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YWHO Clinical Screening Questionnaires / Questionnaires d’évaluation clinique des CBEJO



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Clinical Screening Questionnaires Reference Table: A Summary

Purpose of Clinical Questionnaires Table:

The purpose of this reference document is to provide information to service providers about each clinical questionnaire completed by YWHO clients, including number of items, purpose, frequency of administration, alerts, scoring, and relation of scores to intensity level of services offered.

Time to Complete Clinical Questionnaires:

Based on YWHO youth clients who have completed the tools on the Dacima platform thus far, it takes, on average, approximately 15 - 30 minutes to answer all of the clinical questionnaires.

Some General Examples of Low Medium High Level Intensity Services at YWHO Sites (*not a comprehensive list; Low, Medium, and High intensity services will differ across hubs, depending on services and interventions each site has available*):

  • Low Intensity: Solution Focused Brief Therapy; Motivational Enhancement Therapy (MET) or Cognitive Behavioural Therapy (CBT; 1 4 sessions); individual or group peer support
  • Medium Intensity: Evidence based structured psychotherapy for mental health concerns (Dialectical Behavioural Therapy (DBT) skills, CBT; 6-12 sessions); Evidence based group treatments for substance use/concurrent disorder concerns (MET, CBT, DBT; 6-12 sessions); Family support; Supported education/employment/housing, if relevant.
  • High Intensity: YWHO based psychiatric response ( telepsychiatry or in person); medication consult; access to crisis supports; linkage to other existing higher intensity youth/young adult mental health and/or addictions services (e.g., long term psychotherapy, day treatment, inpatient, residential, ongoing psychiatric services, addiction medicine, specialist addiction treatment, withdrawal support).


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titleNotes/Disclaimer:


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  • None of the screening instruments/clinical questionnaires listed in the document operate in isolation. Service providers should take into account findings from other screening questionnaires, and use their clinical judgment and discussions with clients and their families to make the most appropriate decisions regarding assessment and interventions for clients available at their specific YWHO site.
  • For further information, please contact Janis Wolfe: janis.wolfe@youthhubs.ca.


Clinical Screening Questionnaires Before Session:

Clinical Questionnaire Name

# of times

PurposeFirst VisitSubsequent Visit 
(less than 7 days)

Subsequent Visit

(8 days to less than 29 days)

Subsequent Visit

(30 days or more)

Scores on YWHO Data Collection Platform:

Over time via progress tracker or single point in time?

Items Flagging

Immediate Risk/Action

Scores Mapping onto low (L) - Medium (M) - High (H)

Intensity Services (Hub-Specific)

Kessler Psychological Distress Scale (K10)10Global measure of distress based on questions about anxiety and depressive symptoms that a person has experienced in the most recent 30 days.

✓

--

✓

Can see scores over time with YWHO Data Collection Platform progress tracker.
  • <20 Likely to be well; no feelings of distress (L)
  • 20-24 Likely experiencing mild distress; mild depression and/or anxiety disorder (L)
  • 25-29 Likely experiencing moderate distress; moderate depression and/or anxiety disorder (M)
  • 30-50 Likely experiencing severe distress; severe depression and/or anxiety disorder (H)
Kessler Psychological Distress Scale (Past Week) – (K10W)10Global measure of distress based on questions about anxiety and depressive symptoms that a person has experienced in the most recent 7 days.--

✓

-Can view past single points on same client to provide information over
time; no progress tracker.
  • <20 Likely to be well; no feelings of distress (L)
  • 20-24 Likely experiencing mild distress; mild depression and/or anxiety disorder (L)
  • 25-29 Likely experiencing moderate distress; moderate depression and/or anxiety disorder (M)
  • 30-50Likely experiencing severe distress; severe depression and/or anxiety disorder (H)
Self-Rated Health (SRH)1Simple self-reported measure of general health.

✓

-

✓

✓

Can see scores over time with YWHO Data Collection Platform progress tracker.
  • Excellent - (L)
  • Very good - (L)
  • Good - (L)
  • Fair - (M)/(H)
  • Poor - (M)/(H)
Self-Rated Mental Health (SRMH)1Simple self-reported measure of general mental health.

✓

-

✓

✓

Can see scores over time with YWHO Data Collection Platform progress tracker.
  • Excellent - (L)
  • Very good - (L)
  • Good - (L)
  • Fair - (M)/(H)
  • Poor - (M)/(H)
Global Appraisal of Individual Needs: Short Screener (GAIN - SSS)12 (5 substance use items scored. Other items for clinical use only).Screen to identify substance use disorders, and issues with disordered eating, traumatic distress, gambling, gaming, internet overuse.

✓

--

✓

Can view past single points on same client to provide information over time;
no progress tracker.		“Thinking or feeling that people are watching you,
following you, or out to get you” May represent
potential flag for psychosis (no YWHO Data Collection Platform alert).
  • 0: (L) (unlikely to have a diagnosis or need services)
  • 1-2: (M) (1 or 2 past year symptoms; possible diagnosis in area of substance overuse)
  • 3-5: (H)(3+ past-year symptoms; high probability of substance overuse diagnosis)1
YWHO Substance Monitoring Form4 (first three items scored - last item for clinical use only).Measure of number of days in the past week that clients used alcohol and drugs and frequency of negative consequences.--

✓

-Can view past single points on same client to provide information over time;
no progress tracker.
  • Total score ranges from 0-9 (three items)
  • Higher score, higher frequency of weekly substance use
Patient Health Questionnaire (PHQ-9)9Screen for suicide risk within past two weeks (use of last question within YWHO initiative); Positive screen leads to C-SSRS
completion. Can also view eight depression related item scores to support K-10 score.

✓

-

✓

✓

Can view past single points on same client to provide information over time;
no progress tracker.		Item #9 response triggers suicidal ideation YWHO Data Collection Platform alert to service provider. C-SSRS then completed by provider with youth in session.
  • *Item #9 response (on several days, more than half of days, nearly every day) → (H)
  • 0-4 Depression severity of none (L)
  • 5-9 Depression severity of mild (L)
  • 10-14 Depression severity of moderate (M)
  • 15-19 Depression severity of moderately severe ((M)/(H))
  • 20-27 Depression severity of severe (H)
Outcome Rating Scale (ORS)
4Measure of areas of life functioning using four visual analog scales.

✓

-

✓

✓

Can view past single points on same client to provide information over time;
no progress tracker.
  • Total possible score = 40
  • Clinical cutoff scores:
  • Youth ages 13-17: 28
  • Youth ages 18+: 25
  • Scores at or below cutoffs are typical of youth who
  • seek help/have concerns/would benefit from (L)/(M)/(H)
  • intensity services
  • Lower scores, lower levels of well-being2
Goal-Based Outcomes (GBO)Self-developed number of goals plus single progress rating.Evaluation of change and progress toward goals that are most important to clients.

✓

-

✓

✓

Questionnaire score is a rating at single
point in time; can review past forms to see previous goals.
Goals can represent youth voice and help inform
best intervention at any intensity level ((L)/(M)/(H))

Clinical Screening Questionnaires During Session, if Relevant:

Clinical Questionnaire Name

# of times

PurposeFirst VisitSubsequent Visit 
(less than 7 days)

Subsequent Visit

(8 days to less than 29 days)

Subsequent Visit

(30 days or more)

Scores on YWHO Data Collection Platform:

Over time via progress tracker or single point in time?

Items Flagging

Immediate Risk/Action

Scores Mapping onto low (L) - Medium (M) - High (H)

Intensity Services (Hub-Specific)

Columbia – Suicide Severity
Rating Scale (CSSRS)

*to be completed by service
provider if suicidal ideation is disclosed on PHQ-9 or if clinician feels youth is at risk.

6
(5 suicidal ideation, 1
suicidal behaviour)		Suicidal ideation and behaviour rating scale
to establish a person's immediate risk of suicide.

✓

-

✓

✓

Can view past single points on same client to provide information over time;
no progress tracker.
  • “Yes” to item 4 (Have you had these thoughts and had some intention of acting on them?) or item 5 (Have you started to work out or worked out the details of how to kill yourself? Do you intend to carry out this plan?) indicates presence of ideation with at least some intent to die in the past one month → severe risk and clear need for further evaluation and clinical management (e.g., immediate referral to ER, other community mental health services, client safety precautions).
  • "Yes” to item 6 (Have you ever done anything, started to do anything, or prepared to do anything to end your life?) If in past 3 months → severe risk and clear need for further evaluation and clinical management.

Would typically map on to H intensity services offered at, or outside, Hub.

Clinical Screening Questionnaires After Session:

Clinical Questionnaire Name

# of times

PurposeFirst VisitSubsequent Visit 
(less than 7 days)

Subsequent Visit

(8 days to less than 29 days)

Subsequent Visit

(30 days or more)

Scores on YWHO Data Collection Platform:

Over time via progress tracker or single point in time?

Items Flagging

Immediate Risk/Action

Scores Mapping onto low (L) - Medium (M) - High (H)

Intensity Services (Hub-Specific)

Session Rating
Scale (SRS)		4Visual analog scales to assess key dimensions
of effective therapeutic relationships.

✓

✓

✓

✓

Can view past single points on same client to provide information over time;
no progress tracker.
  • Total possible score = 40
  • Any score < 36 overall (or < 9 on any scale) could be a source of concern - invite youth to comment. (Clients tend to score all alliance measures highly, so service providers should address any suggestion of a problem)
Satisfaction with
Services		5Youth evaluation regarding Hub services received,

✓

✓

✓

✓

Can view past single points on same client to provide information over time;
no progress tracker.
There are no scores associated with this questionnaire.


1. GAIN-SSS:

  • If the youth answers “Never” or “12+ months ago” as one of their answers, then the score for that answer is 0.
  • If the youth answers “4 to 12 months ago” “2 to 3 months ago” or “Past month” the score for that answer is 1.
  • Since there is a total of 5 questions for the substance use domain, the highest score for this domain is 5.

2. See ORS Reliable change chart here. 

Click here to download a printable version of this document:

View file
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YWHO Clinical Screening Questionnaires / Questionnaires d’évaluation clinique des CBEJO



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Kessler Psychological Distress Scale (K10)/ (K10W - Day 08-29) / Échelle de détresse psychologique de Kessler à 10 items / (K10 - semaine précédente)