Youth Outcome Form

IMPORTANT-PLEASE READ THIS FIRST.

These questions are about how you have been feeling OVER THE LAST WEEK. Please read each question carefully. Think how often you have felt like that in the last week and then mark the box you think fits best.

Site ID


Stage Completed

F= First Therapy Session, D= During Therapy, L= Last Therapy Session

Client ID

Session Number


(First Therapy Session=001)

Date Completed

Over the last week

1. I have felt edgy or nervous

0 Not at all1 Only Occasionally2 Sometimes3 Often4 Most or all the time

2. I haven't felt like talking to anyone

0 Not at all1 Only Occasionally2 Sometimes3 Often4 Most or all the time

3. I have felt able to cope when things went wrong

0 Not at all1 Only Occasionally2 Sometimes3 Often4 Most or all the time

4. I have thought of hurting myself

0 Not at all1 Only Occasionally2 Sometimes3 Often4 Most or all the time

5. There's been someone I felt able to ask for help

0 Not at all1 Only Occasionally2 Sometimes3 Often4 Most or all the time

6. My thoughts and feelings distressed me

0 Not at all1 Only Occasionally2 Sometimes3 Often4 Most or all the time

7. My problems have felt too much for me

0 Not at all1 Only Occasionally2 Sometimes3 Often4 Most or all the time

8. It's been hard to go to sleep or stay asleep

0 Not at all1 Only Occasionally2 Sometimes3 Often4 Most or all the time

9. I have felt unhappy

0 Not at all1 Only Occasionally2 Sometimes3 Often4 Most or all the time

10. I have done all the things I wanted to

0 Not at all1 Only Occasionally2 Sometimes3 Often4 Most or all the time