# Self-Care Assessment

For each of the skills in this assessment you will be asked to evaluate your child’s mastery and his or her motivation as described below:

## Mastery

1. **Basic Steps Not Mastered.** These are skills for which your child cannot do all of the basic steps; he or she needs to learn some (or all) of the actions involved.
2. **Needs Assistance with Decisions.** These are skills for which your child can do the basic steps but needs help in making decisions about skill performance—he or she needs to be told when to do the skill, or what materials are needed, or how to begin, or whether the skill has been done well.
3. **Can Do Well and Independently.** These are skills for which your child can do the basic actions and make necessary decisions—so that you do not need to be there at all.

## Motivation

1. **A Problem.** These are skills that your child does not perform without urging; he or she needs to be motivated.
2. **Not a Problem.** These are skills that your child performs regularly without special encouragement.

|  | MASTERY |  |  | MOTIVATION |  |
| --- | --- | --- | --- | --- | --- |
| 1 | 2 | 3 | 1 | 2 |  |
| SKILLS | Basic Steps Not Mastered | Needs Assistance with Decisions | Can Do Well and Independently | A Problem | Not a Problem |
| Basic Dressing |  |  |  |  |  |
| Puts on underpants |  |  |  |  |  |
| Puts on undershirt |  |  |  |  |  |
| Puts on socks* |  |  |  |  |  |
| Puts on pants* |  |  |  |  |  |
| Puts on pullover shirt, sweater* |  |  |  |  |  |
| Puts on front-button shirt, blouse* |  |  |  |  |  |
| Takes off pullover shirt, sweater |  |  |  |  |  |
| Pulls zipper up/down(if started)* |  |  |  |  |  |
| Threads a belt* |  |  |  |  |  |
| Starts a zipper* |  |  |  |  |  |
| Buttons* |  |  |  |  |  |
| Fastens snaps,hooks |  |  |  |  |  |
| Ties shoes* |  |  |  |  |  |
| Puts on a slip |  |  |  |  |  |
| Puts on a bra(if appropriate) |  |  |  |  |  |
| Puts on nylons/pantyhose(if appropriate) |  |  |  |  |  |
| Ties a necktie(if appropriate) |  |  |  |  |  |

---

MASTERY MOTIVATION 12312

SKILLS Basic Steps Not Mastered Needs Assistancewith Decisions Can Do Well and Independently A Problem Not a Problem

### Clothes Selection and Care
- Puts dirty clothes in hamper
- Puts clean clothes away
- Folds and hangs clothes*
- Wears clothes that are clean and pressed
- Selects clothes that fit
- Selects clothes that match
- Selects age-appropriate clothes
- Selects clothes appropriate to weather
- Selects clothes appropriate to social occasion

### Grooming and Personal Hygiene
- Uses toilet and toilet paper
- Washes and dries hands
- Washes and dries face*
- Takes bath or shower, with soap and washcloth*
- Uses deodorant
- Washes and rinses hair*
- Brushes teeth* and uses mouthwash
- Cleans ears
- Shaves (if appropriate)
- Applies makeup (if appropriate)
- Combs and brushes hair*
- Uses a mirror to spot-check appearance
- Trims fingernails/toenails
- Uses aftershave/perfume
- Uses a handkerchief/tissue
- Takes care of eyeglasses or contact lenses (if appropriate)
- Gets a haircut
- Wipes food/dirt off clothes
- Uses tampons or sanitary napkins (if appropriate) and disposes of them properly

### Health Care

|  | MASTERY |  |  | MOTIVATION |  |
| --- | --- | --- | --- | --- | --- |
|  | 1 | 2 | 3 | 1 | 2 |
| SKILLS | Basic Steps Not Mastered | Needs Assistance with Decisions | Can Do Well and Independently | A Problem | Not a Problem |
| Health Care |  |  |  |  |  |
| Eats a well-balanced diet |  |  |  |  |  |
| Gets enough sleep |  |  |  |  |  |
| Exercises regularly (e.g., rides bike, walks) |  |  |  |  |  |
| Cares for minor cuts |  |  |  |  |  |
| Treats minor burns |  |  |  |  |  |
| Identifies cold symptoms |  |  |  |  |  |
| Treats a common cold |  |  |  |  |  |
| Treats a common headache |  |  |  |  |  |
| Treats a common nosebleed |  |  |  |  |  |
| Treats common diarrhea/constipation |  |  |  |  |  |
| Treats common nausea |  |  |  |  |  |