Adult PHP Baseline Assessments Date of Admission & Testing:

Experiences in Close Relationships-Revised (ECR-R)

Adult Attachment Questionnaire Score

Coping
Self-Efficacy low Locus of Control
secure avoidance preoccupied
10 Certain 23 Internal
I Can Cope LOCUS

low anxiety high anxiety

5 Moderately Certain 12
I Can Cope

0 Cannot Cope dismissing 1 External

At All high fearful - avoidant LOCUS
avoidance
Chesney, et. al. (2006) Rotter (1966)

http://www.psych.uiuc.edu/~rcfraley/measures/ecrr.htm

GAF Score HAM-A Score HAM-D Score Young Mania Rating

Day 10
Day 1

Day 2

Day 3

Day 4

Day 5

Day 6

Day 7

Day 8

Day 9

Serene
0
Subjective Unit of Disturbance (SUDS)

Moderate
but manageable, 5

Unbearable
TRACKING

10
Day 11

Day 12

Day 13

Day 14

Day 15

Day 16

Day 17

Day 18

Day 19

Day 20

Serene
0

Moderate
but manageable, 5

Unbearable
10
GAF SCALE

91–100
Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many
qualities. No symptoms.
81–90
Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied
with life, no more than everyday problems or concerns.
71–80
If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational,
or school functioning.
61–70
Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful
interpersonal relationships.
51–60
Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning.
41–50
Serious symptoms OR any serious impairment in social, occupational, or school functioning.
31–40
Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment,
thinking, or mood.
21–30
Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function
in all areas.
11–20
Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication.
1–10
Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear
expectation of death.
0
Not enough information available to provide GAF.

HAM-A Scoring Instructions: Secure Attachment Style (High self-esteem, Interpersonal Trust)
Sum the scores from all 14 parameters. 1.) I find it easy to meet new people.
2.) I enjoy looking at myself in the mirror.
14-17 = Mild Anxiety 3.) I'm very happy with my life right now.
18-24 = Moderate Anxiety 4.) Dancing is great.

25-30 = Severe Anxiety Dismissing Attachment Style (High self-esteem, Interpersonal Mistrust)
1.) I had rather depend on myself than on other people.
2.) I don't like to reveal things about myself to others.
3.) My friends seldom live up to my expectations.
4.) I can get along quite well without a close emotional relationship in my life.
HAM-D Scoring:
Sum the scores from the first 17 items. Fearful-Avoidant Attachment Style (Low self-esteem, Interpersonal Mistrust)
0-7 = Normal 1.) Whenever I hear a doorbell ring, I'm usually a little worried about who it might be.
2.) I feel that most people don't like me.
8-13 = Mild Depression 3.) I don't have much to be proud of.
4.) It's really much safer just to think about a relationship instead of actually initiating one.
14-18 = Moderate Depression
Preoccupied Attachment Style (Low self-esteem, Interpersonal Trust)
19-22 = Severe Depression 1.) I am more affectionate than my partner.
≥ 23 = Very Severe Depression 2.) I fall in love easily.
3.) Sometimes I tell people too much about myself.
4.) My most important goal is to be truly appreciated by another person.

SUDS SCALE

10 = Feels unbearably bad, beside yourself, out of control as in a nervous breakdown, overwhelmed, at the end of your rope. You may feel so upset
that you don't want to talk because you can't imagine how anyone could possibly understand your agitation.

9 = Feeling desperate. What most people call a 10 is actually a 9. Feeling extremely freaked out to the point that it almost feels unbearable and you
are getting scared of what you might do. Feeling very, very bad, losing control of your emotions.

8 = Freaking out. The beginning of alienation.

7 = Starting to freak out, on the edge of some definitely bad feelings. You can maintain control with difficulty.

6 = Feeling bad to the point that you begin to think something ought to be done about the way you feel.

5 = Moderately upset, uncomfortable. Unpleasant feelings are still manageable with some effort.

4 = Somewhat upset to the point that you cannot easily ignore an unpleasant thought. You can handle it OK but don't feel good.

3 = Mildly upset. Worried, bothered to the point that you notice it.

2 = A little bit upset, but not noticeable unless you took care to pay attention to your feelings and then realize, "yes" there is something bothering me.

1 = No acute distress and feeling basically good. If you took special effort you might feel something unpleasant but not much.

0 = Peace, serenity, total relief. No more anxiety of any kind about any particular issue.