OutcomeTools Questionnaire Library

ACE Score- Adverse Childhood Experience and Adverse Childhood Experience – 11 Questions

Description: This survey is a 10-item self-report measure developed for the ACE study to identify childhood experiences of abuse and neglect.  Adverse childhood experiences, or ACEs, are potentially traumatic events that occur in childhood (0-17 years). ACEs are linked to chronic health problems, mental illness, and substance use problems in adolescence and adulthood. ACE scores don’t tally the positive experiences in early life that can help build resilience and protect a child from the effects of trauma.

• ACE- 11- Adds one more question to the standard 10 ACE questions about exploitation.

Results Interpretation: The more ACEs that are reported, the greater the risk for chronic disease, mental illness, violence and being a victim of violence. People have an ACE score of 0 to 10. Each type of trauma counts as one, no matter how many times it occurs.

Copyright: No copyright- public domain

Type: Trauma

Frequency: Typically a one-time instrument

Population: All

Who can administer: Clinician

Reference website: https://www.cdc.gov/injury/priority/aces.html

Publications: https://pubmed.ncbi.nlm.nih.gov/9635069/

Keywords:

Addiction Severity Index Lite (ASI-LITE)

Description: The Addiction Severity Index, Lite version (ASI-Lite) is a shortened version of the Addiction Severity Index (ASI). The ASI is a semi-structured interview designed to address seven potential problem areas in substance-abusing patients: medical status, employment and support, drug use, alcohol use, legal status, family/social status, and psychiatric status. The ASI provides an overview of problems related to substance, rather than focusing on any single area. The ASI-Lite contains 22 fewer questions than the ASI, and omits items relating to severity ratings, and a family history grid.

Results Interpretation: The ASI substance abuse assessment uses the composite score to assign a severity rating. The ratings are based on a scale of 0 to 9 as follows:

• 0–1: No imminent problem, treatment not indicated.
• 2–3: Slight problem; treatment may not be necessary.
• 4–5: Moderate problem, a treatment plan should be considered.
• 6–7: Considerable difficulty, begin a treatment plan.
• 8–9: Extreme problem, treatment is vital.

Copyright: Public Domain

Type: Addiction

Frequency:

Population: Adults

Who can administer: Technician

Reference website: https://pubs.niaaa.nih.gov/publications/assessingalcohol/instrumentpdfs/04_asi.pdf

Publications: https://pubs.niaaa.nih.gov/publications/assessingalcohol/instrumentpdfs/04_asi.pdf

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Adult Self-Report Scale (ASRS-V1.1) Adult ADHD Self-Report Scale

Description:The Symptom Checklist is an instrument consisting of the eighteen DSM-IV-TR criteria. Six of the eighteen questions were found to be the most predictive of symptoms consistent with ADHD. These six questions are the basis for the ASRS v1.1 Screener and are also Part A of the Symptom Checklist. Part B of the Symptom Checklist contains the remaining twelve questions.

Results Interpretation: As a healthcare professional, you can use the ASRS v1.1 as a tool to help screen for ADHD in adult patients. Insights gained through this screening may suggest the need for a more in-depth clinician interview. The questions in the ASRS v1.1 are consistent with DSM-IV criteria and address the manifestations of ADHD symptoms in adults.

Copyright: Public Domain

Type: ADHD Screening

Frequency:

Population: Adults

Who can administer: Self reported

Reference website: https://add.org/wp-content/uploads/2015/03/adhd-questionnaire-ASRS111.pdf

Publications:https://www.unodc.org/documents/treatnet/Volume-A/Trainers-Toolkit/09_Handout_Module_2_ASI_Treatnet_-_Q_by_Q_Manual_VA_M2.pdf

Limitations: 

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AIMS Abnormal Involuntary Movement Scale

Description:The AIMS is a 12-item clinician-rated scale to assess severity of dyskinesias (specifically, orofacial movements and extremity and truncal movements) in patients taking neuroleptic medications. Additional items assess the overall severity, incapacitation, and the patient’s level of awareness of the movements, and distress associated with them. The AIMS has been used extensively to assess tardive dyskinesia in clinical trials of antipsychotic medications. Due to its simple design and short assessment time, the AIMS can easily be integrated into a routine clinical evaluation by the clinician or another trained rater.

Results Interpretation: Items are scored on a 0 (none) to 4 (severe) basis; the scale provides a total score (items 1 through 7) or item 8 can be used in isolation as an indication of overall severity of symptoms

Copyright: Public Domain

Type: Tardive Dyskinesia

Frequency:

Population: Adults

Who can administer:

Reference website: https://www.ohsu.edu/sites/default/files/2019-10/%28AIMS%29%20Abnormal%20Involuntary%20Movement%20Scale.pdf

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AUDIT-INT The Alcohol Use Disorders Identification Test: Interview Version

Description: The AUDIT (Alcohol Use Disorders Identification Test) is a simple and effective method of screening for unhealthy alcohol use, defined as risky or hazardous consumption or any alcohol use disorder. Importantly, the AUDIT provides a framework for intervention to help those with unhealthy alcohol use reduce or cease alcohol consumption and thereby avoid the harmful consequences of alcohol.

Results Interpretation: The AUDIT Decision Tree is a simple method of putting Screening, Brief intervention and Referral to treatment (SBIRT) into practice.On the basis of the AUDIT score, the health practitioner provides feedback on the category of alcohol use in which the person fits. At this point an intervention is suggested.For those with a score of 8-14 this would typically be a brief intervention (see the Drink-Less Program). For those with a score of 15+, options include referral for specialist treatment, detoxification, enrolment in a therapy program and pharmacotherapies (medication), and engagement with a self-help fellowship. https://auditscreen.org/about/audit-decision-tree/

Copyright: Public Domain

Type: Alcohol Screening

Frequency:

Population:

Who can administer

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AUDIT-SR The Alcohol Use Disorders Identification Test: Self-Report Version:

Description: The AUDIT (Alcohol Use Disorders Identification Test) is a simple and effective method of screening for unhealthy alcohol use, defined as risky or hazardous consumption or any alcohol use disorder. Importantly, the AUDIT provides a framework for intervention to help those with unhealthy alcohol use reduce or cease alcohol consumption and thereby avoid the harmful consequences of alcohol.

Results Interpretation: The AUDIT Decision Tree is a simple method of putting Screening, Brief intervention and Referral to treatment (SBIRT) into practice.On the basis of the AUDIT score, the health practitioner provides feedback on the category of alcohol use in which the person fits. At this point an intervention is suggested.For those with a score of 8-14 this would typically be a brief intervention (see the Drink-Less Program). For those with a score of 15+, options include referral for specialist treatment, detoxification, enrolment in a therapy program and pharmacotherapies (medication), and engagement with a self-help fellowship. https://auditscreen.org/about/audit-decision-tree/

Copyright: Open

Type: Alcohol screening

Frequency: As often as necessary

Population:

Who can administer

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PDF Link

Brief Addiction Monitor (BAM)

Description: The primary purpose of the Brief Addiction Monitor (BAM) is to support individualized, measurement-based care for substance use disorders (SUD). The BAM monitors a patient’s progress in SUD care and yields reliable data that is both easy to collect and readily integrated into SUD treatment planning. The BAM is a 17-item, multidimensional questionnaire, designed to be administered as a clinical interview (in-person or telephonically) or via patient self-report, for all patients seeking or enrolled in SUD specialty care. It retrospectively assesses (past 30 days) three SUD-related domains: Risk factors for substance use, Protective factors that support sobriety, and drug and alcohol use.

Results Interpretation:

• It is important to compare most recent BAM scores with prior BAM scores to assess changes in functioning and risk status.
o The goal is to see sizeable changes on each scale with each administration of the BAM.
• It is important to take into consideration the relative scores on risk and protective factors:
o If protective factor score is greater than risk factor score, the patient is less at risk for use. o If risk factor score is greater than protective factor score, the patient is more at risk for use. o If risk factor score is is equal to protective factor score, the patient is at risk for use and a focus of treatment should be to shift the balance to building protective factors and coping with risk factors.

Copyright: Public Domain

Type: SUD

Frequency: 30 days

Population: Adults 18+

Who can administer: Technician

Reference website: https://www.mentalhealth.va.gov/providers/sud/docs/BAM_Scoring_Clinical_Guidelines_01-04-2011.pdf

Publications: https://www.mentalhealth.va.gov/providers/sud/docs/BAM_Scoring_Clinical_Guidelines_01-04-2011.pdf

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CAGE Substance Abuse Screening Tool

Description: The CAGE questionnaire is a 4-question screening tool that clinicians may use to help in the diagnosis of alcoholism. CAGE is an acronym for the focus of the questions.
C – Cutting Down
A – Annoyance by Criticism
G – Guilty Feeling
E – Eye-openers

Results Interpretation: A higher score being an indication of alcohol problems. A total score of two or greater is considered clinically significant. The normal cutoff for the CAGE is two positive answers, however, the Consensus Panel recommends that the primary care clinicians lower the threshold to one positive answer to cast a wider net and identify more patients who may have substance abuse disorders.

Copyright: Public Domain

Type: Screening in a primary care setting for alcohol

Frequency:

Population:

Who can administer

Reference website: https://americanaddictioncenters.org/alcoholism-treatment/cage-questionnaire-assessment

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Center for Epidemiologic Studies Depression Scale Revised (CESD-R)

Description: The CESD-R is a screening test for depression and depressive disorder. The CESD-R measures symptoms defined by the American Psychiatric Association’ Diagnostic and Statistical Manual (DSM-V) for a major depressive episode.

Results Interpretation: The total score is calculated by finding the sum of 20 items.
Scores range from 0-60. A score equal to or above 16 indicates a
person at risk for clinical depression.

Copyright: Public Domain

Type: Depression and depressive disorder

Frequency:

Population: Adults

Who can administer: 

Reference website: https://cesd-r.com/cesdr/

Publications: Radloff LS. The CES-D scale: a self-report depression scale for research in the general population. Applied Psychological Measurement. 1977;1:385-401.

Keywords

Clinical Global Impression (CGI-SELF)

Description: The CGI is a 3-item observer-rated scale that measures illness severity (CGIS), global improvement or change (CGIC) and therapeutic response. The illness severity and improvement sections of the instrument are used more frequently than the therapeutic response section in both clinical and research settings. The Early Clinical Drug Evaluation Program (ECDEU) version of the CGI (reproduced here) is the most widely used format, and asks that the clinician rate the patient relative to their past experience with other patients with the same diagnosis, with or without collateral information. Several alternative versions of the CGI have been developed, however, such as the FDA Clinicians’ Interview-Based Impression of Change (CIBIC), which uses only information collected during the interview, not collateral. The CGI has proved to be a robust measure of efficacy in many clinical drug trials, and is easy and quick to administer, provided that the clinician knows the patient well.

Results Interpretation: The CGI is rated on a 7-point scale, with the severity of illness scale using a range of responses from 1 (normal)
through to 7 (amongst the most severely ill patients).
CGI-C scores range from 1 (very much improved) through to 7 (very much worse). Treatment response ratings should take account of both therapeutic efficacy and treatment-related adverse events and range from 0 (marked improvement and no side-effects) and 4 (unchanged or worse and side-effects outweigh the therapeutic effects). Each component of the CGI is rated separately; the instrument does not yield a global score.

Copyright: Public Domain

Type: illness severity, global improvement, and therapeutic response

Frequency:

Population: Adults

Who can administer: 

Reference website: https://www.psywellness.com.sg/docs/CGI.pdf

Publications: 

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Child and Adolescent Disruptive Behavior Inventory – Parent Survey (CADBI):

Description: The Child and Adolescent Disruptive Behaviour Inventory (CADBI), Burns, et al., (2001a) is a 25-item parent and teacher questionnaire designed to assess a range of problem behaviours that often occur in childhood and adolescence. The CADBI has been used in research on disruptive behaviours in children.

Results Interpretation: The Child and Adolescent Disruptive Behaviour Inventory (CADBI), Burns, et al., (2001a) is a 25-item parent and teacher questionnaire designed to assess a range of problem behaviours that often occur in childhood and adolescence. The CADBI has been used in research on disruptive behaviours in children.

Copyright: Open

Type: screening and diagnostic for defiant behavior, inattention and hyperactivity/impulsivity.

Frequency:

Population: The CADBI has been tested in multiple validation studies with children and adolescence aged 3 to 18

Who can administer: Clinician

Reference website: https://www.psychtools.info/cadbi/#:~:text=The%20Child%20and%20Adolescent%20Disruptive,on%20disruptive%20behaviours%20in%20children.

Publications: 

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Child and Adolescent Inpatient Behavioral Rating Scale (CAIBRS)

Description: The purpose of this instrument is to provide a consistent and stable approach for measuring variation in observed behaviors. This behavioral rating scale can be used as a measure to identify changes including trends and patterns in specified behaviors. The instrument consists of 64 defined behaviors. There is also space to add behaviors that might not be reflected in these scales. The items have been grouped thematically, however behaviors to be observed and rated should be selected from across the instrument; item selection should not be limited by how the items are categorized.

Results Interpretation: With the exception of items 63 and 64, all of the items are rated using a scale of severity: 0 = not present, 1 = mild, 2 = moderate, and 3 = severe. In turn, severity may be said to be a measurement of three dimensions: intensity, frequency and duration. These attributes may be assessed individually or in combination.

Copyright: Public Domain

Type:

Frequency: This instrument may be used as either a pretreatment/post-treatment measure or as the basis for repeated (weekly, daily, shift-to-shift, or hourly) observations.

Population:

Who can administer

Reference website: https://ccca.dbhds.virginia.gov/content/Child%20%20Adol%20BRS%20with%20Instructions.pdf

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CANS –
Description: Trauma Comprehensive (CANS-Trauma)- an assessment tool that is designed to evaluate the needs and strengths of children and adolescents who have experienced trauma.The CANS-Trauma is based on the original CANS tool, which was developed to assess the needs and strengths of children and youth who are receiving mental health services. However, the CANS-Trauma has been adapted specifically for use with children and youth who have experienced trauma, such as physical or sexual abuse, neglect, or exposure to violence.

Results Interpretation:

The CANS-Trauma survey is scored based on a series of items that assess the child or adolescent’s functioning in various areas, such as their emotional well-being, behavior, and relationships with others. Each item is scored on a 5-point scale, with higher scores indicating greater levels of need.

In general, higher scores on the CANS-Trauma survey indicate a greater need for intervention and support. However, it is important to note that the interpretation of the results depends on the individual child or adolescent and their specific needs and circumstances.

Who Can Administer: Typically completed by a trained professional, such as a mental health clinician

CFARS Problem Severity Ratings (CFARS)- 

Description: Used to assess the severity of functional impairment in adults who have a psychiatric or psychological condition. The survey is used by mental health professionals to evaluate the level of functioning of individuals and to develop treatment plans that are tailored to the specific needs of each individual.

CFARS survey is comprised of 10 items that assess various domains of functioning, including mood and affect, behavior towards others, communication, daily living skills, and global functioning. Each item is rated on a 5-point scale, with higher scores indicating greater levels of impairment.

Results Interpretation: The survey assesses various domains of functioning, including mood and affect, behavior towards others, communication, daily living skills, and global functioning. Each item is rated on a 5-point scale, with higher scores indicating greater levels of impairment. The CFARS results are typically used to develop a treatment plan that is tailored to the individual’s specific needs and focuses on improving their level of functioning. The results may also be used to monitor the individual’s progress over time and to evaluate the effectiveness of the treatment that they receive.

Who Can Administer: Requires training to administer

Clinical Institute Withdrawal Assessment of Alcohol Scale, Revised (CIWA-Ar)

Description: The CIWA-Ar provides an efficient (<5 mins) and objective means of assessing alcohol withdrawal that can then be utilized in treatment protocols.
Patients frequently under-report alcohol use and physicians often overlook alcohol problems in patients. (Kitchens JM 1994) It is estimated that 1 of every 5 patients admitted to a hospital abuses alcohol. (Schuckit 2001)
Unrecognized alcohol withdrawal can lead to potentially life-threatening consequences including seizures and delirium tremens.

Results Interpretation: Patients with scores ≤8 typically do not require medication for withdrawal.

Limitations: The Clinical Institute Withdrawal Assessment for Alcohol, revised (CIWA-Ar) scale has ten items, each evaluated independently then aggregated to yield a score correlating with severity of alcohol withdrawal.
There is no absolute relationship between alcohol use pattern and risk of physiologic dependence or withdrawal for a given individual. In general, any suspicion of daily alcohol use over several weeks or more, regardless of quantity, should raise concern for potential alcohol withdrawal.
Cannot be used effectively in intubated/sedated patients. A sedation scale such as the Richmond Agitation-Sedation Scale (RASS) is more appropriate in this setting.
Additional variables that may contribute to risk include age, medical comorbidities like hepatic dysfunction, concomitant medication use, and low seizure threshold. (Roffman JL 2006)

Clinical Institute Withdrawal Assessment Scale – Benzodiazepines (CIWA-B)

Description: The Clinical Institute Withdrawal Assessment – Benzodiazepine (CIWA-B) is a clinician. Rating tool for assessing and monitoring the severity of benzodiazepine withdrawal.

Results Interpretation: Interpretation of scores:
Sum of items 1-20: 1–20 = mild withdrawal
21–40 = moderate withdrawal
41–60 = severe withdrawal
61–80 = very severe withdrawal

Clinical Opiate Withdrawal Scale (COWS)

Description: Flow-sheet for measuring symptoms for opiate withdrawals over a period of time.

Results Interpretation:
Score:5-12 = mild;
13-24 = moderate;
25-36 = moderately severe;
more than 36 = severe withdrawal

Keywords: Addiction Treatment

Columbia – Suicide Severity Rating Scale with Risk Scale (CSSRS)

Description: A tool used to assess suicidal ideation and behavior in individuals. The CSSRS is designed to help identify individuals who may be at risk for suicide and to develop appropriate interventions to prevent suicide.

The CSSRS is a comprehensive tool that assesses a range of factors related to suicidal ideation and behavior, including the presence and severity of suicidal thoughts, plans, and behaviors, as well as the level of intent and lethality of these thoughts and behaviors. The tool is designed to be administered by trained mental health professionals, but can also be self-administered by individuals.

Results Intrepretation:

The CSSRS is divided into two parts: the Suicidal Ideation Scale and the Suicide Behavior Scale. The Suicidal Ideation Scale assesses the severity of an individual’s suicidal thoughts, while the Suicide Behavior Scale assesses the severity of an individual’s suicidal behavior.

The CSSRS also includes a Risk Scale, which categorizes an individual’s level of risk based on their responses to the Suicidal Ideation Scale and the Suicide Behavior Scale. The Risk Scale consists of four levels of risk: Low, Moderate, High, and Severe.

The interpretation of the CSSRS results depends on the level of risk identified by the Risk Scale:

1. Low Risk: Individuals in this category have minimal suicidal ideation or behavior. They may have occasional thoughts of suicide but have no intent to act on them.
2. Moderate Risk: Individuals in this category have frequent or persistent suicidal ideation but have no intent to act on them. They may have engaged in some self-harm behaviors, but these behaviors do not indicate an imminent risk of suicide.
3. High Risk: Individuals in this category have serious suicidal ideation and may have some intent to act on these thoughts. They may have engaged in some self-harm behaviors that indicate an imminent risk of suicide.
4. Severe Risk: Individuals in this category have a clear plan for suicide and a high intent to act on it. They may have engaged in serious self-harm behaviors or attempted suicide in the past.

Columbia- Suicide Severity Rating Scale with Risk Scale with Risk Factors (CSSRS-RF)

Description: The Columbia-Suicide Severity Rating Scale with Risk Scale and Risk Factors (CSSRS-RF) is an updated version of the original CSSRS that includes additional questions about suicide risk factors. The CSSRS-RF is designed to provide a more comprehensive assessment of an individual’s suicide risk by gathering information about their current and past suicidal thoughts and behaviors, as well as their personal and environmental risk factors

Results Interpretation:

The results of the CSSRS-RF are interpreted based on the responses to the Suicidal Ideation Scale, Suicide Behavior Scale, Risk Factors, and Risk Scale.

The Risk Scale categorizes an individual’s level of suicide risk based on their responses to the Suicidal Ideation Scale, Suicide Behavior Scale, and Risk Factors. The Risk Scale consists of four levels of risk: Low, Moderate, High, and Severe.

The interpretation of the CSSRS-RF results depends on the level of risk identified by the Risk Scale:

1. Low Risk: Individuals in this category have minimal suicidal ideation or behavior and few or no personal or environmental risk factors for suicide.
2. Moderate Risk: Individuals in this category have frequent or persistent suicidal ideation and/or behavior and some personal or environmental risk factors for suicide. They may have engaged in some self-harm behaviors, but these behaviors do not indicate an imminent risk of suicide.
3. High Risk: Individuals in this category have serious suicidal ideation and/or behavior and significant personal or environmental risk factors for suicide. They may have engaged in some self-harm behaviors that indicate an imminent risk of suicide.
4. Severe Risk: Individuals in this category have a clear plan for suicide and a high intent to act on it. They may have engaged in serious self-harm behaviors or attempted suicide in the past, and they have significant personal or environmental risk factors for suicide.

Who Can Administer: The CSSRS-RF is designed to be administered by trained mental health professionals and can be used to inform clinical decision-making and develop a plan of care for individuals at risk for suicide.

Columbia-Suicide Severity Rating Scale – C-SSRS-DS

Columbia-Suicide Severity Rating Scale – C-SSRS-Follow-up

Description: A survey used to track changes in an individual’s suicidal ideation and behavior over time. The C-SSRS-F is typically administered after an initial assessment using the Columbia-Suicide Severity Rating Scale (CSSRS) or CSSRS with Risk Scale and Risk Factors (CSSRS-RF).

Frequency: The C-SSRS-F is typically administered on a regular basis, such as weekly or monthly, depending on the individual’s level of risk. The frequency of administration may decrease as the individual’s risk of suicide decreases.

Results Interpretation:

If an individual’s level of suicide risk decreases over time, it suggests that their treatment plan is effective and their suicidal ideation and behavior are under control. This is a positive outcome and indicates that the individual may be ready for a lower level of care or a less intensive treatment plan.

If an individual’s level of suicide risk remains stable over time, it suggests that their treatment plan may need to be adjusted to further reduce their suicidal ideation and behavior. It may also indicate that the individual needs ongoing support and monitoring to maintain their level of functioning and prevent a crisis from occurring.

Columbia-Suicide Severity Rating Scale – C-SSRS-LR

Columbia-Suicide Severity Rating Scale – C-SSRS-SLC

Columbia-Suicide Severity Rating Scale – C-SSRS-TRIAGE

Depression Anxiety Stress Scale (DASS21)

Description: The DASS is a set of three self-report scales designed to measure the negative emotional states of depression, anxiety and stress. The DASS was constructed not merely as another set of scales to measure conventionally defined emotional states, but to further the process of defining, understanding, and measuring the ubiquitous and clinically significant emotional states usually described as depression, anxiety and stress. The DASS should thus meet the requirements of both researchers and scientist-professional clinicians. Each of the three DASS scales contains 14 items, divided into subscales of 2-5 items with similar content. The Depression scale assesses dysphoria, hopelessness, devaluation of life, self-deprecation, lack of interest/involvement, anhedonia, and inertia. The Anxiety scale assesses autonomic arousal, skeletal muscle effects, situational anxiety, and subjective experience of anxious affect. The Stress scale is sensitive to levels of chronic non-specific arousal. It assesses difficulty relaxing, nervous arousal, and being easily upset/agitated, irritable/over-reactive and impatient. Subjects are asked to use 4-point severity/frequency scales to rate the extent to which they have experienced each state over the past week. Scores for Depression, Anxiety and Stress are calculated by summing the scores for the relevant items. In addition to the basic 42-item questionnaire, a short version, the DASS21, is available with 7 items per scale. Note also that an earlier version of the DASS scales was referred to as the Self-Analysis Questionnaire (SAQ)

Results Interpretation: The DASS has 42 items. The DASS-21 has 21 items if you are under time pressure. The DASS-21 scores are multiplied by two so that you can compare the DASS-21 score with the normal DASS.

Who Can Administer: Self Repot

Dual Diagnosis Capability in Addiction Treatment (DDCAT)

Description:

A tool used to evaluate addiction treatment programs’ ability to provide integrated care for individuals with co-occurring mental health and substance use disorders. The survey was developed by the Substance Abuse and Mental Health Services Administration (SAMHSA) and is used to assess addiction treatment programs’ capacity to provide services to individuals with co-occurring disorders.

The DDCAT survey consists of 48 questions that assess the following six domains:

1. Screening and Assessment: The extent to which the program uses standardized, evidence-based screening and assessment tools to identify individuals with co-occurring disorders.
2. Staffing: The extent to which the program has trained and qualified staff to provide integrated care for individuals with co-occurring disorders.
3. Treatment Integration: The extent to which the program provides integrated treatment services, including co-located mental health and substance use disorder services.
4. Continuity of Care: The extent to which the program provides coordinated care and services across multiple providers and settings.
5. Program Environment: The extent to which the program provides a recovery-oriented and welcoming environment for individuals with co-occurring disorders.
6. Consumer Involvement: The extent to which the program involves individuals with co-occurring disorders and their families in the treatment process and incorporates their feedback into program improvement.

Who Can Administer: The DDCAT survey is typically administered by trained assessors who review program documents and observe program operations. The survey results provide valuable information to addiction treatment programs and can be used to identify areas for improvement and develop plans to enhance the program’s capacity to provide integrated care for individuals with co-occurring disorders.

Family Assessment Device (FAD)

Description: The Family Assessment Device (FAD) assesses structural and organizational properties of families and the patterns of transactions among family members. It has been found to distinguish between healthy and unhealthy families, and has been used in TBI samples.

Results Interpretation: Scores range from 1 (healthy functioning) to 4 (unhealthy functioning). The higher the overall score, the worse the level of family function.

Raw scores can be calculated for the six subscales (Problem Solving, Communication, Roles, Affective Responsiveness, Affective Involvement, and Behavior Control) and for the General Functioning scale.

The FAD is scored by adding responses of each scale (1 – 4) and dividing by the number of items in each scale (between 6 – 12). The higher the overall score, the worse the level of family function.

Population: 12 years and up

Functional Assessment Device – General Functioning

Description: The FAD-GF has been used to assess global family functioning in numerous studies of children with TBI and their families.

Results Interpretation: Scores range from 1 (healthy functioning) to 4 (unhealthy functioning). The higher the overall score, the worse the level of family function.

Raw scores can be calculated for the six subscales (Problem Solving, Communication, Roles, Affective Responsiveness, Affective Involvement, and Behavior Control) and for the General Functioning scale.

The FAD is scored by adding responses of each scale (1 – 4) and dividing by the number of items in each scale (between 6 – 12). The higher the overall score, the worse the level of family function.

Generalized Anxiety Disorder-7 (GAD-7)

Description: The GAD-7 is a 7-item scale to identify and monitor anxiety disorders. Each question is score between 0-3 and a composite score of each item determines the overall score. This is a valid and efficient tool for screening and assessing the severity of general anxiety disorder in clinical practice and research. Cut-off point was identified with a sensitivity of 89% and sensitivity of 82% (Spitzer, Kroenke, Williams, Lowe, 2006).

Type: Anxiety

Results Interpretation:
0–4: minimal anxiety
5–9: mild anxiety
10–14: moderate anxiety
15–21: severe anxiety

Hamilton Anxiety Rating Scale (HAM-A)

Description: The HAM-A was one of the first rating scales developed to measure the severity of anxiety symptoms, and is still widely used today in both clinical and research settings. The scale consists of 14 items, each defined by a series of symptoms, and measures both psychic anxiety (mental agitation and psychological distress) and somatic anxiety (physical complaints related to anxiety). Although the HAM-A remains widely used as an outcome measure in clinical trials, it has been criticized for its sometimes poor ability to discriminate between anxiolytic and antidepressant effects, and somatic anxiety versus somatic side effects. The HAM-A does not provide any standardized probe questions. Despite this, the reported levels of interrater reliability for the scale appear to be acceptable.

Results Interpretation: Each item is scored on a scale of 0 (not present) to 4 (severe), with a total score range of 0–56, where <17 indicates mild severity, 18–24 mild to moderate severity and 25–30 moderate to severe.

Type: Anxiety

Intuitive Eating Scale-2 (IES-2)

Description: The 21-item Intuitive Eating Scale (IES; Tylka, 2006) measures individuals’ tendency to follow their physical hunger and satiety cues when determining when, what, and how much to eat.

Results Interpretation: The response format for the IES is a 5-point Likert-type scale (i.e., 1 strongly disagree, 2 disagree, 3 neutral, 4 agree, 5 strongly agree). Higher scores indicate higher levels of intuitive eating.

Keywords: Intuitive eating

LEC-5- Life Events Checklist (LEC) for DSM-5 Extended Version

Description: Survey designed to assess an individual’s exposure to potentially traumatic events. It is often used in clinical and research settings to evaluate the impact of trauma on mental health and functioning. The LEC for DSM-5 Extended Version is a validated and widely-used tool, and can be helpful in identifying individuals who may benefit from further evaluation or treatment for trauma-related symptoms. It is important to administer the survey in a sensitive and respectful manner, and to provide appropriate support and resources for individuals who may be struggling with trauma-related issues.

Scoring: List of 17 different events that an individual may have experienced, including things like natural disasters, combat exposure, physical assault, sexual assault, and serious accidents or illnesses. For each event, the respondent is asked to indicate whether they have experienced it, and if so, how much distress or impairment they experienced as a result.

Administered: The LEC is typically administered as part of a larger assessment battery, and may be used to inform clinical diagnoses or treatment planning. It is important to note that not everyone who experiences a traumatic event will develop a mental health disorder, but exposure to trauma is a known risk factor for conditions like posttraumatic stress disorder (PTSD), depression, and anxiety.

The Michigan Alcoholism Screening Test (MAST)

Description: The Michigan Alcoholism Screening Test (MAST) is a questionnaire designed to screen for alcohol use disorder (AUD) and identify individuals who may need further evaluation or treatment for alcohol-related problems. The test was first developed in 1971 and has been widely used in clinical and research settings.

Scoring: The Michigan Alcoholism Screening Test (MAST) is a questionnaire designed to screen for alcohol use disorder (AUD) and identify individuals who may need further evaluation or treatment for alcohol-related problems. The test was first developed in 1971 and has been widely used in clinical and research settings.

The MAST consists of 25 multiple-choice questions that assess an individual’s drinking behavior, as well as the impact of alcohol use on their daily life. Questions include things like “Have you ever felt guilty about your drinking?” and “Has your drinking ever caused problems with your job or school?”

Responses are assigned point values, with higher scores indicating a greater likelihood of alcohol-related problems. Scores of 6 or higher are generally considered indicative of an alcohol use disorder and may warrant further evaluation by a healthcare professional.

Administered: The MAST survey can be administered by a trained healthcare professional, such as a physician, psychologist, social worker, nurse, or substance abuse counselor. The survey may also be administered by a trained research assistant under the supervision of a healthcare professional or principal investigator.

Major Depression Inventory (MDI)

Description: The Major Depression Inventory (MDI) is a self-report questionnaire used to assess the severity of symptoms of depression in adults. The MDI consists of 10 items that cover the most common symptoms of depression, such as sadness, loss of interest or pleasure, decreased energy, feelings of worthlessness, and difficulty concentrating.

Results Interpretation: The MDI consists of 10 items that ask about symptoms such as sadness, loss of interest, sleep disturbance, and changes in appetite and energy levels.

The scores on the MDI can range from 0 to 50, with higher scores indicating more severe depression symptoms. The scoring can be interpreted as follows:

0-5: No depression 6-15: Mild depression 16-25: Moderate depression 26-35: Severe depression 36-50: Very severe depression

Administered By: The Major Depression Inventory (MDI) survey can be administered by a trained healthcare professional, such as a psychiatrist, psychologist, social worker, or mental health counselor. The survey may also be administered by a trained research assistant under the supervision of a healthcare professional or principal investigator.

Marital Status Inventory (MSI)

Description: Survey designed to assess the quality of a married or committed couple’s relationship. It is often used in clinical and research settings to evaluate the strength of the relationship and identify areas of conflict or concern. The MSI is typically administered to both partners in a relationship and can be helpful in identifying areas of strength and weakness in the relationship. It can also be used to track changes in the relationship over time, and to evaluate the effectiveness of interventions designed to improve relationship functioning.

Scoring:

The Marital Status Inventory (MSI) survey is a questionnaire designed to assess an individual’s satisfaction with their marital relationship. The MSI survey consists of 128 questions, and responses are scored on a 7-point scale ranging from 1 (strongly disagree) to 7 (strongly agree).

The MSI survey is scored by calculating a total score for each of the following subscales:

1. Affective Communication: This subscale measures the degree to which couples feel comfortable expressing emotions to each other.
2. Role Orientation: This subscale measures the degree to which couples are satisfied with their respective roles within the relationship.
3. Sexual Adjustment: This subscale measures the degree to which couples are satisfied with their sexual relationship.
4. Interpersonal Adjustment: This subscale measures the degree to which couples are satisfied with their overall interpersonal relationship.
5. Idealistic Distortion: This subscale measures the degree to which couples hold unrealistic or idealistic expectations for their relationship.

To calculate the total score for each subscale, the scores for each question in that subscale are summed and then divided by the number of questions in that subscale. The resulting score for each subscale ranges from 1 to 7.

The overall satisfaction with the relationship is typically measured by calculating a weighted average of the subscale scores, with greater emphasis placed on the interpersonal adjustment subscale score. The weighted average score ranges from 1 to 7, with higher scores indicating greater satisfaction with the relationship.

Results Interpretation:

The results of the MSI can be interpreted in several ways, depending on the specific goals of the assessment. Some possible interpretations include:

• Total score: The total score on the MSI can range from 20 to 100, with higher scores indicating greater satisfaction with the marital relationship. A score of 60 or above is generally considered indicative of a satisfactory relationship, while scores below 60 may suggest areas for improvement or further evaluation.
• Subscale scores: In addition to the total score, the MSI provides subscale scores for different aspects of the relationship, such as communication, intimacy, and problem solving. These subscale scores can be helpful in identifying specific areas of strength or weakness in the relationship.
• Comparison to normative data: The MSI has been validated using normative data from a large sample of individuals, which can be used to compare an individual’s scores to those of the general population. This can be helpful in understanding how an individual’s relationship satisfaction compares to others.

Mood Disorder Questionnaire

Description: A screening tool designed to identify individuals who may be experiencing symptoms of bipolar disorder. The survey consists of 13 multiple-choice questions that assess an individual’s mood, behavior, and other symptoms associated with bipolar disorder.

Scoring:

The Mood Disorder Questionnaire (MDQ) is a screening tool used to assess for the presence of bipolar disorder. The questionnaire consists of 13 items and takes approximately 5-10 minutes to complete. After completing the questionnaire, the results are scored based on the following criteria:

1. If the individual answers “yes” to 7 or more of the first 12 questions, and if these symptoms have been present for most of the day, nearly every day, for at least 1 week, then the first part of the criteria for a positive screen is met.
2. If the symptoms in the first criterion have caused moderate to severe problems or impairment in social, occupational, or other important areas of functioning, or have required hospitalization or caused psychotic symptoms, then the second part of the criteria for a positive screen is met.

If both criteria are met, the individual may be referred for further evaluation by a healthcare professional, such as a psychiatrist or psychologist.

Administration: The MDQ can be administered by a healthcare professional, such as a psychiatrist, psychologist, social worker, or primary care physician. It may also be administered by a trained research assistant under the supervision of a healthcare professional or principal investigator.

Personal Health Questionnaire Depression Scale (PHQ-8)

Description: A self-administered screening tool used to assess an individual’s level of depression. The PHQ-8 is a shorter version of the PHQ-9 and includes 8 items that measure different aspects of depression, such as feelings of sadness, loss of interest in activities, and changes in sleep patterns.

Scoring:

Each item is scored on a scale of 0 to 3, with response options ranging from “not at all” to “nearly every day.” The total score is obtained by summing the scores for each item, with a possible score range of 0 to 24.

The following is a breakdown of the scoring for each item:

Item 1: Little interest or pleasure in doing things 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day

Item 2: Feeling down, depressed, or hopeless 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day

Item 3: Trouble falling or staying asleep, or sleeping too much 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day

Item 4: Feeling tired or having little energy 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day

Item 5: Poor appetite or overeating 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day

Item 6: Feeling bad about yourself – or that you are a failure or have let yourself or your family down 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day

Item 7: Trouble concentrating on things, such as reading the newspaper or watching television 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day

Item 8: Moving or speaking so slowly that other people could have noticed? Or so fidgety or restless that you have been moving a lot more than usual 0 = Not at all 1 = Several days 2 = More than half the days 3 = Nearly every day

After obtaining the total score, the severity of depression can be classified as follows:

0-4: None 5-9: Mild 10-14: Moderate 15-19: Moderately severe 20-24: Severe

Administer: The PHQ-8 can be administered by a healthcare professional, such as a physician, psychologist, social worker, or mental health counselor. It may also be self-administered by the individual under the supervision of a healthcare professional.

Patient Health Questionnaire (PHQ-9)

Description: The Patient Health Questionnaire (PHQ) is a self-administered version of the PRIME-MD diagnostic instrument for common mental disorders. The PHQ-9 is the depression module, which scores each of the 9 DSM-IV criteria as “0” (not at all) to “3” (nearly every day).

Results Interpretation: Major depressive disorder (MDD) is suggested if: • Of the 9 items, 5 or more are checked as at least‘more than half the days’ • Either item 1 or 2 is checked as at least‘ more than half the days’ Other depressive syndrome is suggested if: • Of the 9 items, between 2 to 4 are checked as at least‘more than half the days’ • Either item 1 or 2 is checked as at least‘more than half the days’ PHQ-9 scores can be used to plan and monitor treatment. To score the instrument, tally the numbers of all the checked responses under each heading (not at all=0, several days=1, more than half the days=2, and nearly every day=3). Add the numbers together to total the score on the bottom of the questionnaire. Interpret the score by using the guide listed below. Note: Depression should not be diagnosed or excluded solely on the basis of a PHQ-9 score. A PHQ-9 score ≥ 10 has a sensitivity
of 88% and a specificity of 88% for major depression.1
Since the questionnaire relies on patient self-report, the practitioner should verify all responses. A definitive diagnosis is made taking into account how well the patient understood the questionnaire, as well
as other relevant information from the patient. Regarding severity, PHQ-9 comprises five categories, where a cut-off point of 0–4 indicates no depressive symptoms, 5–9 mild depressive symptoms, 10–14 moderate depressive symptoms, 15–19 moderately-severe depressive symptoms, and 20–27 severe depressive symptoms

Frequency:Recommended Frequency for administering the PHQ-9: Monthly until remission or for first 6 months after diagnosis. At least quarterly while on active treatment. At least annually after that.

Patient Health Questionnaire modified for Adolescents(PHQ-A)

Description: The benefit of using the PHQ-A is its development for an adolescent population and inclusion of a question about suicidal ideation and suicide attempts. Although it was not designed specifically for adolescents, the PHQ-9 is the current standard depression screening instrument for adults in LVPG primary care.

Results Interpretation: Scoring and Interpretation
Each item on the measure is rated on a 4-point scale (0=Not at all; 1=Several days; 2=More than half the days; and
3=Nearly every day). The total score can range from 0 to 27, with higher scores indicating greater severity of depression.
The clinician is asked to review the score of each item on the measure during the clinical interview and indicate the raw
score in the section provided for “Clinician Use.” The raw scores on the 9 items should be summed to obtain a total raw
score and should be interpreted using the table below:
Interpretation Table of Total Raw Score
Total Raw Score Severity of depressive disorder or episode
0-4 None
5-9 Mild
10-14 Moderate
15-19
20-27
Moderately severe
Severe

Pittsburg Sleep Quality Index (PSQI)

Description:

a self-report survey that is used to assess an individual’s sleep quality and patterns. The PSQI consists of 19 items that assess different aspects of sleep, including sleep quality, duration, latency, efficiency, disturbances, medication use, and daytime dysfunction.

The PSQI is typically administered as a self-report questionnaire, with individuals rating various aspects of their sleep over the previous month. The questionnaire takes approximately 10-15 minutes to complete and can be administered by a healthcare professional, such as a physician, psychologist, or sleep specialist.

The PSQI assesses seven components of sleep: subjective sleep quality, sleep latency, sleep duration, habitual sleep efficiency, sleep disturbances, use of sleeping medication, and daytime dysfunction. Each component is scored on a 0-3 scale, with higher scores indicating greater sleep problems.

After the individual has completed the questionnaire, the results are scored and interpreted by a healthcare professional. The PSQI provides guidelines for scoring and interpreting the results, with a total score of 5 or greater indicating poor sleep quality.

Results Interpretation:

The PSQI results can be interpreted in several ways, depending on the specific goals of the assessment. Some possible interpretations include:

• Total score: The total score on the PSQI can range from 0 to 21, with higher scores indicating poorer sleep quality. A score of 5 or higher is generally considered indicative of poor sleep quality, while scores below 5 suggest good sleep quality.
• Subscale scores: In addition to the total score, the PSQI provides subscale scores for different aspects of sleep, such as sleep latency, sleep duration, and daytime dysfunction. These subscale scores can be helpful in identifying specific areas of sleep disturbance or deficiency.
• Comparison to normative data: The PSQI has been validated using normative data from a large sample of individuals, which can be used to compare an individual’s scores to those of the general population. This can be helpful in understanding how an individual’s sleep quality compares to others.

Personal Drinking Questionnaire (SOCRATES 8A)

Description:

a screening tool designed to assess an individual’s level of alcohol consumption and related behaviors. The SAAST consists of 20 multiple-choice questions and takes approximately 5-10 minutes to complete.

The SAAST is based on the Stages of Change model, which proposes that individuals progress through a series of stages when making behavior changes. The SAAST assesses an individual’s stage of change related to their alcohol use, as well as their perceived confidence and motivation to change.

The SAAST consists of three subscales:

1. Recognition: This subscale assesses an individual’s awareness of their alcohol use and its negative consequences.
2. Ambivalence: This subscale assesses an individual’s conflicted feelings about changing their alcohol use, including their perceived benefits and drawbacks of drinking.
3. Taking Action: This subscale assesses an individual’s readiness to change their alcohol use and their confidence in their ability to do so.

The SAAST can be used by individuals or administered by healthcare professionals, such as physicians, psychologists, or addiction counselors. The results of the SAAST can be used to guide treatment planning and support for individuals seeking to reduce or abstain from alcohol use.

Results Interpretation: 

The SOCRATES 8A results can be interpreted in several ways, depending on the specific goals of the assessment. Some possible interpretations include:

• Total score: The total score on the SOCRATES 8A can range from 19 to 95, with higher scores indicating greater readiness and motivation to change drinking behavior. A higher score suggests that the individual is more likely to change their drinking behavior.
• Subscale scores: In addition to the total score, the SOCRATES 8A provides subscale scores for three different stages of change: precontemplation, contemplation, and action. These subscale scores can be helpful in identifying where an individual is in the process of changing their drinking behavior and can inform the approach to treatment.
• Comparison to normative data: The SOCRATES 8A has been validated using normative data from a large sample of individuals, which can be used to compare an individual’s scores to those of the general population. This can be helpful in understanding how an individual’s readiness and motivation to change their drinking behavior compares to others.

Personal Drug Use Questionnaire (SOCRATES 8D)

Description:

a survey that aims to assess an individual’s readiness to change their substance use behavior. The survey consists of 19 items that measure eight dimensions related to drug and alcohol use: recognition, ambivalence, taking steps, recognition of problems, taking responsibility, commitment, support, and self-efficacy.

The recognition dimension assesses the individual’s awareness of the negative consequences of their substance use, while the ambivalence dimension measures their conflicting thoughts and feelings about changing their behavior. The taking steps dimension evaluates the individual’s actual efforts to change their substance use, while the recognition of problems dimension measures their ability to identify substance-related problems.

The taking responsibility dimension assesses the individual’s willingness to take responsibility for their substance use, while the commitment dimension evaluates their commitment to making changes. The support dimension measures the individual’s perception of the support available to them to help them change their behavior, and the self-efficacy dimension measures their confidence in their ability to change their substance use behavior.

Results:

survey consists of 19 items that measure eight dimensions related to drug and alcohol use. Each item is scored on a 5-point Likert scale, with responses ranging from 1 (strongly disagree) to 5 (strongly agree).

The eight dimensions are scored as follows:

1. Recognition: Items 1, 2, 3, 4, 5, 6, and 7 are summed to create a score for the recognition dimension.
2. Ambivalence: Items 8, 9, 10, 11, 12, and 13 are summed to create a score for the ambivalence dimension.
3. Taking Steps: Items 14, 15, 16, and 17 are summed to create a score for the taking steps dimension.
4. Recognition of Problems: Item 18 is scored individually.
5. Taking Responsibility: Item 19 is scored individually.
6. Commitment: The sum of items 3, 7, 11, 13, 15, and 16 is divided by 6 to create a score for the commitment dimension.
7. Support: The sum of items 4, 5, 6, and 7 is divided by 4 to create a score for the support dimension.
8. Self-efficacy: The sum of items 1, 2, 8, 9, 10, and 12 is divided by 6 to create a score for the self-efficacy dimension.

Each dimension is scored separately, and the scores can range from 1 to 5, with higher scores indicating greater readiness to change. The scores can be used to assess an individual’s readiness to change their substance use behavior and guide the development of interventions and support to address any substance use concerns.

Administration:

The Personal Drug Use Questionnaire, or SOCRATES 8D, can be administered by trained professionals such as addiction counselors, mental health professionals, physicians, nurses, or any other healthcare provider with expertise in addiction assessment and treatment.

These professionals should have experience in administering and interpreting the SOCRATES 8D questionnaire to effectively assess an individual’s readiness to change their substance use behavior and provide appropriate interventions and support.

PTSD Checklist for DSM-5 (PCL-5)

Description: A self-report questionnaire used to screen, diagnose, and assess the severity of post-traumatic stress disorder (PTSD) in individuals. The PCL-5 was developed based on the diagnostic criteria for PTSD in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5).

The questionnaire consists of 20 items that assess the presence and severity of PTSD symptoms in four categories: intrusion, avoidance, negative alterations in cognitions and mood, and alterations in arousal and reactivity. The items are rated on a 5-point Likert scale, ranging from 0 (not at all) to 4 (extremely), with higher scores indicating more severe symptoms.

The PCL-5 is a widely used and validated tool for the assessment of PTSD, and it can be completed by individuals in a variety of settings, including primary care clinics, mental health clinics, and military treatment facilities. The questionnaire can help healthcare providers and clinicians identify individuals who may require further evaluation or treatment for PTSD.

Results: A self-report questionnaire used to assess the presence and severity of post-traumatic stress disorder (PTSD) symptoms. The questionnaire consists of 20 items that correspond to the DSM-5 diagnostic criteria for PTSD.

Each item is rated on a 5-point Likert scale, ranging from 0 (“not at all”) to 4 (“extremely”), based on how much the symptom has bothered the individual over the past month.

To score the PCL-5, the individual’s responses to each item are summed to obtain a total score. The total score can range from 0 to 80, with higher scores indicating greater severity of PTSD symptoms.

There are also subscales that can be calculated by grouping together certain items based on the DSM-5 symptom clusters. These subscales are:

• Intrusion: items 1-5
• Avoidance: items 6-7 and 9-13
• Negative alterations in cognitions and mood: items 8 and 14-18
• Hyperarousal: items 19-20

Subscale scores can be calculated by summing the relevant item scores for each subscale.

Administration: The PTSD Checklist for DSM-5 (PCL-5) is typically administered by mental health professionals or healthcare providers who are trained in the assessment and treatment of trauma-related disorders. This may include psychologists, psychiatrists, licensed clinical social workers, licensed professional counselors, or other licensed mental health professionals.

PTSD Checklist – Civilian Version (PCL-C)

Description:

The PTSD Checklist – Civilian Version (PCL-C) is a self-report questionnaire designed to assess symptoms of post-traumatic stress disorder (PTSD) in civilians who have experienced traumatic events. The PCL-C consists of 17 items that correspond to the diagnostic criteria for PTSD in the DSM-IV, which includes symptoms such as re-experiencing, avoidance, and hyperarousal.

The PCL-C asks respondents to rate the severity of each symptom they have experienced in the past month on a scale from 1 (not at all) to 5 (extremely). Total scores can range from 17 to 85, with higher scores indicating more severe PTSD symptoms.

The PCL-C can be used as a screening tool to identify individuals who may be experiencing PTSD symptoms and require further evaluation or treatment. It is important to note that a diagnosis of PTSD can only be made by a trained healthcare professional, and the PCL-C should not be used as a substitute for a comprehensive clinical evaluation.

The PCL-C is widely used in research studies and clinical settings to assess the prevalence and severity of PTSD symptoms in civilian populations.

Scoring:

The PCL-C consists of 17 items that correspond to the diagnostic criteria for PTSD in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Each item is rated on a 5-point scale, ranging from 0 (not at all) to 4 (extremely), indicating the level of distress or impairment related to each symptom in the past month.

To score the PCL-C, the responses to each item are added together to obtain a total score ranging from 0 to 68. A higher score indicates a greater severity of PTSD symptoms.

There is no established cutoff score for the PCL-C, but a total score of 30 or above is often used as an indicator of possible PTSD. However, it is important to note that a clinical diagnosis of PTSD cannot be made based solely on the PCL-C score, and a comprehensive evaluation by a mental health professional is necessary for accurate diagnosis and treatment.

PTSD Checklist – Military Version (PCL-M)

Description:

a self-report questionnaire that assesses symptoms of post-traumatic stress disorder (PTSD) in military personnel and veterans who have been exposed to traumatic events during their service.

The PCL-M consists of 20 items that correspond to the diagnostic criteria for PTSD in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Each item is rated on a 5-point scale, ranging from 0 (not at all) to 4 (extremely), indicating the level of distress or impairment related to each symptom in the past month.

The 20 items of the PCL-M include questions about intrusive thoughts or memories, avoidance behaviors, negative mood or emotions, and hyperarousal symptoms. The questionnaire is designed to assess the severity of PTSD symptoms and can be used to screen for PTSD or to monitor symptom change over time.

The PCL-M is widely used in military and veteran populations and is considered a reliable and valid measure of PTSD symptoms

Scoring:

The PCL-M consists of 17 items that correspond to the diagnostic criteria for PTSD in the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5). Each item is rated on a 5-point scale, ranging from 0 (not at all) to 4 (extremely), indicating the level of distress or impairment related to each symptom in the past month.

To score the PCL-M, the responses to each item are added together to obtain a total score ranging from 0 to 68. A higher score indicates a greater severity of PTSD symptoms.

There is no established cutoff score for the PCL-M, but a total score of 30 or above is often used as an indicator of possible PTSD. However, it is important to note that a clinical diagnosis of PTSD cannot be made based solely on the PCL-M score, and a comprehensive evaluation by a mental health professional is necessary for accurate diagnosis and treatment.

It is also important to note that the PCL-M is specifically designed for use with military personnel and veterans, and should not be used to assess PTSD symptoms in individuals who have not experienced military-related trauma.

Administer: The PCL-M can be administered by trained mental health professionals or healthcare providers who have experience in working with military personnel and veterans. It can also be self-administered by the individual.

RAND-36 (SF- 36) Health Status Questionnaire

Description:

is a widely used survey tool that assesses an individual’s health-related quality of life. The questionnaire consists of 36 items that cover eight different health concepts:

1. Physical functioning: the ability to perform physical activities and daily tasks
2. Role limitations due to physical health problems: the impact of physical health on work and other daily activities
3. Bodily pain: the level of pain and discomfort experienced
4. General health perceptions: overall perception of health
5. Vitality: level of energy and fatigue
6. Social functioning: ability to engage in social activities and relationships
7. Role limitations due to emotional problems: the impact of emotional problems on work and other daily activities
8. Mental health: emotional well-being and psychological distress

Each item on the questionnaire asks the respondent to rate their level of functioning or well-being on a scale ranging from “excellent” to “poor” or “all of the time” to “none of the time”.

The responses to the items are scored and combined to generate scores for each of the eight health concepts, as well as two summary scores for physical health and mental health. These scores can be used to assess an individual’s overall health status, track changes over time, and compare health outcomes across different populations or treatment interventions.

The RAND-36 (SF-36) Health Status Questionnaire can be administered in various formats, including paper and pencil, online, or by telephone. It is a widely used tool in clinical research, health services evaluation, and clinical practice.

Scoring: 

Roland Morris Disability Questionnaire

Description:

a self-reported questionnaire used to evaluate the level of functional disability experienced by patients with lower back pain. The RMDQ consists of 24 statements that relate to the patient’s level of functional ability, such as the ability to stand for prolonged periods, to lift heavy objects, and to perform daily activities such as getting dressed or bathing.

The questionnaire asks patients to rate their level of difficulty in performing each activity on a scale of 0 to 24, with 0 indicating no difficulty and 24 indicating extreme difficulty. The total score is calculated by summing the scores for all 24 items, with a higher score indicating a greater level of functional disability.

The RMDQ is widely used in clinical settings as a reliable and valid measure of functional disability related to lower back pain. It has been translated into many languages and is used internationally as a tool to assess the effectiveness of interventions aimed at reducing pain and improving function in patients with lower back pain.

The RMDQ is a simple and easy-to-administer questionnaire that can be completed by patients in a matter of minutes. It is a useful tool for healthcare professionals in evaluating the level of disability experienced by their patients and in monitoring the effectiveness of treatments aimed at improving functional ability in patients with lower back pain.

Scoring:

Each item on the RMDQ is scored on a scale from 0 to 24, with 0 indicating no disability and 24 indicating maximum disability. The total score is calculated by summing the scores for all 24 items, with a maximum possible score of 24.

The RMDQ is a reliable and valid measure of functional disability related to lower back pain. It is widely used in clinical settings as a tool to assess the effectiveness of interventions aimed at reducing pain and improving function in patients with lower back pain.

Interpreting the RMDQ score can depend on the context of the patient’s condition and treatment goals. A lower score indicates less functional disability, while a higher score indicates greater disability. A change in the RMDQ score over time can be used to monitor treatment progress and assess the effectiveness of interventions.

It’s important to note that the RMDQ is just one tool among many that healthcare professionals may use to evaluate a patient’s lower back pain and functional disability. It should be used in conjunction with a comprehensive clinical evaluation and other diagnostic tools to ensure accurate diagnosis and effective treatment.