The Arc's Caregiver Assessment of Health Status of People with Intellectual Disability

The Arc, a national nonprofit organization for people with intellectual and developmental disabilities is seeking to find out more about caregiver views of the health status of the people with intellectual disability for whom they provide care as part of our HealthMeet project.  This project aims to help identify and reduce health disparities among people with intellectual disability.

This survey has two goals. First, this survey can be used as a checklist to help you evaluate any "red flag" health concerns that you may have about the person for whom you provide care. This checklist should not be used in place of seeing a doctor when you have concerns.

Second, the concerns that you have identified and the information you provide will be used to find out more about caregivers and health concerns that impact people with intellectual disability. By using this checklist, you give The Arc permission to use this information to help better understand and evaluate health issues impacting people with intellectual disability and their caregivers.

The information provided in this survey is confidential and will never be used to identify someone specifically.  You will have the opportunity to provide contact information if you choose to do so.  This information will only be used to send accessible health resources to you. 

If you have any questions about this survey, please contact Jennifer Sladen at sladen@thearc.org.  To find out more about The Arc, our HealthMeet project, and our work to serve people with intellectual disability and their families, visit www.thearc.org.

*This survey is adapted from the following:  Adapted from Marks, B., Sisirak, J., & Heller, T. (2010). Health Matters: Establishing Sustainable Exercise and Nutrition Health Promotion Programs for Adults with Developmental Disabilities. Brookes Publishing: Philadelphia. All rights reserved. Adapted with permission from Marks, B., Sisirak, J., & Plachy, T. (2007). Head-to-Toe Sign and Symptoms Checklist for Lay Health Workers. HealthMatters Program 2012, Chicago, IL.

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Health Status of the Person You Care For...

Please answer these questions about the current health status and concerns for the person with intellectual disability you take care of.

Does this person have a chronic illness?

Do you have concerns about this person's behavior?

Do you have concerns about this person's eating habits or weight gain/loss?

Are you worried that the person is in pain?

Do you have concerns about this person's skin and nail health?

Are you concerned about this person's ears, eyes, or nose health?

Do you have concerns about the person's oral health (mouth or dental issues)?

Are there concerns about breathing or respiratory issues?

Do you have concerns regarding the person's stomach health?

Are there concerns about the person's legs, feet, and toes or ability to walk?

Do you have concerns about the person's bladder or ability to urinate?

Do you care for a male or female?