labor
Inadequate social support
Other

Behavior(What client does)
Consider client’s:
 willingness to learn
 cultural norms/values/beliefs
 high risk behaviors(see below)
 statement’s
referencing baby
 plans for baby or
pregnancy

Status(How client is)

KBS rating considerations:
Knowledge(What client knows)
Consider knowledge ofpregnancy topics, including: pregnancy options
 fetal G&D
 danger /warning signs
 breastfeeding
 S/S of Labor
 childbirth & delivery
procedures
 Self Care Measures(see below)
 physical changes
 environmental
hazards
 high-risk pregnancies,
delivery complications
or fetal demise high-risk behaviors
 preparation for babycare maternal role

Consider: physical symptoms or complications, such
as: PTL, inadequate weight gain, Gestational
hypertension, gestational diabetes, hyperemesis, bleeding/abnormal vaginal
discharge, edema, high fever, STD’s emotional readiness for pregnancy &delivery.
 bonding with pregnancy/ baby realistic expectations of pregnancy andmotherhood
 ability to meet ADL’s. home maintenance,
self care, work, school.
 Social support
 Prematurity and related birth outcomes

Guidelines & Notes:








Self Care Measures include managing the discomforts of pregnancy and engaging in behaviors that promotea healthy pregnancy, such as diet, prenatal vitamins, exercise, activity, rest, safe sexual activity.
High risk behaviors include inappropriate use of substances, exposing self to hazards/toxins, engaging in
dangerous activities.
This problem refers to the pregnancy itself. Other contributing or related problems should be opened &assessed individually, such as:
Substance use during pregnancy: If a pregnant woman is using drugs, alcohol or tobacco during
pregnancy, the Substance Use problem must be assessed as an actual problem with signs and symptoms
indicated.
Family planning: Anticipatory teaching can be documented in the Pregnancy problem. The Family Planningproblem may be opened during pregnancy and should be addressed when the client delivers
Mental Health: Open the Mental Health problem when indicated by signs and symptoms on page 10.

26Child’s Behavior






Difficulty bonding with unborn baby
Difficulty coping with body changes
Difficulty with prenatal exercise/ rest/ diet/behaviors

Child’s Status

Caregiver’s
Knowledge

Signs/ Symptoms:

1
None

2
Minimal3
Basic4Adequate

5Superior

No knowledge of:● growth anddevelopment● medical
diagnosis, disability
or delay

Minimalknowledge of:● growth anddevelopment● medical
diagnosis, disability
or delayBasicknowledge of:● growth anddevelopment● medical
diagnosis,
disability or delay

Adequateknowledge of:● growth anddevelopment● medical
diagnosis,
disability, or delay

Superior
knowledge of:● growth anddevelopment● medical
diagnosis,
disability, or
delay

Not
Appropriate

RarelyAppropriate

Inconsistently
Appropriate

Usually
Appropriate

Consistently
Appropriate

Does not:●exhibit behavior
appropriate fordevelopmental
stage

Rarely:● exhibits behavior
appropriate fordevelopmental
stage

Inconsistently:● exhibits
behavior
appropriate fordevelopmental
stage

Usually:● exhibits
behavior
appropriate fordevelopmental
stage

Consistently:● exhibits
behavior
appropriate fordevelopmental
stage

Extreme S/SExtreme:●delays in one ormore areas ofdevelopmental
screening/assessment●impact on life
functioning

Severe S/S
Severe:●delays in one ormore areas ofdevelopmental
screening/assessment●impact on life
functioning
Newborn has notregained birthweight by 2-3
weeks

Minimal S/S
Minimal:●delays in one ormore areas ofdevelopmental
screening/assessment●impact on life
functioning● deviations fromweight gain
expectations

No S/S
No:●delays on
developmental
screening/assessment● deviations fromweight gain
expectations

Newborn does notregain BW within 1month or low birthweight not gaining
weightModerate S/SModerate:●delays in one ormore areas ofdevelopmental
screening/assessment●impact on life
functioning●deviations fromweight gain
expectations

Infant or childdrops 2 or more
major percentiles
or has fallen below
3rd percentile

Infant or childfallen below 10th
percentile

Variable school
performancewith somestruggles

Adequate school
performance atappropriate gradelevel in mostsubjects

Child 2-5 above
95th major
percentile weightfor height
Poor school
performanceIf pattern
unknown,current weightfor height on orclose to 50th
percentile andno significant
history ofweight problem
reported

Child 2-5 between
85th and 95th
percentile weightfor height

Marginal school
performance

23

Consistently
performing at
grade level in all
subjects

Cognition (pg 245):

Limited reasoning/ abstract thinking ability
Impulsiveness
Repetitious language/ behavior
Wanders
Other

KBS rating considerations:
Knowledge
Behavior(What client knows)(What client does)
Consider:Consider: awareness of needs client’s ability should be
and how to copecompared to all people (theuniverse), not to those withlike cognitive deficits

Status(How client is)
Consider: if client has necessary
services and support tocope with daily living.
 “street smarts”
 ability to complete forms,
follow simple directions,complete 2-step directions,adjust behavior androutines to fit situations
such as school, shopping,
appointments, and public
transportation

Guidelines & Notes:
 Cognition should be assessed and documented for all clients with intellectual disabilities in orderto capture the prevalence of intellectual disabilities in the client population.
 Assess as actual and put on careplan if: PHN will be facilitating identification of cognitive
issues (testing) or getting appropriate services; and/or if the interventions will be helping theclient access services. Use this problem to show that we are intervening around the cognitive
problems.
 Assess as actual and leave off careplan if: the client is already receiving appropriate services.
In that case “other provider” can be noted.

24

Behavior







1
None
No knowledgeof:● cognitive
deficit● ways to deal
with limitations● resources andhow to access

2
MinimalMinimalknowledge of:● cognitive
deficit● ways to deal withlimitations● resources andhow to access

3
Basic
Basic
knowledge of:● cognitive
deficit● ways to deal
with limitations● resources andhow to access

4
Adequate
Adequateknowledge of:● cognitive
deficit● ways to deal
with limitations● resources andhow to access

5
Superior
Superior
knowledge of:● cognitive
deficit● ways to deal
with limitations● resources andhow to access

Not
Appropriate
Does not:●utilize, accept,
or seek
resources/
assistanceRarelyAppropriate
Rarely:● utilizes, accepts,
or seeks
resources/
assistance●does for self

Inconsistently
Appropriate
Inconsistently:● utilizes,
accepts, orseeks
resources/
assistance●does for self

Usually
Appropriate
Usually:●utilizes,
accepts & seeks
resources/
assistance●does for self

Consistently
Appropriate
Consistently:●utilizes, accepts& seeks
resources/
assistance●does for self

Over-relies on
resources

StatusSigns/ Symptoms:
 Diminished judgment
 Disoriented to time/ place/ person
 Limited recall of recent events
 Limited recall of long past events
 Limited calculating/ sequencing skills
 Limited concentration

Knowledge

Ability to think and use information

Extreme S/SExtreme:●limitations

Severe S/S
Severe:●limitations

Moderate S/SModerate:●limitations

Minimal S/S
Minimal:●limitations

No S/SNo:●limitations

No supports in
place

Rarely has
supports in placeSome
supports in
place

Most supports
in place

Supports in
place

Not able tofunction insociety

Minimally able tofunction insociety

Usuallyfunctioning wellin society

Functions wellin society

Moderately
able tofunction insociety25