Registration Form (Registration)*

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-

Start of Visit Form (START_VISIT)*

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✔

      •     Add provider of START_VISIT

Service Request Form (SERVICE_REQUEST)*

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✔

✔

Virtual/Remote Only Information Page (YOUTH_VIRTUAL_INFO_SHEET)

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✔

✔

Consent – Youth (CONSENT)

✔

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Virtual Reason for Visit (REASON_VISITVRFV)

✔

✔

✔

Virtual Demographic Survey – Youth (DEMOVDEMO)

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-

✔ (30+ days later)

Self-Rated Health (SRH)

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Self-Rated Mental Health (SRMH)

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Kessler Psychological Distress Scale-6 (K6) or
Kessler Psychological Distress Scale-6 pas week (K6W)

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Global Appraisal of Individual Needs: Short Screener (GAIN-SSS) or
YWHO Substance Monitoring Form (YSMF)

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Generalized Anxiety Disorder Scale (GAD-7)

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Patient Health Questionnaire (PHQ-9)

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Columbia – Suicide Severity (C-SSRS)* ˖

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Outcome Rating Scale (ORS)

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Goal-Based Outcomes (GBO)

✔

✔

✔

Session Rating Scale (SRS)

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-

-

Virtual Satisfaction and Service Experience (SATISFACTION)VSWS) To be administered after every

visit during pilot phase of YWHO Virtual Hub

✔

✔

✔

End of Visit Form (END_VISIT)*

✔

✔

✔

*Form is Completed by Service Provider

˖ Only completed if youth identified suicide ideation in the PHQ-9, or anytime @ the discretion of the clinician

Note: At the discretion of the service provider, any tool can be administered less than 7 days, if helpful for service provision

*Examples of Non-Clinical Visits would be would be housing or employment services