How do they express if they are happy or sad?
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How do family members and caregivers communicate with them? Be sure to also ask siblings and other children in the household — they can be very creative and may have their own way of communi-cating with the individual.
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Physical
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Are they dressed in an appropriate way compared with other girls and boys in the household or community? (e.g., Are they naked or partially clothed when others are fully clothed?)
If no, ask caregivers for a blanket and/or clothing before continuing with the interview.
Yes □
No □
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Is the child with disabilities excluded from household activities (e.g., are they inside a room on their own, or near the other family members)?
Yes □
No □
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Are they physically restrained in some way?
Yes □
No □
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Are there any obvious signs of injury or illness (e.g., bruises, bandages, or scabies)?
Yes □
No □
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Is there hitting and other forms of physical violence between family members (especially between children)?
Yes □
No □
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How are they moving around the room? Describe below if they move by themselves, or with assistance from care-givers. If being assisted by care-givers, is the child or the care-giver at risk of an injury?
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6
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Behavior
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Has there been any recent change in their behavior (e.g., mood swings; agitation; fear of other people; sleep or eating disturbances; withdrawal; changes in their usual communication; self-injury or inappropriate sexual behaviors)?
Yes □
No □
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How are they interacting with you and with other family members? For example, maybe they are watching you closely, or trying to play with a brother or sister. Look for things that interest them and ask about these.
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Environment
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What is the current state of the home? Is the home of the same quality and/or standard as nearby homes?
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Toilet and bathing space: Does this space provide for privacy for those with disabilities?
Yes □
No □
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How close are they to important facilities (e.g., health centers, child friendly space, schools and community meeting points)?
Yes □
No □
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Do they have any equipment that might help them to reach these places (e.g., a wheelchair)? What is the current state of the equipment?
Yes □
No □
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Are there any places nearby where other girls and boys seem to be meeting to discuss different things? Could the individual with disabilities get to this space?
Yes □
No □
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