# week five assignment capstone

esults Section Draft
Prepare the Results section of your evaluation report. Refer to page 222 of the textbook for assistance with this section. When reporting statistical results, be sure to use APA style; please refer to the APA Publications Manual for proper formatting of statistical outcome data.
*Note: Avoid first person verbiage and write in third person, no direct quotes, and do not give possession to in-text citations or inanimate objects.
The book is Evaluation Fundamentals Insights into Effectiveness, Quality, and values
Author Arlene Finks
The book is a hard copy I can not attach
ATTACHED FILE(S)
Running Head: WEEK 5 DISCUSSION 1
WEEK 5 DISCUSSION 2
Week 5 Discussion
Name:
Instructor:
Date:
Week 5 Discussion
Analysis was carried out in SPSS to determine before (Pre) and after (Post) treatment of participants from the two groups, that is, level of anxiety among children who between 3 to 13 years and adult opiate substance abuse for adults aged 65 and above.
Wilcoxon Signed Rank test was used to examine Spence Children’s Anxiety Scale (SCAS) outcome variables for the levels of anxiety between children of ages 3 to 13 (Reardon et al., 2018). The variables SCAS_Pre_Total and SCAS_Pst_Total, which were the sums of score items before and after treatment, were used. Analysis was as shown in Table 1.
Table 1

Descriptive Statistics

N

Mean

Std. Deviation

Minimum

Maximum

SCAS_Pre_Total

54

67.6481

9.50106

48.00

84.00

SCAS_Pst_Total

54

67.7593

9.28569

48.00

84.00

Test Statisticsa

SCAS_Pst_Total – SCAS_Pre_Total

Z

-.962b

Asymp. Sig. (2-tailed)

.336

a. Wilcoxon Signed Ranks Test

b. Based on negative ranks.
According to the analysis, Z (52) = -.962, p = .336. The descriptive statistics showed that children anxiety was higher after treatment (M = 67.76, SD = 9.29) compared to before treatment (M = 67.64, SD = 9.50). The difference was not significant however since the p-value was greater than .05.
Wilcoxon Singed Rank Test was also used to examine the difference in mean scores for adult opiate substance abuse (ASI) before and after treatment. Table 2 showed the results of the analysis.
Table 2

Descriptive Statistics

N

Mean

Std. Deviation

Minimum

Maximum

ASI_Pre_Total

46

26.6304

6.08225

17.00

39.00

ASI_Pst_Total

46

27.6739

6.45344

19.00

42.00

Test Statisticsa

ASI_Pst_Total – ASI_Pre_Total

Z

-3.584b

Asymp. Sig. (2-tailed)

.000

a. Wilcoxon Signed Ranks Test

b. Based on negative ranks.
Analysis indicated that Z (44) = -3.584, p < .01. According to descriptive statistics, the ASI scores after treatment were higher (M = 27.67, SD = 6.45) compared to ASI scores before treatment (M = 27.67, SD = 6.45). The differences in opiate substance abuse among older people showed that treatment significantly increased the intake since p-value was less than .05 level of significance. When a control and treatment group are considered, Mann-Whitney U test was the most suitable test to determine the difference in means for SCAS and ASI scores between those who received treatment and those who did not (Lin et al., 2021). The analysis were as shown in Table 3. Table 3 Test Statisticsa SCAS_Pre_Total SCAS_Pst_Total Mann-Whitney U 331.500 330.500 Wilcoxon W 682.500 681.500 Z -.565 -.582 Asymp. Sig. (2-tailed) .572 .561 a. Grouping Variable: Groups Analysis indicated that the difference was not significant for both SCAS_Pre_Total (Z (52) = -.565, p = .572) and SCAS_Pst_Total (Z (52) = -.582, p = .561). Table 4 shows the Mann-Whitney U test for the opiate substance abuse scores. Table 4 Test Statisticsa ASI_Pre_Total ASI_Pst_Total Mann-Whitney U 219.000 187.000 Wilcoxon W 625.000 593.000 Z -.746 -1.480 Asymp. Sig. (2-tailed) .456 .139 a. Grouping Variable: Groups Analysis indicated insignificance difference in means between treatment and control group for both ASI_Pre_Total (Z (44) = -.746, p = .456) and ASI_Pst_Total (Z (44) = -1.48, p = .139). Reference Reardon, T., Spence, S. H., Hesse, J., Shakir, A., & Creswell, C. (2018). Identifying children with anxiety disorders using brief versions of the Spence Children’s Anxiety Scale for children, parents, and teachers.Psychological assessment,30(10), 1342. Lin, T., Chen, T., Liu, J., & Tu, X. M. (2021). Extending the Mann‐Whitney‐Wilcoxon rank sum test to survey data for comparing mean ranks.Statistics in Medicine,40(7), 1705-1717. A. Thomas McLellan, Ph.D. Deni Carise, Ph.D. Thomas H. Coyne, MSW T. Ron Jackson, MSW Remember:This is an interview, not a test ≈Item numbers circled are to be asked at follow-up.≈ ≈Items with an asterisk * are cumulative and should be rephrased at INTRODUCING THE ASI:Introduce and explain the seven potential problem areas:Medical, Employment/Support Status, Alcohol, Drug, Legal, Family/Social, and Psychiatric.All clients receive this same standard interview.All information gathered is confidential; explain what that means in your facility; who has access to the information and the process for the release of information. There are two time periods we will discuss: 1.The past 30 days 2.Lifetime Patient Rating Scale:Patient input is important.For each area, I will ask you to use this scale to let me know how bothered you have been by any problems in each section.I will also ask you how important treatment is for you for the area being discussed. The scale is: 0 - Not at all 1 - Slightly 2 - Moderately 3 - Considerably 4 - Extremely Inform the client that he/she has the right to refuse to answer any question. If the client is uncomfortable or feels it is too personal or painful to give an answer, instruct the client not to answer.Explain the benefits and advantages of answering as many questions as possible in terms of developing a comprehensive and effective treatment plan to help them. Please try not give inaccurate information! INTERVIEWER INSTRUCTIONS: 1. Leave no blanks. 2. Make plenty of Comments (if another person reads this ASI, they should have a relatively complete picture of the client's perceptions of his/her problems). 3. -9 = Question not answered. -8 = Question not applicable. 4. Terminate interview if client misrepresents two or more sections. 5. When noting comments, please write the question number. HALF TIME RULE:If a question asks the number of months, round upperiods of 14 days or more to 1 month.Round up 6 months or more to 1 year. CONFIDENCE RATINGS:⇒ Last two items in each section. ⇒ Do not over-interpret. ⇒ Denial does not warrant misrepresentation. ⇒ Misrepresentation = overt contradiction in information. Probe, cross-checkand make plenty of comments! HOLLINGSHEAD CATEGORIES: 1. Higher execs, major professionals, owners of large businesses. 2. Business managers if medium sized businesses, lesser professions, i.e., nurses, opticians, pharmacists, social workers, teachers. 3. Administrative personnel, managers, minor professionals, owners/ proprietors of small businesses, i.e., bakery, car dealership, engraving business, plumbing business, florist, decorator, actor, reporter, travel agent. 4. Clerical and sales, technicians, small businesses (bankteller, bookkeeper, clerk, draftsperson, timekeeper, secretary). 5. Skilled manual - usually having had training (baker, barber, brakeperson, chef, electrician, fireman,machinist, mechanic, paperhanger, painter, repairperson, tailor, welder, police, plumber). 6. Semi-skilled (hospital aide, painter, bartender, bus driver, cutter, cook, drill press, garage guard, checker, waiter, spot welder, machine operator). 7. Unskilled (attendant, janitor, construction helper,unspecified labor, porter, including unemployed). ALCOHOL/DRUG USE INSTRUCTIONS: The following questions refer to two time periods: the past 30 days and lifetime. Lifetime refers to the time prior to the last 30 days. ⇒ 30 day questions only require the number of days used. ⇒ Lifetime use is asked to determine extended periods of use. ⇒ Regular use = 3+ times per week, binges, or problematic irregular use in which normal activities are compromised. ⇒ Alcohol to intoxication does not necessarily mean "drunk", use the words “to feel or felt the effects", “got a buzz”, “high”, etc. instead of intoxication. As a rule of thumb, 3+ drinks in one sitting, or 5+ drinks in one day defines “intoxication". ⇒ How to ask these questions: →“How many days in the past 30 have you used....?” →“How many years in your life have you regularly used....?” {Module Name} Module Addiction Severity Index - 5th Edition Clinical/Training Version LIST OF COMMONLY USED DRUGS: Alcohol:Beer, wine, liquor Methadone: Dolophine, LAAM Opiates:Pain killers = Morphine, Diluaudid, Demerol, Percocet, Darvon, Talwin, Codeine, Tylenol 2,3,4, Robitussin, Fentanyl Barbiturates: Nembutal, Seconal, Tuinol, Amytal, Pentobarbital, Secobarbital, Phenobarbital, Fiorinol Sed/Hyp/Tranq: Benzodiazepines = Valium, Librium, Ativan, Serax Tranxene, Xanax, Miltown, Other = ChloralHydrate (Noctex), Quaaludes Dalmane, Halcion Cocaine:Cocaine Crystal, Free-Base Cocaine or “Crack,” and “Rock Cocaine” Amphetamines: Monster, Crank, Benzedrine, Dexedrine, Ritalin, Preludin, Methamphetamine, Speed, Ice, Crystal Cannabis:Marijuana, Hashish Hallucinogens: LSD (Acid), Mescaline, Mushrooms (Psilocybin), Peyote, Green, PCP (Phencyclidine), Angel Dust, Ecstacy Inhalants:Nitrous Oxide, Amyl Nitrate (Whippits, Poppers), Glue, Solvents, Gasoline, Toluene, Etc. Just note if these are used: Antidepressants, Ulcer Meds = Zantac, Tagamet Asthma Meds = Ventoline Inhaler, Theodur Other Meds = Antipsychotics, Lithium {Module Name} Module Addiction Severity Index - 5th Edition Clinical/Training Version Agency Name: ___________________________Site Name:______________________________ ID #: __ __ __ __ __ __Date: __ __ / __ __ / __ __ __ __ GENERAL INFORMATION COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ GENERAL INFORMATION G1. ID Number __________________________ G4. Date of Admission mm/dd/yyyy __ __ /__ __ /__ __ __ __ G5. Date of Interview mm/dd/yyyy __ __ /__ __ /__ __ __ __ G6. Time Begun Use 24 hr clock; code hours:minutes ___ ___ : ___ ___ G7. Time Ended Use 24 hr clock; code hours:minutes ___ ___ : ___ ___ HRS MINS G8. Class 1 - Intake 2 - Follow-up ___ G9. Contact Code___ 1 - In person2 - Telephone (Intake ASI must be in person) G10. Gender 1 - Male 2 - Female ___ G99. Treatment Episode Number ___ ___ G11. Interviewer Code Number ___ ___ ___ G12. Special 1 - Patient terminated 2 - Patient refused 3 - Patient unable to respond ___ G14. How long have you lived at your current address? __ __ / __ __ YRS MOS G15. Is this residence owned by you or your family? 0 - No 1 - Yes ___ G16. Date of birth__ __ /__ __ /__ __ __ __ mm/dd/yyyy G17 Of what race do you consider yourself? ___ 1 - White (not Hisp) 5 - Asian/Pacific 2 - Black (not Hisp) 6 - Hispanic-Mexican 3 - American Indian 7 - Hispanic-Puerto Rican 4 - Alaskan Native 8 - Hispanic-Cuban 9 - Unknown G18. Do you have a religious preference?___ 1 - Protestant 4 - Islamic 2 - Catholic 5 - Other 3 - Jewish 6 - None G19. Have you been in a controlled environment in the past 30 days? ___ 1 - No 4 - Medical tx 2 - Jail/prison 5 - Psychiatric tx 3 - Alcohol or drug tx 6 - Other A place, theoretically, without access to drugs/alcohol. G20. How many days? ___ ___ If G19 is No, code -8. Refers to total number of days detained in the past 30 days. MEDICAL STATUS M1. * How many times in your life have you been hospitalized for medical problems? ___ ___ Include O.D.’s and D.T.’s.Exclude detox, alcohol/drug, psychiatric treatment and childbirth (if no complications).Enter the number of overnight hospitalizations for medical problems. M2. How long ago was your last hospitalization for__ __ / __ __ a physical problem? YRS MOS If no hospitalizations in Question M1, then code -8 / -8. MEDICAL COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ INTERVIEWER SEVERITY RATING M9. How would you rate the patient’s need for medical treatment? Refers to the patient’s need for additional medical treatment. ___ M4. Are you taking any prescribed medication on a regular basis for a physical problem? 0 - No 1 - Yes ___ If Yes, specify in comments. Medication prescribed by a MD for medical conditions; not psychiatric medicines.Include medicines prescribed whether or not the patient is currently taking them.The intent is to verify chronic medical problems. M5. Do you receive a pension for a physical disability? 0 - No 1 - Yes ___ If Yes, specify in comments. Include Workers’ compensation, exclude psychiatric disability. M6. How many days have you experienced medical problems in the past 30 days? ___ ___ Include flu, colds, etc.Include serious ailments related to drugs/alcohol, which would continue even if the patient were abstinent (e.g., cirrhosis of liver, abscesses from needles, etc.). For Questions M7 & M8, ask patient to use the Patient Rating Scale M7. How troubled or bothered have you been by these medical problems in the past 30 days? Restrict response to problem days in Question M6. ___ M8. How important to you now is treatment for these medical problems? If client is currently receiving medical treatment, refer to the need for additional medical treatment by the patient. ___ CONFIDENCE RATINGS Is the above information significantly distorted by: M10. Patient’smisrepresentation? 0 - No 1 - Yes ___ M11. Patient’s inability to understand? 0 - No 1 - Yes ___ M3. Do you have any chronic medical problems which continue to interfere with your life? 0 - No 1 - Yes ___ If Yes, specify in comments. A chronic medical condition is a serious physical condition that requires regular care (i.e., medication, dietary restriction) preventing full advantage of their abilities. EMPLOYMENT/SUPPORT STATUS E1. * Education completed GED = 12 years, note in comments. Include formal education only. __ __ / __ __ YRS MOS EMPLOYMENT/SUPPORT COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ E2. * Training or technical education completed Formal, organized training only.For military training, only include training that can be used in civilian life (i.e., electronics, computers). __ __ MOS E3. Do you have a profession, trade, or skill? 0 - No 1 - Yes ___ Employable, transferable skill acquired through training. If Yes, specify: __________________________________ E6. How long was your longest full-time job? Full-time = 35+ hours weekly; does not necessarily mean most recent job. __ __ / __ __ YRS MOS E10. Usual employment pattern, past 3 years? ___ 1 - Full time (35+ hours) 5 - Military service 2 - Part time (regular hours) 6 - Retired/disability 3 - Part time (irregular hours) 7 - Unemployed 4 - Student 8 - In controlled environment Answer should represent the majority of the last 3 years, not just the most recent selection.If there are equal times for more than one category, select that which best represents the current situation. E4. Do you have a valid driver’s license? 0 - No 1 - Yes___ Valid license; not suspended/revoked. E5. Do you have an automobile available for use? 0 - No 1 - Yes ___ If answer to E4 is No, then E5 must be No. Does not require ownership, only requires availability on a regular basis. E7. * Usual (or last) occupation ___ Specify Use Hollingshead Categories Reference Sheet E11. How many days were you paid for working in the past 30 days?___ ___ Include “under-the-table” work, paid sick days and vacation. E8. Does someone contribute to your support in any way? 0 - No 1 - Yes ___ Is patient receiving any regular support (i.e., cash, food, housing) from family/ friend.Include spouse’s contribution; exclude support by an institution. E9. Does this support constitute the majority of your support? 0 - No 1 - Yes ___ If E8 is No, then E9 is -8. EMPLOYMENT/SUPPORT COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ INTERVIEWER SEVERITY RATING E22. ___ How would you rate the patient’s need for employment counseling? EMPLOYMENT/SUPPORT STATUS (cont) For questions E12-E17: How much money did you receive from the following sources in the past 30 days? E12. Employment Net or “take home” pay, include any “under the table” money. \$___ ___,___ ___ ___ E13. Unemployment compensation \$___ ___,___ ___ ___ E14. Welfare Include food stamps, transportation money provided by an agency to go to and from treatment. \$___ ___,___ ___ ___ E15. Pension, benefits or social security Include disability, pensions, retirement, veteran’s benefits, SSI & workers’ compensation. \$___ ___,___ ___ ___ E16. Mate, family or friends Money for personal expenses (i.e., clothing); include unreliable sources of income. Record cash payments only, include windfalls (unexpected), money from loans, legal gambling, inheritance, tax returns, etc. \$___ ___,___ ___ ___ E17. Illegal Cash obtained from drug dealing, stealing, fencing stolen goods, illegal gambling, prostitution, etc. Do not attempt to convert drugs exchanged to a dollar value. \$___ ___,___ ___ ___ E18. How many people depend on you for the majority of their food, shelter, etc.? ___ ___ Must be regularly depending on patient; do include alimony/child support, do not include the patient or self-supporting spouse, etc. E19. How many days have you experienced employment problems in the past 30? ___ ___ Include inability to find work, if they are actively looking for work, or problems with present job in which that job is jeopardized. For Questions E20 & E21, ask patient to use the Patient Rating Scale E20. How troubled or bothered have you been by these employment problems in the past 30 days? If the patient has been incarcerated or detained during the past 30 days, they cannot have employment problems.In that case, code -8. ___ E21. How important to you now is counseling for these employment problems? Stress help in finding or preparing a job, not giving them a job. ___ CONFIDENCE RATINGS Is the above information significantly distorted by: E23. Client’s misrepresentation? 0 - No 1 - Yes ___ E24. Client’s inability to understand? 0 - No 1 - Yes ___ ALCOHOL/DRUGS Route of Administration Types: 1 - Oral 2 - Nasal 3 - Smoking4 - Non-IV injection 5 - IV Note the usual or most recent route.For more than one route, choose the most severe.The routes are listed from least severe to most severe. A. Past 30 Days B. Lifetime (Years) C. Route of Admin D1. Alcohol (any use at all) ___ ___ ___ ___ D2. Alcohol (to intoxication) ___ ___ ___ ___ D3. Heroin ___ ___ ___ ___ ___ D4. Methadone ___ ___ ___ ___ ___ D5. Other Opiates/Analgesics ___ ___ ___ ___ ___ D6. Barbiturates ___ ___ ___ ___ ___ D7. Other Sedatives/Hypnotics/ Tranquilizers ___ ___ ___ ___ ___ D8. Cocaine ___ ___ ___ ___ ___ D9. Amphetamines ___ ___ ___ ___ ___ D10. Cannabis ___ ___ ___ ___ ___ D11. Hallucinogens ___ ___ ___ ___ ___ D12. Inhalants ___ ___ ___ ___ ___ D13. More than one substance per day Including alcohol ___ ___ ___ ___ D15.How long was your last period of voluntary abstinence from this major substance? ___ ___ MOS Last attempt of at least one month, not necessarily the longest.Periods of hospitalization/incarceration do not count.Periods of antabuse, methadone, or naltrexone use during abstinence do count. 00 = never abstinent D16. How many months ago did this abstinence end? If D15 = 0, then D16 = -8, 00 = Still abstinent ___ ___ MOS ALCOHOL/DRUGS COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ D14. ___ ___ According to the interviewer, which substance is/are the major problem? Interviewer should determine the major drug or drugs of abuse. Code the number next to the drug in questions D1-D12, or: 00 = no problem 15 = alcohol & one or more drugs 16 = more than one drugs but no alcohol. Ask patient when not clear. ALCOHOL/DRUG COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ INTERVIEWER SEVERITY RATING How would you rate the patient’s need for treatment for: D32. Alcohol problems___ D33. Drug problems___ How many times in your life have you been treated for: D19.* Alcohol abuse? ___ ___ D20.* Drug abuse? ___ ___ Include detoxification, halfway houses, in/outpatient counseling, and AA or NA (if 3+ meetings within one month period). How many of these were detox only? D21.* Alcohol? If D19 = 0, then D21 = -8 ___ ___ D22.* Drugs? If D20 = 0, then D22 = -8 ___ ___ How much money would you say you spent during the past 30 days on: D23. Alcohol? \$___ ___,___ ___ ___ D24. Drugs? \$___ ___,___ ___ ___ Only count actual money spent.What is the financial burden caused by drugs/alcohol? D25. How many days have you been treated in an outpatient setting for alcohol or drugs in the past 30 days? Include AA/NA ___ ___ How many days in the past 30 have you experienced: D26. Alcohol problems? ___ ___ D27. Drug problems? ___ ___ Include craving, withdrawal symptoms, disturbing effects of use, or wanting to stop and being unable to. For Questions D28 - D31, ask patient to use the Patient Rating Scale How troubled or bothered have you been in the past 30 days by these: D28. Alcohol problems ___ D29. Drug problems ___ How important to you now is treatment for these: D30. Alcohol problems___ D31. Drug problems___ CONFIDENCE RATINGS Is the above information significantly distorted by: D34. Client’s misrepresentation? 0 - No 1 - Yes ___ D35. Client’s inability to understand? 0 - No 1 - Yes ___ D17.* How many times have you had Alcohol D.T.’s? Delirium Tremems (DTs): Occur 24-48 hours after last drink, or significant decrease in alcohol intake, shaking, severe disorientation, fever, hallucinations, they usually require medical attention. ___ ___ D18.* How many times have you overdosed on drugs? Overdoses (OD):Require requires intervention by someone to recover, not simply sleeping it off, include suicide attempts by OD. ___ ___ ALCOHOL/DRUGS (cont) How many times in your life have you been arrested and charged with the following? L3. * Shoplifting/Vandalism___ ___ L4. * Parole/Probation Violations ___ ___ L5. * Drug Charges ___ ___ L6. * Forgery ___ ___ L7. * Weapons Offense ___ ___ L8. * Burglary/Larceny/Breaking & Entering ___ ___ L9. * Robbery ___ ___ L10. * Assault ___ ___ L11. * Arson ___ ___ L12. * Rape ___ ___ L13. * Homicide/Manslaughter ___ ___ L14. * Prostitution ___ ___ L15. * Contempt of Court ___ ___ L16. * Other: ___________________________________ ___ ___ Include total number of counts, not just convictions. Do not include juvenile (pre-age 18) crimes, unless they were tried as an adult. Include formal charges only. L17.* How many of these charges resulted in convictions? ___ ___ If L3-16 = 00, then Question L17 = -8. Do not include misdemeanor offenses from questions L18-20 below. Convictions include fines, probation, incarcerations, suspended sentences, guilty please, and plea bargaining. LEGAL STATUS L1. Was this admission prompted or suggested by the criminal justice system? 0 - No 1 - Yes ___ Judge, probation/parole officer, etc. LEGAL COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ L2. Are you on probation or parole? 0 - No 1 - Yes___ Note duration and level in comments. How many times in your life have you been charged with the following: L18. * Disorderly conduct, vagrancy, public intoxication ___ ___ L19. * Driving while intoxicated ___ ___ L20. * Major driving violations Moving violations:speeding, reckless driving, no license, etc. ___ ___ L21. * How many months were you incarcerated in your life? If incarcerated 2 weeks or more, round this up to 1 month. List total number of months incarcerated. ___ ___ MOS L22. How long was your last incarceration? Of 2 weeks or more. Code -8 if never incarcerated. ___ ___ MOS L23. What was it for? Use codes 03–16, 18–20 If multiple charges, code most severe.Code -8 if never incarcerated. ___ ___ L24. Are you presently awaiting charges, trial, or sentence? 0 - No 1 - Yes ___ L25. What for? ___ ___ Refers to Question L24.Use the number of the type of crime committed:03-16 and 18-20.If multiple charges, code most severe. LEGAL COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ INTERVIEWER SEVERITY RATING L30. How would you rate the patient’s need for legal services or counseling? ___ L26. How many days in the past 30 were you detained or incarcerated? Include being arrested and released on the same day. ___ ___ LEGAL STATUS (cont) L27. How many days in the past 30 have you engaged in illegal activities for profit? ___ ___ Exclude simple drug possession.Include drug dealing, prostitution, selling stolen goods, etc.May be cross-checked with E17 under Employment section. For Questions L28 & L29, ask patient to use the Patient Rating Scale L28. How serious do you feel your present legal problems are? Exclude civil problems. ___ L29. How important to you now is counseling or referral for these legal problems? Patient is rating a need for additional referral to legal counsel for defense against criminal charges. ___ CONFIDENCE RATINGS Is the above information significantly distorted by: L31. Client’s misrepresentation? 0 - No 1 - Yes ___ L32. Client’s inability to understand? 0 - No 1 - Yes ___ FAMILY HISTORY COMMENTS (Include the question number with your notes) ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________ FAMILY HISTORY Have any of your blood-related relatives had what you would call a significant drinking, drug use or psychiatric problem? Specifically, was there a problem that did or should have led to treatment? 0 - Clearly NO for all relatives in the category 1 - Clearly YES for any relative within category -9 - Uncertain or don’t know -8 - Never was a relative In cases where there is more than one person for a category, record the occurrence of problems for any in that group. Accept the patient’s judgment on these questions. Mother’s Side Alc Drug PsychFather’s Side Alc Drug PsychSiblings Alc Drug Psych H1. Grandmother ___ ___ ___H6. Grandmother ___ ___ ___H11. Brother ___ ___ ___ H2. Grandfather ___ ___ ___H7. Grandfather ___ ___ ___H12. Sister ___ ___ ___ H3. Mother ___ ___ ___H8. Father ___ ___ ___ H4. Aunt ___ ___ ___H9. Aunt ___ ___ ___ H5. Uncle ___ ___ ___H10. Uncle ___ ___ ___ FAMILY/SOCIAL RELATIONSHIPS F1. Marital Status___ 1 - Married 4 - Separated 2 - Remarried 5 - Divorced 3 - Widowed 6 - Never married Common-law marriage = 1.Specify in comments. F2. How long have you been in this marital status? Refers to F1. If never married, then since age 18. __ __ / __ __ YRS MOS F3. Are you satisfied with this situation? 0 - No 1 - Indifferent 2 - Yes Satisfied=client generally liking the situation. Refers to F1 and F2. ___ FAMILY/SOCIAL COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ F4. * Usual living arrangements (past 3 years)___ 1 - With sexual partner & children 6 - With friends 2 - With sexual partner alone 7 - Alone 3 - With children alone 8 - Controlled environment 4 - With parents 9 - No stable arrangement 5 - With family Choose arrangements most representative of the past 3 years.If there is an even split in time between these arrangements, choose the most recent arrangement. F5. How long have you lived in these arrangements? If with parents or family, since age 18. Code years and months living in arrangements from F4. __ __ / __ __ YRSMOS F6. Are you satisfied with these arrangements? 0 - No 1 - Indifferent 2 - Yes ___ Do you live with anyone who: F7. Has a current alcohol problem? 0 - No 1 - Yes ___ F8. Uses non-prescribed drugs? 0 - No 1 - Yes Or abuses prescribed drugs ___ Would you say you have had a close reciprocal relationship with any of the following people: F12. Mother___ F13. Father___ F14. Brothers/Sisters___ F15. Sexual Partner/Spouse___ F16. Children___ F17. Friends___ 0 - Clearly NO for all in class-9 - Uncertain or “I don’t know” 1 - Clearly YES for any in class-8 - Never was a relative By reciprocal, you mean “that you would do anything you could to help them out and vice versa.” F9. With whom do you spend most of your free time? 1 - Family 2 - Friends 3 - Alone ___ If a girlfriend/boyfriend is considered as family by patient, then they must refer to them as family throughout this section, not a friend. F10. Are you satisfied with spending your free time this way? 0 - No 1 - Indifferent 2 - Yes ___ A satisfied response must indicate that the person generally likes the situation. Refers to F9. F11. How many close friends do you have? Stress that you mean close. Exclude family members. These are “reciprocal” relationships or mutually supportive relationships. ___ FAMILY/SOCIAL COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ Has anyone ever abused you? 0 - No 1 - Yes Past 30 Days In Your Life F27. Emotionally? Make you feel bad through harsh words ___ ___ F28. Physically? Caused you physical harm ___ ___ F29. Sexually? Force sexual advances/acts ___ ___ INTERVIEWER SEVERITY RATING F36. How would you rate the patient’s need for family and/ or social counseling? ___ FAMILY/SOCIAL RELATIONSHIPS (cont) Have you had significant periods in which you have experienced serious problems getting along with: 0 - No 1 - Yes Past 30 Days In Your Life F18. Mother ___ ___ F19. Father ___ ___ F20. Brothers/Sisters ___ ___ F21. Sexual Partner/Spouse ___ ___ F22. Children ___ ___ F23. Other significant family ___ ___ Specify: _______________________ F24. Close Friends ___ ___ F25. Neighbors ___ ___ F26. Co-Workers ___ ___ “Serious problems” mean those that endangered the relationship. A “problem” requires contact of some sort, either by telephone or in person. If no contact, code -8. How many days in the past 30 have you had serious conflicts: F30. With your family? ___ ___ F31. With other people? (excluding family) ___ ___ For Questions F32 - F35, ask patient to use the Patient Rating Scale How troubled or bothered have you been in the past 30 days by: F32. Family problems ___ F33. Social problems ___ How important to you now is treatment or counseling for these: F34. Family problems Patient is rating his/her need for counseling for family problems, not whether they would be willing to attend. ___ F35. Social problems Include patient’s need to seek treatment for such social problems as loneliness, inability to socialize, and dissatisfaction with friends. Patient rating should refer to dissatisfaction, conflicts, or other serious problems. ___ CONFIDENCE RATINGS Is the above information significantly distorted by: F37. Client’s misrepresentation? 0 - No 1 - Yes ___ F38. Client’s inability to understand? 0 - No 1 - Yes ___ PSYCHIATRIC STATUS COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ PSYCHIATRIC STATUS How many times have you been treated for any psychological or emotional problems: P1. * In a hospital or inpatient setting? ___ ___ P2. * Outpatient/private patient? ___ ___ Do not include substance abuse, employment, or family counseling.Treatment episode = a series of more or less continuous visits or treatment days, not the number of visits or treatment days. Enter diagnosis in comments if known. P3. Do you receive a pension for a psychiatric disability? 0 - No 1 - Yes___ P12. How many days in the past 30 have you experienced these psychological or emotional problems? Refers to problems noted in Questions P4-P10. ___ ___ For Questions P13 & P14, ask the patient to use the Patient Rating Scale P13. How much have you been troubled or bothered by these psychological or emotional problems in the past 30 days? Patient should be rating the problem days from Question P12. ___ P14. How important to you now is treatment for these psychological problems? ___ Have you had a significant period of time (that was not a direct result of drug/alcohol use) in which you have: 0 - No 1 - Yes Past 30 Days In Your Life P4. Experienced serious depression Sadness, hopelessness, loss of interest, difficulty with daily functioning ___ ___ P5. Experienced serious anxiety or tension Uptight, unreasonably worried, inability to feel relaxed ___ ___ P6. Experienced hallucinations Saw things/heard voices that others didn’t see/hear ___ ___ P7. Experienced trouble understanding, concentrating or remembering ___ ___ P8. Experienced trouble controlling violent behavior including episodes or rage or violence Patient can be under the influence of alcohol/drugs. ___ ___ P9. Experienced serious thoughts of suicide Patient seriously considered a plan for taking his/ her life. Patient can be under the influence of alcohol/drugs. ___ ___ P10. Attempted suicide Include actual suicidal gestures or attempts. Patient can be under the influence of alcohol / drugs. ___ ___ P11. Been prescribed medication for any psychological or emotional problems Prescribed for the patient by a physician.Record “Yes” if a medication was prescribed even if the patient is not taking it. ___ ___ PSYCHIATRIC STATUS COMMENTS (Include the question number with your notes) ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ ______________________________________________________ INTERVIEWER SEVERITY RATING P21. How would you rate the patient’s need for psychiatric/ psychological treatment? ___ The following items are to be completed by the interviewer: At the time of the interview, the patient was:0 - No 1 - Yes P15. Obviously depressed/withdrawn___ P16. Obviously hostile___ P17. Obviously anxious/nervous___ P18. Having trouble with reality testing, thought disorders, paranoid thinking___ P19. Having trouble comprehending, concentrating, remembering___ P20. Having suicidal thoughts___ PSYCHIATRIC STATUS (cont) CONFIDENCE RATINGS Is the above information significantly distorted by: P22. Client’s misrepresentation? 0 - No 1 - Yes ___ P23. 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NovoPsych
Spence Children’s Anxiety Scale – Child (SCAS-
Child)
Instructions:
Please tap to button to show how often each of these things happen to you. There are no
right or wrong answers.
Never Sometimes Often Always
1 I worry about things 0 1 2 3
2 I am scared of the dark 0 1 2 3
3
When I have a problem, I get a
funny feeling in my stomach
0 1 2 3
4 I feel afraid 0 1 2 3
5
I would feel afraid of being on my
own at home
0 1 2 3
6
I feel scared when I have to take a
test
0 1 2 3
7
I feel afraid if I have to use public
toilets or bathrooms
0 1 2 3
8
I worry about being away from my
parents
0 1 2 3
9
I feel afraid that I will make a fool of
myself in front of people
0 1 2 3
10
I worry that I will do badly at my
school work
0 1 2 3
11
I am popular amongst other kids my
own age
0 1 2 3
12
I worry that something awful will
happen to someone in my family
0 1 2 3
13
I suddenly feel as if I can’t breathe
when there is no reason for this
0 1 2 3
14
I have to keep checking that I have done
things right (like the switch is off, or the
door is locked)
0 1 2 3
15
I feel scared if I have to sleep on my
own
0 1 2 3
16
I have trouble going to school in the
mornings because I feel nervous or
afraid
0 1 2 3
Page 1 of 3
NovoPsych
Never Sometimes Often Always
17 I am good at sports 0 1 2 3
18 I am scared of dogs 0 1 2 3
19
I can’t seem to get bad or silly
thoughts out of my head
0 1 2 3
20
When I have a problem, my heart
beats really fast
0 1 2 3
21
I suddenly start to tremble or shake
when there is no reason for this
0 1 2 3
22
I worry that something bad will
happen to me
0 1 2 3
23
I am scared of going to the doctors
or dentists
0 1 2 3
24 When I have a problem, I feel shaky 0 1 2 3
25
I am scared of being in high places
or lifts (elevators)
0 1 2 3
26 I am a good person 0 1 2 3
27
I have to think of special thoughts to stop
bad things from happening (like numbers
or words)
0 1 2 3
28
I feel scared if I have to travel in the
car, or on a Bus or a train
0 1 2 3
29
I worry what other people think of
me
0 1 2 3
30
I am afraid of being in crowded places
(like shopping centres, the movies,
buses, busy playgrounds)
0 1 2 3
31 I feel happy 0 1 2 3
32
All of a sudden I feel really scared
for no reason at all
0 1 2 3
33 I am scared of insects or spiders 0 1 2 3
34
I suddenly become dizzy or faint
when there is no reason for this
0 1 2 3
35
I feel afraid if I have to talk in front of
my class
0 1 2 3
36
My heart suddenly starts to beat too
quickly for no reason
0 1 2 3
Page 2 of 3
NovoPsych
Never Sometimes Often Always
37
I worry that I will suddenly get a scared
feeling when there is nothing to be afraid
of
0 1 2 3
38 I like myself 0 1 2 3
39
I am afraid of being in small closed
places, like tunnels or small rooms
0 1 2 3
40
I have to do some things over and over
again (like washing my hands, cleaning
or putting things in a certain order)
0 1 2 3
41
I get bothered by bad or silly
thoughts or pictures in my mind
0 1 2 3
42
I have to do some things in just the right
way to stop bad things
happening
0 1 2 3
43 I am proud of my school work 0 1 2 3
44
I would feel scared if I had to stay
away from home overnight
0 1 2 3
45 Is there something else that you are really afraid of?
0Yes
0No
46 If you are afraid of something else please write down what it is. How often are you afraid of this thing?
Developer Reference:
Spence, S.H. (1997). Structure of anxiety symptoms among children: A confirmatory factor-
analytic study. Journal of Abnormal Psychology, 106(2), 280-297.
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