There are two ways to tell that a dwelling is occupied by rats: We either see the beady-eyed little creatures directly or, more often, we are made aware of their presence by what they leave behind. The more extensive the mess, the greater the infestation. This is a simple and straightforward (if slightly silly) principle that translates well into screening for the impact of health issues on a person’s life.

Absenteeism, disrupted productivity and interruption of social activities have many different causes. When the effects of physical or mental health issues begin to take a toll the result is often reduced productivity or learning, loss of social contacts and an increase in mental health issues, such as depression. The HRST has a number of ways to indirectly measure the degree to which a person’s life is affected by their health picture. We fondly refer to these as the “rat droppings” items. The first of these is Clinical Issues Affecting Daily Life.

In this area we gather information about the severity of health issues by using the number of days, full or partial, which a person is taken away from their normal activities by health or behavioral issues. Two people with the exact same diagnosis can have two very different health pictures.

Factors that can influence this can include:

• Severity of the disorder.
• Self or home-care practices.
• Access to health care resources.
• Presence of additional health or behavioral issues Missing regular activities due to illness or other clinical issues is often one of the first signs that there is an emerging problem.
• Response to treatment.

Days that should be included when determining how clinical issues impact participation are those where the person is unable to participate in normal work, school, social or home activities. Both full and partial days affected should be considered when determining the impact of health-related issues on normal activities

Some examples are:

• Days when the person is sick or injured.
• Days when behavioral issues impact participation.
• Days when an “episode” (seizure, asthma attack, allergic reaction) impacts participation.
• Days when there are appointments that address a diagnosed condition – these are probably the most difficult to understand, but they give a very good indication of the severity of the person’s involvement with their health issues.

Missing regular activities due to illness or other clinical issues is often one of the first signs that there is an emerging problem.

Many absences from structured activities do not count as clinical issues impacting daily life:

• Days when the person makes the choice to be absent not related to health issues.
• Someone making the choice for me, “My son does not need a day program!”
• Policy-driven absences that affect all participants and are un-related to specific health issues.

Missing regular activities due to illness or other clinical issues is often one of the first signs that there is an emerging problem. It may also be an indicator or a hidden issue such as abuse going on in the home setting. In very basic terms, the more time a person’s health issues distract them from normal activities the worse their overall health picture. This results in reduced work productivity or learning, reduced income potential and erosion of social contacts. Appreciating and addressing these issues in a timely manner can go a long way toward helping the person lead a more productive, satisfying and connected life.