top of page

FIRST NAME

Deborah

LAST NAME

Shepard

Assessment Completed

CLIENT PROFILE

PROGRAMME DETAILS

CLIENT PROFILE

PROGRAMME DETAILS

ASSESSMENT FORMS

ASSESSMENT FORMS

Anchor 1

Contact Details

DATE OF BIRTH:

PHONE:

07719 565317

EMAIL:

ADDRESS:

39

Abbey Road

Heywood

OL10 4UF

Referral Details

ORGANISATION:

Alzheimer's society

CONTACT:

Julie Mann

Client Notes

Needs Of The Client (From referral)

Deborah is the main carer for her mum Christine who was diagnosed with dementia 2 years ago. Christine also has several other health problems which impact upon her dementia. Deborah also works which is a challenge with her caring needs. There is a lot of conflict between Deborah and her siblings as they do not provide her with any help. When I spoke to Deborah she was at breaking point and felt she had lost herself and purpose for living. I have made and urgent referral to adult care to try and get some home care support to lessen some of the carers burden she is feeling. I think she would benefit greatly from your service to give her some time for herself. Deborah does not drive but hopefully she will get a taxi to you. It might be worth her having a chat with Les to provide emotional support. I would appreciate you contacting Deborah as soon as you possible can xx

I have tried several times to contact Deborah with no reply..

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

Are you sure you want to proceed?

GO BACK
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.

NEXT FORM

SOME FIELDS ARE MISSING ABOVE. PLEASE CHECK YOUR ANSWERS AND TRY AGAIN

bottom of page