Form Soc 157c - Standardized Silp Readiness Assessment Tool Page 4
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8STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
Self-Care and Interaction With Others (note: it is important that the NMD have good skills and a
history that predicts success in these areas in order to be SILP-ready).
Subject
Description
SW/PO Notes
6.
Safety
Is the SILP living situation the NMD is requesting a
Yes
No
safe environment?
Skills to be developed
_______________________
Ask NMD to describe their relationship with those who
_______________________
they will be sharing living space. Has there been any
_______________________
history of violence with those individuals (including
_______________________
partner violence)?
Are any individuals residing in the unit engaged in
dangerous behavior that could pose a threat to the NMD
(e.g. drug dealing, CSEC/CSEY, violent criminal activity)?
Can the NMD describe what a safe living environment
looks like? Can they identify where/to whom would they
go to if they found themselves in an unsafe situation?
7.
Medical/Dental Care
Does NMD know where the nearest hospital or
Yes
No
emergency 24-hour clinic is located and how to find one?
Skills to be developed
_______________________
Does NMD know the benefits of preventative care?
_______________________
Does NMD have a primary care doctor?
_______________________
Does NMD have a Medi-Cal benefits card and/or their
_______________________
Medi-Cal number and know what type of Medi-Cal plan
they have?
8.
Mental Health Care
Does NMD know what to do if they have a psychiatric
Yes
No
emergency?
Skills to be developed
_______________________
_______________________
Does NMD know how to access therapy and psychotropic
_______________________
medication if needed?
_______________________
9.
Prescriptions and
Does NMD know how to obtain and renew prescribed
Yes
No
OTC Drugs
medications?
Skills to be developed
_______________________
Does NMD understand the importance of following
_______________________
the directions on over-the-counter medication and
_______________________
prescriptions (risks of over-dosing, mixing certain
_______________________
medications, side effects of some medications that can
make you drowsy and unable to perform certain tasks like
driving, operating machinery)?
Does the NMD report current medication use? If so,
do they understand how to take it properly and any
consequences of discontinuing use?
10.
Healthy Sexuality
Does NMD understand myths around preventing
Yes
No
pregnancy (e.g. that “pulling out” or only having
Skills to be developed
unprotected sex during your period do not prevent
_______________________
pregnancy)?
_______________________
_______________________
Does NMD understand that only the proper use of
_______________________
condoms or abstinence can fully protect against STIs but
that limiting sexual partners can help reduce the risk?
Does the NMD know where to go to get contraception
and treatment for sexually transmitted infections?
SOC 157C (7/17) (Optional)
PAGE 4 OF 8
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