Links to supporting documentation, including licensing agents, have been provided when possible. You can also develop and utilize your own custom questionnaires for an additional charge.
Public Domain
Public Domain Questionnaires
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
Keywords
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:
Keywords:
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
Publications:
Keywords:
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
Reference website
Publications
Limitations
Keywords
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
Reference website
Publications
Limitations
Keywords
PDF Link
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
Limitations
Keywords
PDF Link:
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
Publications
Limitations
Keywords
PDF Link
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:
Keywords
PDF Link
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:
Keywords
PDF Link
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
Publications
Keywords
CANS – Trauma Comprehensive (CANS-Trauma)
Columbia-Suicide Severity Rating Scale – C-SSRS-DS
Columbia-Suicide Severity Rating Scale – C-SSRS-Follow-up
Columbia-Suicide Severity Rating Scale – C-SSRS-LR
Columbia-Suicide Severity Rating Scale – C-SSRS-SLC
Columbia-Suicide Severity Rating Scale – C-SSRS-TRIAGE
Patient Health Questionnaire modified for Adolescents(PHQ-A)
Copyrighted
No Cost
Acceptance and Action Questionnaire (AAQ-II)
Positive Relationship with Parents – Parent Survey (PRP-Parent)
Positive Relationship with Parents – Teen Survey (PRP-Teen)