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score PEACH Score sheet Child s name

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  • pg 1
									                                                                 PEACH Score sheet
        Child's name:                          D.O.B.                             Date completed:
        Parent/caregiver completing P.E.A.C.H:                                                 Administered by:
        Comments:
                                              Frequency of reported behaviour                      Compare current settings
                                                                                              Much
                                   Never              Some                        Score       worse
        Sub scale Question           0     Seldom 1 times 2 Often    3 Always 4   (0-4)        -2

        USE &
        DISCOMF Usage
        ORT 1 routine
                Notice
                malfunctio
              2n

                   Discomfor
                   t   (Never
               3 4, Always 0)
                   SUBSCALE
                   % (boxes
                   1+2+3)/12*1
                   00                                                                     A
                   Respond
QUIET          4   to name
                   Follow
                   verbal
                   instruction
               5   s
                   Follow a
               8   story
                   Conversat
                   ion in
               9   quiet
                   Recognize
              12   voices
                   SUBSCALE%
                   (boxes
                   4+5+8+9+12)/2
                   0*100                                                                  B
                   Respond
NOISE          6   to name
                   Follow
                   verbal
                   instruction
               7   s
                   Conversat
                   ion in
              10   noise
                   Listen in
              11   car
          SUBSCALE
          (boxes
          6+7+10+11)/
          16*100                                                           C
       Conversat
       ion on
       phone13
TELEPHONE
          SUBSCALE
          % (box
          13)/4*100                                                        D
         Recognise
ENVIRONMENT 14 sounds
      15 Locate sounds
      16 Recognise songs
          SUBSCALE
          (boxes
          14+15+16)/1
          2*100                                                            E
          TOTAL
          (boxes
          A+B+C+D+E
GRAND   TOTAL
          )                                                                F
          %TOTAL (F/64)*100


Scoring Key - Frequency of reported behaviour
0 = Never no examples are given
1= Seldom 1 or 2 examples are given and the behaviour occurs 25% of the time
2 = Sometimes 3 or 4 examples are given and the behaviour occurs 50% of the time
3 = Often 5 or 6 examples are given and the behaviour occurs 75% of the time
4=Always more then 6 examples are given and the behaviour occurs 100% of the time
heet
ompleted:
       Administered by:

       Compare current settings with previous settings

           Worse      Same      Better     Much      Score
            -1          0        +1      better +2 (-2 to+2)




                                           TOTAL           A




                                             TOTAL         B
             TOTAL    C




             TOTAL    D




             TOTAL    E


  GRAND TOTAL
(boxes A+B+C+D+E)     F
     Average (F/16)

								
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