Ohio Youth Problem, Functioning, and Satisfaction Scales - P - Monarch Therapeutic Services, LLC Transforms Distress Into Hope

OHIO YOUTH PROBLEM, FUNCTIONING AND SATISFACTION SCALES - P

Ohio Youth Problem, Functioning and Satisfaction Scales - P Parent Rating - Short Form

* Indicates required field

Full Name of Client *

First

Last

Client's Date of Birth (MM/DD/YYYY) *

Please rate the degree to which your child has experienced the following problems in the past 30 days.

Arguing with others *

Can't seem to sit still, having too much energy *

Getting into fights *

Hurting self (cutting or scratching self, taking pills) *

Yelling, swearing, or screaming at others *

Talking or thinking about death *

Fits of anger *

Feeling worthless or useless *

Refusing to do things teachers or parents ask *

Feeling lonely and having no friends *

Causing trouble for no reason *

Feeling anxious or fearful *

Using drugs or alcohol *

Worrying that something bad is going to happen *

Breaking rules or breaking the law (out past curfew, stealing) *

Feeling sad or depressed *

Skipping school or classes *

Nightmares *

Lying *

Eating Problems *

Section 2: Please rate the degree to which your child's problems affect his or her current ability in everyday activities. Consider your child's current level of functioning.

Getting along with friends *

Completing household chores (cleaning rooms, other chores) *

Getting along with family *

Attending school and getting passing grades in school *

Dating or developing relationships with boyfriends or girlfriends *

Learning skills that will be useful for future jobs *

Getting along with adults outside the family (teachers, principal) *

Feeling good about self *

Keeping neat and clean, looking good *

Thinking clearly and making good decisions *

Caring for health needs and keeping good health habits (taking medicines or brushing teeth) *

Concentrating, paying attention, and completing tasks *

Controlling emotions and staying out of trouble *

Earning money and learning how to use money wisely *

Being motivated and finishing projects *

Doing things without supervision or restrictions *

Participating in hobbies (baseball cards, coins, stamps, art) *

Accepting responsibility for actions *

Participating in recreational activities (sports, swimming, bike riding) *

Ability to express feelings *

Section 3a - Please select your response to each question

Section 3b - Please select your response to each question

Overall, how satisfied are you with your relationship with your child right now? *

How satisfied are you with the mental health services your child has received so far? *

How capable of dealing with your child's problems do you feel right now *

To what degree have you been included in the treatment planning process for your child? *

How much stress or pressure is in your life right now? *

Mental health workers involved in my case listen to and value my ideas about treatment planning for my child. *

How optimistic are you about your child's future right now? *

To what extent does your child's treatment plan include your ideas about your child's treatment needs? *

Name of Monarch Staff/Clinician *

Date of Assessment (MM/DD/YYYY) *

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