SOCIAL FUNCTIONING SCALE Section one: Withdrawal Part One: 1. 3: < 9.am 2: 9.am to 11.am 1: 11am to 1pm 0: >1pm What time do you get up each day? Average weekday Average weekday (if different) 2. How many hours of the waking day do you spend alone? (e.g. on own in room. Walking out alone, listening to radio or watching TV alone, etc.)? Count the number of hours in an average day spent alone and tick () one of the following. Hours spent alone 0 – 3 Very little time spent alone 3. Some of the time 2 6 - 9 Quite a lot of the time 1 9 - 12 A great deal of the time 12 - Practically all the time 0 How often will you start a conversation at home? 1 rarely 2 sometimes 3 often How often will you leave the house (for any reason)? 0 almost never 5. 3 3 - 6 0 almost never 4. 1 rarely 2 sometimes 3 often How do you react to the presence of strangers? 0 avoids them 1 feels nervous 2 accepts them 3 likes them INTERPERSONAL FUNCTIONING Part Two 1. How many friends do you have at the moment? (persons whom you will see regularly, do activities with etc)? Number of friends ……………. 2. Have you someone you find it easy to discuss feelings and difficulties with? 3. How often have you confided in them? 0 1 2 almost never rarely sometimes 3 often Do other people discuss their problems with you? 0 1 2 almost never rarely sometimes 3 often 4. 5. Do you have a boy/girl-friend? 6. Have you had any arguments with friends, relatives or neighbours recently? 3 2 1 none 1 or 2 minor continued minor or 1 major 7. (If not married) (If married = 3) 3 YES 3 YES 0 NO 0 NO 0 many major How often are you able to carry out a sensible or rational conversation 0 almost never 2 sometimes 3 often 2 sometimes 3 often Do you feel uneasy with groups of people? 0 1 2 almost never rarely sometimes 3 often 10. Do you out of preference spend time on your own? 0 1 2 almost never rarely sometimes 3 often 10 9. 1 rarely How easy or difficult do you find talking to people at the moment? 0 1 almost never rarely PRO-SOCIAL ACTIVITIES Part Three Put a tick () in the appropriate column to show how often you have participated in any of the following over the past three months. 0 Never Cinema Theatre / Concert, etc Watching an indoor sport. (e.g. squash, table - Tennis) Watching an out door sport. (e.g. football, rugby) Art gallery / Museum Exhibition Visiting places of interest Meeting, talk, etc. Evening class. Visiting relatives Being visited by relatives Visiting friends* Being visited by friends* Parties Formal occasions Disco etc Nightclub / social club Playing an indoor sport Playing an outdoor sport Club / society Pub Eating out Church activity 1 Rarely 2 Sometimes 3 Often RECREATION ACTIVITIES Please place a tick in the appropriate column to indicate how often you have done any of the following activities over the past 3 months. 0 Never 1 Rarely 2 Sometimes 3 Often Rarely 1 Sometimes 2 Often 3 Playing musical instruments Sewing, knitting Gardening Reading things Watching television Listening to records or radio Cooking DIY activities Fixing things (car, bike, household, etc.) Walking / rambling Driving / cycle (as a recreation Swimming Hobby (e.g. Collecting things) Shopping Artistic activity) painting, crafts, etc.) Any other recreation or pastime? ……………………………………. …………………………………….. …………………………………….. SECTION THREE: INDEPENDENCE (C) Please place a tick the following. against each item to show how able you are doing or using Public Transport Handling money correctly Budgeting Cooking for self Weekly shopping How to look for a job Washing own clothes Personal hygiene Washing, tidying, etc Purchasing from shops Leaving the house alone Choosing and buying own clothes Taking care of personal appearance 3 2 1 0 Adequately (no help) Needs help (for prompting) Unable (or without lots of help) Not known INDEPENDENCE (P) Please place a tick against each item to show how often able you have done the following over the past three months. Buying items from shops alone (without help) Washing pots, tidying up, etc Regular washing, bathing, etc Washing own clothes Looking for a job (if unemployed) Doing the food shopping Prepare and cook meal Leaving the house Using buses, train, etc Using money Budgeting Choosing and buying clothes for self Takes care of personal appearance 0 1 2 3 Never Rarely Sometimes Often SECTION FOUR: EMPLOYMENT 1. Are you in regular employment (including industrial therapy, rehabilitation or re-training courses. Yes - No (please circle) If yes: What sort of job? How many hours do you work each week? How long have you lasted in employment? If no: When were you last employed? What sort of job? How many hours a week? 2. If not employed: Are you registered disabled? Yes - No (please circle) Do you attend hospital as a day patient? Yes - No (please circle) Do you think you are capable of some sort of employment? Definitely yes / Would have difficulty / Definitely no (please circle) How often do you attempt to find a job (e.g. go to Job Centre, look in newspaper, etc). Almost never 3. / rarely / sometimes If not employed: How do you usually occupy your day? Morning Afternoon Evening / often (please circle)
