What's the DLA-20? | So Much Room for Daily Living Activities

Daily Living Activities

“There’s so much room for activities!” The 2008 film Step Brothers follows new step-brothers, middle-aged Dale and Brennan, as they attempt to handle living in their parents’ house together. They become friends, and try to convert their twin beds into bunk beds so they have more room for activities. It quickly collapses and after minor first aid, they need to find a new place to play.

Daily Living Activities     

How you spend your time is important, which is why Dale and Brennan were so committed to making their bunk beds work so they could spend more time together in their play space. How you spend your time is also a viable indicator to your mental and physical health. Think about what you do in a day. You go to work, make meals, exercise, spend time with friends and family. You do household chores, take care of personal hygiene, read books, watch television. That’s a lot. 

Now think of what happens when you’re upset or sick. You don’t want to be at work; you’d rather not see anyone; you’re not motivated to eat well or exercise. What we accomplish in a day is connected to our physical health, emotions and how we’re feeling.

This is what the DLA-20 is founded on

No, not the Step Brothers movie. The connection between mental health and activities. Co-authored by Willa Presmanes and distributed by MTM Services through training contracts with the National Council for Behavioral Health, the DLA-20 is an outcomes measure that uses information about a client’s daily living activities to track progress.

How is it set up?

It assesses their current behavior in 20 activities of daily living, by considering the following 10 areas:

  • Health practices
  • Household stability
  • Communication
  • Safety
  • Managing time
  • Nutrition
  • Relationships
  • Alcohol and drug use
  • Sexual health and behavior
  • Personal care and hygiene

By continuously assessing clients in the context of these areas, clinicians can determine their success and identify areas of concern.


The DLA-20 is made up of 20 - daily living activities. The provider and individual seeking service rank the client’s current behaviors compared to qualifiers on a scale from one to seven. The assessment typically takes 10-20 minutes on clinical reviews to complete.

Below is an example of DLA-20 questions from the National Council for Behavioral Health:

DLA-20 Questions.png

These comprehensive activities and areas of daily life make it easier for clinicians to fully understand how their clients are doing.

For example…

A clinician might look at the results of the first DLA-20 and note that their client scores low (x≤4) in health practices, e.g., not taking medications as prescribed, communication, nutrition, and relationships with nutrition and relationships being the lowest. The clinician identifies nutrition and relationships as being the main areas of concern to the client and develops a treatment plan centered around these key difficulties.

Three months after implementing the treatment plan, the provider collaborates with the client and reviews changes on the DLA-20. The client scored higher in the nutrition and relationships category and, consequently, communication and health practices also improved. The clinician can use this progress as a motivator for the client to keep working. Together, they continue to review results every three months.

By using the DLA-20, the clinician focuses on the areas that are the most critical for their client. They emphasize the client’s strengths and successes, or continuing problems, by referencing the difference in their scores.

The 5 reasons to use the DLA-20

There are five major benefits to using the DLA-20:

  1. Consistent

The DLA-20 is standardized with definitions and qualifiers for scoring. This detailed measure makes it easier for different people to rate a client the same over time. This consistency ensures the validity of the results generated by the DLA-20 measure. Clinicians can be confident that they and their colleagues are rating the client appropriately.

  1. Sensitive

Every patient is different – even if they are dealing with the same illness. The DLA-20 ensures that a client’s unique factors are not lost in the measure and the assessment is accurate.

  1. Relevant

The treatment plan created based on this outcomes measure are based on the client ratings. It’s relevant to what the client needs specifically.

  1. Service-Driven

The services and levels of care offered to clients are not based just on their diagnosis. They are uniquely based on their DLA-20 ratings to make sure they’re focusing on the areas they need the most help in.

  1. Outcome-Driven

This measure produces results. By using the DLA-20 reliably and effectively, you will be documenting your clients’ real improvement from repeated measures

These five characteristics make the DLA-20 an effective outcomes tool that helps produce results.

Beyond Your Client

You can show the quality of care your entire agency provides by looking at your DLA-20 data aggregated over time. This data can support you in the following scenarios:

  • Value-based contract negotiations
  • Presentations to your board of directors
  • Annual reports

This data can also be used wherever you need to prove your successes.

Your EHR can help

Many EHRs are integrating the copy-written DLA-20 into their software so that you can easily administer the measure and record your client’s responses. Your EHR should make it easier to track progress and report on it. If your EHR does not integrate with the DLA-20 or does not have easy reporting functionality, consider looking into one that does.

Learn more in our FREE webinar

It can be confusing to visualize if this measure would work in your agency based on a blog post. To help, we have a free Behavioral Healthcare webinar planned to describe the DLA-20 in more detail and how it could work in your agency. DLA-20 author Willa Presmanes and Bridging Access to Care COO Nadine Akinyemi team up to host the webinar How to Improve Client Outcomes with the DLA-20 on Wednesday April 4, 2018 1pm ET, 12pm CT.

Stay away from bunk beds

You know daily living activities are important – now you need to know how to assess them. Use the DLA-20 to assess your client’s capability in their daily living activities and help them become more competent. Just don’t recommend they start building bunk beds.

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Topics: Industry Insights