|
Goal Attainment Scaling for
________________________________________ |
|
||||||
|
Levels of Predicted |
Scale 7 (Wt.) ____ Nutrition |
Scale 8 (Wt.) _____ Breastfeeding |
Scale 9 (Wt.) ____ Communicable
Diseases |
Scale 10 (Wt.) ____ Substance
Use/Abuse |
Scale 11 (Wt.) ____ Housing (Substandard) |
Scale 12 (Wt.) ______ Housing (No substandard) |
|
|
+ 2 |
7 per week 1 2 3 4 5 6 7 8 |
No problems
with breast feeding 1 2 3 4 5 6 7 8 |
Open to
discussion and effectively addressees 1 2 3 4 5
6 7 8 |
Understands
and has stopped using 1 2 3 4 5
6 7 8 |
Retains/maintains
housing 1 2 3 4 5
6 7 8 |
Retains/maintains housing 1 2 3 4 5
6 7 8 |
|
|
+1 More
than |
6 per week 1 2 3
4 5 6 7 8 |
Breastfeeds
with no discomfort 1 2 3 4 5 6 7 8 |
1 2 3 4 5
6 7 8 |
Understands
and makes efforts but not 100% successful 1 2 3 4 5
6 7 8 |
Obtains
permanent housing 1 2 3 4 5
6 7 8 |
Obtains
permanent housing 1 2
3 4 5
6 7 8 |
|
|
0 Expected |
5 per week 1 2 3 4 5 6 7 8 |
No discomfort But does not breast feed 1 2 3 4 5 6 7 8 |
Not
comfortable but seeks to follow protocol 1 2
3 4 5
6 7 8 |
Seems to understands problems and is making efforts 1 2 3 4 5
6 7 8 |
Emergency or
temporary housing 1 2 3 4 5
6 7 8 |
Needs housing
and is following direction to attain housing 1 2
3 4 5
6 7 8 |
|
|
-1 |
3-4 per week 1 2 3 4 5 6 7 8 |
Breastfeeds
with discomfort 1 2 3 4 5 6 7 8 |
Not comfortable and does not seem to
follow protocol 1 2 3 4 5
6 7 8 |
Seems to understand and makes little
effort 1 2 3 4 5
6 7 8 |
1 2
3 4 5
6 7 8 |
Needs housing
but makes little effort 1 2
3 4 5
6 7 8 |
|
|
-2 |
0-2 per week 1 2 3 4 5 6 7 8 |
Expresses extreme discomfort with
breastfeeding 1 2 3 4 5 6 7 8 |
Expresses no
concern verbal /nonverbal 1 2
3 4 5
6 7 8 |
Does not act if understands the problem 1 2 3 4 5
6 7 8 |
Stuck in
substandard housing 1 2 3 4 5
6 7 8 |
Extreme
distress due to inability to obtain individual housing 1 2
3 4 5
6 7 8 |
|
GAS Composite Scores 1 = ____ 2 = ____ 3 = ____ 4 = ____ 5 = ____ 6 = ____ 7 = ____ 8 = ____