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depression, instructing the individual to never stop the medications abruptly without consulting his/her physician, and reminding the individual that some medications need to be discontinued gradually.

If the individual with depression is a child or an adolescent, it is important to ask the parent, school representative, or caregiver questions about medication. Each individual involved in care may have different answers and levels of understanding. To reduce the stress for the child, it is important that the message be consistent. The care management process thus provides an excellent opportunity for educating all caregivers.

Readiness-to-Change Ruler

It is crucial that the individual with depression take the prescribed antidepressant as indicated until efficacy may be established while being educated about the medications. The changes required to achieve this goal are the next step in assessment for CMAG. The readiness-to-change ruler is used to assess motivation to change. It is a simple tool.74 However, with an individual with depression, self-reporting may be compromised due to trust or because it simply may be “just too much” for the person to accomplish due to his/her deficiency of energy.

Scripting for this would include, “If you were to rate your readiness to change (selected behavior) on a scale of 1-10, one being ‘not prepared’ and 10 means “I’ve changed,” what number would you pick?” See CMAG-2 for follow-up questions dependent upon the initial responses given.75

For the individual with depression, rating readiness to change is an ongoing assessment. Every day, his/her status may change, depending upon mood and other circumstances. For this reason, always be prepared for a question or answer that may be challenging for the integrated care management professional. Be aware that the depressed individual often has so many hopeless thoughts that he/she will say anything to end the conversation and go back to no social contact.

Depression also may cause a significant decline in motivation (amotivational syndrome), which can impact an individual’s readiness to change. Therefore, it should be considered when applying this tool.

Functional Social Support Questionnaire (FSSQ)

The final assessment tool in CMAG128 is the FSSQ. This is an eight-question form that assesses the individual with depression and his/her support to manage this complex disorder. Since depression may affect multiple ages of individuals from children to the elderly, support may mean different things to different individuals. The FSSQ is primarily focused on adults; however a non- formal assessment of the child or adolescent may be accomplished by asking similar questions to those suggested earlier. Also, it is imperative that the

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