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GiveCare Score

The GiveCare Score is a single 0-100 number answering "How is this caregiver doing right now?" It composes four validated instruments into one strength-framed metric where higher = better.

Four instruments

# Instrument Items Scale Framing Source
1 BSFC-s (Burden Scale for Family Caregivers, short form) 10 0-3 per item Deficit Graessel et al., Erlangen1
2 CWBS-s (Caregiver Well-Being Scale, short form) 14 1-5 per item Strength Tebb, Berg-Weger, Rubio2
3 GC-SDOH-30 30 (5 per zone) 0-4 per item Deficit GiveCare original (evidence base: PRAPARE, AHC, NAM)
4 EMA-3 (Ecological Momentary Assessment) 3 daily Mixed Mixed (stress deficit, mood/coping strength) GiveCare original

BSFC-s

Ten items scored 0-3, measuring caregiver burden. Publicly available instrument from the University of Erlangen1.

Band Raw score Interpretation
Mild 0-14 Manageable pressures
Moderate 15-19 Growing pressures
Severe 20-30 Significant pressures

Threshold derivation

These thresholds are GiveCare's own derivation, linearly scaled from the full BSFC non-dementia cutoffs. They are not published by the original authors.

CWBS-s

Fourteen items scored 1-5, measuring caregiver well-being. Strength-framed: higher scores indicate greater well-being. This is the only instrument in the composite that directly measures positive capacity rather than deficit2.

GC-SDOH-30

Thirty items across six zones, 5 per zone, scored 0-4. Deficit-framed. Adaptive administration: zones scoring below 40 trigger deep-dive questioning. See Assessments for full instrument details.

EMA-3

Three daily micro-check items:

  1. Stress (deficit-framed) — current pressure level
  2. Mood (strength-framed) — emotional state
  3. Coping (strength-framed) — perceived ability to manage

Designed for daily SMS check-ins without caregiver fatigue. Short enough to answer in under 30 seconds.

Score bands

Band Range Color Interpretation
Standing Strong 75-100 Green Protective factors outweigh pressures
Holding Steady 50-74 Blue Managing well, room to build
Pushing Through 25-49 Amber Pressures mounting, targeted support helps
Carrying a Lot 0-24 Red Significant pressures, proactive outreach

Confidence levels

The score's reliability depends on how many instruments have been completed:

Level Instruments Margin Display
early_estimate 1 +/- 15 Show with confidence band
building 2 +/- 8 Show with confidence band
solid 3-4 Tight Show directly

A caregiver with only one completed instrument still gets a score — but the system communicates the uncertainty honestly. The score refines as more instruments complete.

Instrument progression

Assessment instruments are introduced progressively to avoid overwhelming caregivers at signup:

flowchart LR
    A["Website visit"] -->|BSFC-s| B["SMS signup"]
    B -->|SDOH-6 + CWBS-14 monthly| C["Active user"]
    C -->|EMA-3 daily| D["Engaged user"]
    D -->|SDOH-30 per flagged zone| E["Deep assessment"]
Stage Instrument Frequency
Website BSFC-s (10 questions) Once, at first visit
SMS signup SDOH-6 snapshot + CWBS-14 Monthly
Daily engagement EMA-3 Daily
Flagged zones GC-SDOH-30 deep-dive Per flagged zone, as needed

Spike detection

The system monitors score changes between assessments and triggers responses:

Change Direction Response
>= 20 points Improvement Celebration message — reinforces what is working
>= 20 points Decline Proactive check-in — identifies what changed
>= 30 points Sharp decline Immediate outreach + safety flag review

Sharp declines feed into Crisis Routing. A 30-point drop in a single assessment window is treated as a potential safety signal, triggering the crisis detection pipeline regardless of the caregiver's current band.

Connection to zones

Each zone contributes a weighted component to the composite score. Zone weights reflect clinical evidence for their impact on caregiver outcomes — see Zones (P1-P6) for weight rationale.

Code reference

Score computation in packages/care-domain/src/scoring/givecareScore.ts:

export type Band = 'strong' | 'steady' | 'building' | 'needs_attention'
export const BAND_LABELS: Record<Band, string> = {
  strong: 'Standing strong',
  steady: 'Holding steady',
  building: 'Pushing through',
  needs_attention: 'Carrying a lot',
}

  1. Graessel E et al. "Burden Scale for Family Caregivers (BSFC-s)." University of Erlangen. Source → ↩↩

  2. Tebb SC, Berg-Weger M, Rubio DM. "The Caregiver Well-Being Scale Revisited." Health & Social Work 38(4), 2013. Source → ↩↩