Virtual Frequency of Administration for Non Clinical Visits
My Wellness Passport Forms: | First Visit | Subsequent Visit | Subsequent Visit |
Registration Form (Registration)* | ✔ | - | - |
Before and/or While Youth is Receiving Services | |||
Start of Visit Form (START_VISIT)* | ✔ | ✔ | ✔ |
• Add provider of START_VISIT | |||
Service Request Form (SERVICE_REQUEST)* | ✔ | ✔ | ✔ |
Consent – Youth (CONSENT) | ✔ | - | - |
Virtual Reason for Visit (VRFV) | ✔ | ✔ | ✔ |
Virtual Demographic Survey – Youth (VDEMO) | ✔ | - | ✔ (30+ days later) |
Self-Rated Health (SRH) | - | - | - |
Self-Rated Mental Health (SRMH) | - | - | - |
Kessler Psychological Distress Scale-6 (K6) or | - | - | - |
Global Appraisal of Individual Needs: Short Screener (GAIN-SSS) or | - | - | - |
Generalized Anxiety Disorder Scale (GAD-7) | - | - | - |
Patient Health Questionnaire (PHQ-9) | - | - | - |
Columbia – Suicide Severity (C-SSRS)* ˖ | - | - | - |
Outcome Rating Scale (ORS) | - | - | - |
Goal-Based Outcomes (GBO) | ✔ | ✔ | ✔ |
After Youth Has Received Services | |||
Session Rating Scale (SRS) | - | - | - |
Virtual Satisfaction and Service Experience (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 | |||
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