HELPFUL INFORMATION
The materials on this page may be helpful for you if you are volunteering at CHAMP events, planning to develop a CHAMP program at a new location, or providing falls risk assessment and intervention services in some other format or setting. All the materials except for the Mini-Cog assessment are in the CHAMP manual and provided separately here for easy download and printing.
Data Collection Forms
- Assessment Summary Form (for visits #1-5)
- Assessment Summary Form for Follow-Up Visits (for visits #6-10)
Participant Intake Forms
Self-Report Measures
- Activities-specific Balance Confidence Scale (ABC)1
- Geriatric Depression Scale2 (for administration by interview)
- Geriatric Depression Scale2 (for self-administration)
- Geriatric Depression Scale Short Form2 (for administration by interview)
- Rapid Assessment of Physical Activity3 (RAPA)
Cognitive Assessments
- Mini-Mental State Examination4 (MMSE)
- Intersecting pentagons figure from the MMSE — you may want to print and laminate this to show to participants for standardized administration of item #11
- Mini-Cog
Exercise Recommendations
- Otago Exercise Programme Manual — the manual includes all of the Otago exercises, each on a single page
- Exercise Prescription Form
