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FIRST NAME

Anne

LAST NAME

Campbell

Assessment Completed

​

CLIENT PROFILE

PROGRAMME DETAILS

CLIENT PROFILE

PROGRAMME DETAILS

ASSESSMENT FORMS

ASSESSMENT FORMS

Anchor 1

Contact Details

DATE OF BIRTH:

Feb 19, 1953

PHONE:

01706 710913/ 07950 711759

EMAIL:

​

ADDRESS:

​

4

Footwood Cresent

Rochdale

OL12 6PB

Referral Details

ORGANISATION:

KWHC

CONTACT:

Julie Mann

Client Notes

Needs Of The Client (From referral)

Anne is the main carer for her husband Aiden who has Alzheimer's. Aiden was diagnosed about 6 years ago and Anne has refused any form of support. I was contacted by their daughter recently who has agreed for Aiden to attend the willows once a week to enable her to have some respite, he is attending on Wednesday. Anne has agreed that she will attend your service but would have to bring Aiden along with her, she has recently been using massage on him which he enjoyed. They are both physically fit.

On speaking to Anne she has now increased to respite days at the willows and would rather attend on her own after dropping off Aiden. If unable to contact Anne then please ring her daughter Kate on 07910 452978.

Additional Notes (From KWH)

Availability Information

Yes

No

Does the client need to start services immediately?

Therapy Details

Does the client require holistic therapies?

Yes

No

Counselling Details

Yes

No

Does the client require counselling services?

WARNING!

Clicking "I'M SURE" below will save all your answers in this assessment. You will not be able to make changes without contacting Admin/Support

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I'M SURE

STATEMENT

No

Well-being Assessment Form

Client has Dementia -

SWEMWBS

STATEMENT

No

NONE OF THE TIME

SOME OF THE TIME 

ALL OF THE TIME 

RARELY

OFTEN

1.

I've been feeling optimistic about the future

2.

I've been feeling useful

3.

I've been feeling relaxed

4

I've been dealing with problems well

5

I've been thinking clearly

6

I've been feeling close to other people

7

I've been able to make up my own mind about things

INITIAL SCORE:

40

WELL-BEING INDICATOR:

ABOVE AVERAGE

Well-being scale:

0 - 21 = Low   |   22- 24 = Below Average   |   25 - 26 =  Average   |   27 - 35 = Excellent

Short version of the "Warwick-Edinburgh Mental Well-being Scale" (SWEMWBS) @NHS Scotland, University of Warwick and University of Edinburgh 2006 all rights reserved

ONSSWQ

NOT AT ALL

EXTREMELY 

1

How satisfied are you with your life nowadays?

2

How happy did you feel yesterday?

3

How anxious did you feel yesterday?

4

Do you feel that the things you do are worthwhile?

The Office of National Statistics' subjective well-being questions (ONSSWQ). All rights reserved

SOCIAL TRUST

MOST PEOPLE

CAN BE TRUSTED

CAN'T BE

TOO CAREFUL

No

STATEMENT

1

Would you say that people can be trusted?

The New Economic Foundation's social trust question (NEFST). All rights reserved

KWWBS

STATEMENT

No

DISAGREE

AGREE

1

Overall, I have a great sleep: pattern

2

I, mostly, have a great range of motion:

3

Most of the time, I don't feel tense 

4

Generally, I don't feel physically drained

Developed at Kenny Webber by adapting established principles and techniques from research into the physical aspects of mental health.

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