Professional Documents
Culture Documents
Compiled Assessment Results
Compiled Assessment Results
com
Selected Goals
Responses:
1 sadness 1
2 alcohol 0
3 anger 1
4 sleep 0
5 body_image 0
6 stress 1
7 worrying 1
8 concentration 1
9 family 1
10 breakup 1
11 relationships 0
12 focus 1
13 panic 0
14 people 0
15 grief 0
16 domestic_violence 0
17 self_esteem 1
18 distraction 1
19 postpartum 0
20 drugs 1
21 smoking_chew 1
Sheehan Disability Scale (SDS)
Responses:
1. Work: How much have your problems disrupted your Moderately (6)
work?
2. Social Life: How much have your problems disrupted Extremely (10)
your social life?
3. Family Life/Home Responsibilities: How much have Materially (8)
your problems disrupted your family life/home
responsibilities?
Patient Health Questionnaire (PHQ-9)
Responses:
Over the last two weeks, how often have you been bothered by any of the following
problems?
1. Little interest or pleasure in doing things More than half the days (2)
2. Feeling down, depressed or hopeless Nearly every day (3)
3. Trouble falling asleep, staying asleep, or sleeping too Not at all (0)
much
4. Feeling tired or having little energy Several days (1)
5. Poor appetite or overeating Several days (1)
6. Feeling bad about yourself - or that you’re a failure or Nearly every day (3)
have let yourself or your family down
7. Trouble concentrating on things, such as reading the More than half the days (2)
newspaper or watching television
8. Moving or speaking so slowly that other people could Not at all (0)
have noticed. Or, the opposite - being so fidgety or
restless that you have been moving around a lot more
than usual
9. Thoughts that you would be better off dead or of Not at all (0)
hurting yourself in some way
10. If you checked off any problems, how difficult have Somewhat difficult (1)
those problems made it for you to do your work, take
care of things at home, or get along with other people?
Generalized Anxiety Disorder Assessment (GAD-7)
Responses:
Over the last two weeks, how often have you been bothered by any of the following
problems?
1. Feeling nervous, anxious or on edge More than half the days (2)
2. Not being able to stop or control worrying More than half the days (2)
3. Worrying too much about different things Nearly every day (3)
4. Trouble relaxing Nearly every day (3)
5. Being so restless that it is hard to sit still Not at all (0)
6. Becoming easily annoyed or irritable Nearly every day (3)
7. Feeling afraid as if something awful might happen? Several days (1)
Drug Use Questionnaire (DAST10)
Responses:
1. Have you used drugs other than those required for Yes (1)
medical reasons?
2. Have you abused prescription drugs? No (0)
3. Are you always able to stop using drugs when you No (1)
want to?
4. Have you had 'blackouts' or 'flashbacks' as a result of No (0)
drug use?
5. Do you ever feel bad or guilty about your drug use? Yes (1)
6. Does your spouse (or parents) ever complain about Yes (1)
your involvement with drugs?
7. Have you neglected your family because of your use of Yes (1)
drugs?
8. Have you engaged in illegal activities in order to obtain Yes (1)
drugs?
9. Have you ever experienced withdrawal symptoms (felt Yes (1)
sick) when you stopped taking drugs?
10. Have you had medical problems as a result of your No (0)
drug use (e.g. memory loss, hepatitis, convulsions,
bleeding, etc.)?
Mood Disorder Questionnaire (MDQ)
Responses:
Has there ever been a period of time when you were not your usual self and...
Responses:
1. How often do you have trouble wrapping up the final Never (0)
details of a project, once the challenging parts have
been done?
2. How often do you have difficulty getting things in Sometimes (2)
order when you have to do a task that requires
organization?
3. How often do you fidget or squirm with your hands or Rarely (1)
feet when you have to sit down for a long time?
4. When you have a task that requires a lot of thought, Often (3)
how often do you avoid or delay getting started?
5. How often do you have problems remembering Sometimes (2)
appointments or obligations?
6. How often do you feel overly active and compelled to Often (3)
do things, like you were driven by a motor?