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family/caregiver of children with depression be assessed as well for their support issues.

This assessment is critical with the individual with depression because social support is sometimes what keeps the individual safe. Family is often a determining factor for recovery but can also complicate the life of the individual, resulting in regression regardless of treatment. In addition to questions on the support scale, initiate a conversation with the individual about his family member or caregiver who is supportive and knowledgeable about mental illness. During this conversation, note if there has been a change in living partners through separation or divorce or a change in living arrangements as a result of a loss of a home or overcrowding. Is this living situation stable? This may take a visit to the home for assessment.

Additional questions might include:

  • Who helps you manage your depression?

  • Who helps you with other aspects of your life?

  • How do you ask for support?

  • Do you feel anyone is “too helpful”? What do you do to help them know how much help you need?

  • How do you tell your family and friends specific ways to help you follow your treatment plan?

  • Do you ever bring family or support individuals with you to meet your healthcare team?

  • Tell the individual that the healthcare team is a support system, too. Then ask, Who is involved in your care? Are they supportive? Do they listen? Do they help you solve problems? Suggest that the individual discuss his/her trust level with the treatment team.

Financial issues are always challenging to assess with any individual experiencing depression and/or co-occurring illnesses. However, since a productive lifestyle may be a goal for improvement, questions about employment and finances should be asked. Since trust is a factor, be aware that these questions should not be asked until a relationship is formed. Also, be aware that taking any questioning too far may jeopardize your relationship. Balance must be achieved and empathy expressed.

Interventions coinciding with this scale may be contact with a social worker who may assist with financial and/or living situations. Family consultation and counseling may also be required.

Social functioning and support is a constant and dynamic assessment of individuals within any case management process. In the case of medication adherence it is critical; however different assessment tools may be necessary

Depression

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