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Title | Description | Category |
|---|---|---|
Reach Out and Read | Gathers demographic information, and information about activities, and media use | Mental Health - Family/Environment |
Relational Self-Schema Measure - RSSM | A personality measure that assesses how one experiences the self when with different significant others. After naming a range of friends, relatives and colleagues, the respondent is asked to imagine being with each person and then to rate how they feel about themselves. | Adolescent Self-Administered |
Resilience Builders Group Encounter | This measure is used for program evaluation and modification for the Resilience Builder program. It is a self-report measure designed to provide a snapshot of the child's state of mind on a given day on factors related to resilience. | General Medical - Adult |
Review of Systems | General Medical Care Assessment form | General Medical - Data Collection |
Revised Child Anxiety and Depression Scale | The Revised Child Anxiety and Depression Scale (RCADS) is a 47-item, youth self-report questionnaire | Mental Health - Anxiety - Mental Health - Depression/Mood Disorders/Suicide |
Revised Child Anxiety and Depression Scale – Parent Version | Revised Child Anxiety and Depression Scale – Parent Version (RCADS-P) assesses parent report of youth’s symptoms of anxiety and depression. | Mental Health - Anxiety - Mental Health - Depression/Mood Disorders/Suicide |
Revised Dyadic Adjustment Scale | A 14 item tool to assess the quality of marital relationships. | Mental Health - Family/Environment |
Safety (Ages 0-11 Years) | Items assessing safety concerns (e.g. safety in the home, gun safety, water safety) as recommended by AAP's Bright Futures Guidelines. | General Medical - Bright Futures Compliant |
Safety Checklist: 1 Week through 10.5 Months | The Safety Checklists and Safety Guidance are based on AAP’s Bright Futures Guidelines (4th edition), published in 2017, and updated with more recent information. | General Medical - Safety - Bright Futures Compliant |
Safety Checklist: 10.5 Months through 4 Years | The Safety Checklists and Safety Guidance are based on AAP’s Bright Futures Guidelines (4th edition), published in 2017, and updated with more recent information. | General Medical - Safety - Bright Futures Compliant |
Safety Checklist: 5-10 Years | The Safety Checklists and Safety Guidance are based on AAP’s Bright Futures Guidelines (4th edition), published in 2017, and updated with more recent information. | General Medical - Safety - Bright Futures Compliant |
Safety Checklist: 7-10 Years (Youth) | The Safety Checklists and Safety Guidance are based on AAP’s Bright Futures Guidelines (4th edition), published in 2017, and updated with more recent information. | General Medical - Safety - Bright Futures Compliant |
Safety Checklist: 11-17 Years (Parent/Guardian) | The Safety Checklists and Safety Guidance are based on AAP’s Bright Futures Guidelines (4th edition), published in 2017, and updated with more recent information. | General Medical - Safety - Bright Futures Compliant |
Safety Checklist: 11-17 Years (Youth Report) | The Safety Checklists and Safety Guidance are based on AAP’s Bright Futures Guidelines (4th edition), published in 2017, and updated with more recent information. | General Medical - Safety - Bright Futures Compliant |
Safety Checklist: 18-21 Years Young Adult | The Safety Checklists and Safety Guidance are based on AAP’s Bright Futures Guidelines (4th edition), published in 2017, and updated with more recent information. | General Medical - Safety - Bright Futures Compliant |
Safety Checklist: Newborn | The Safety Checklists and Safety Guidance are based on AAP’s Bright Futures Guidelines (4th edition), published in 2017, and updated with more recent information. | General Medical - Safety - Bright Futures Compliant |
Safety Checklist: Prenatal | The Safety Checklists and Safety Guidance are based on AAP’s Bright Futures Guidelines (4th edition), published in 2017, and updated with more recent information. | General Medical - Safety - Bright Futures Compliant |
School Intervention Questionnaire | 8 item questionnaire designed for teacher feedback regarding services provided and disciplinary actions taken. | Educator/Teacher Administered |
School Intervention Questionnaire - Long Form | Gathers information about children and their learning environment. | Educator/Teacher Administered |
SCOFF | SCOFF is a simple tool for eating disorders, with questions designed to raise the suspicion that an eating disorder might exist before rigorous clinical assessment. | Mental Health - Eating Disorders |
Screen for Adult Anxiety Related Disorders (SCAARED) | 44-item questionnaire assessing self-report of anxiety in adults. | Mental Health - Anxiety |
Screen for Child Anxiety Related Disorders (SCARED) Child Version (To be filled out by the CHILD) | 41-item questionnaire assessing self-report of anxiety in children and adolescents | Mental Health - Teen Administered |
Screen for Child Anxiety Related Disorders (SCARED) Parent Version (To be filled out by the PARENT) | 41-item questionnaire assessing anxiety in children and adolescents | Mental Health - Anxiety |
Screening Checklist for Contraindications to Vaccines for Adults | Inquires about current infections, recent vaccinations, allergies, and other contraindications. | General Medical - Vaccine Information/Consent |
Screening Checklist for Contraindications to Vaccines for Children and Teens | Inquires about current infections, recent vaccinations, allergies, and other contraindications. | General Medical - Vaccine Information/Consent |
SEEK - PQ-R (Parent Questionnaire) | Screener for emotional/behavioral problems in young children, with additional items assessing parent emotional functioning. | General Medical - Social Determinants of Health |
SEEK Parent Questionnaire-Re (with firearms and SDoH questions) | A short questionnaire about problems that affect many families that can affect the safety of their children. | General Medical - Social Determinants of Health |
SEEK Parent Questionnaire-Re Plus Followups (with firearms and SDoH questions) | Screener for emotional/behavioral problems in young children, with additional items assessing parent emotional functioning. Includes follow up questions to help with addressing barriers. | General Medical - Social Determinants of Health |
SEEK - Safe Environment for Every Kid (SEEK) | A tool used to screen for parental depression, alcohol and substance abuse, domestic violence, major stress, and food insecurity | General Medical - Social Determinants of Health |
Self-Description Inventory | Self report tool for adults and children 8th grade or above that designed to measure the possession of basic emotional and social communication skills. | Mental Health - Social Skills |
Service Follow Up Questionnaire | Brief questionnaire can be scheduled at intervals after a referral to Infants and Toddlers to find out if the parent attended an evaluation for their child <3 years with developmental or autism concerns and what impression was determined. | |
Service Provider Questionnaire | This questionnaire is used to collect data from professionals about the status of a referral made to them. It is not intended for use with patients. | Quality Monitoring/Satisfaction |
Session Alliance Inventory (Patient Version) | A brief survey regarding the patient's experiences with the therapist. | Quality Monitoring/Satisfaction |
Sexuality and Gender Questionnaire | Questionnaire for Youth and Young Adults about Sexuality Health Practices and Gender identity. | General Medical - General |
Social and Communication Disorders Checklist - Parent | A 12-item screening tool for social and communication disorders | Development - Autism Screening |
Social and Communication Disorders Checklist - Teacher | A 12-item screening tool for social and communication disorders | Educator/Teacher Administered |
Social Communication Questionnaire (Current) Copyright © 2003 Western Psychological Services* | A screening instrument to help identify which children may have an Autism Spectrum
Disorder. | Development - Autism Screening |
Social Communication Questionnaire (Lifetime) Copyright © 2003 Western Psychological Services* | The Social Communication Questionnaire, previously known as the Autism Screening Questionnaire (ASQ), is available in two forms, Lifetime and Current. Scores provide an index of symptom severity and indicate the likelihood that a child has an ASD. | Development - Autism Screening |
Social Health Questionnaire | Questionnaire evaluates the patient's social determinants of health | General Medical - Social Determinants of Health |
Social Responsiveness Scale™, Second Edition - Preschool (SRS-2)* | Identifies the presence and severity of social impairment within the autism spectrum and differentiates it from that which occurs in other disorders | Development - Autism Screening |
Social Responsiveness Scale™, Second Edition - School Age, Parent Respondent (SRS-2)* | Identifies the presence and severity of social impairment within the autism spectrum and differentiates it from that which occurs in other disorders. | Development - Autism Screening |
Social Responsiveness Scale™, Second Edition - School Age, Teacher Respondent (SRS-2)* | Identifies the presence and severity of social impairment within the autism spectrum and differentiates it from that which occurs in other disorders. | Educator/Teacher Administered |
Social Skills Inventory | The SSI is a 90-item self report tool for adults and children 8th grade or above that designed to measure the possession of basic emotional and social communication skills. | Mental Health - Social Skills |
Spence Preschool Anxiety Scale - Parent Report | A 28 item tool that provides an indication of the number and severity of anxiety symptoms. | Mental Health - Anxiety |
Sport Concussion Assessment Tool ™ - 6 Immediate Assessment /Neuro Screen | Sport Concussion Assessment Tool ™ - 6 is a standardized tool for evaluating injured athletes for concussion and can be used in athletes aged from 13 years and older. | Clinician Tools |
Sport Concussion Assessment Tool ™ - 6 Off-Field Assessment | Sport Concussion Assessment Tool ™ - 6 is a standardized tool for evaluating injured athletes for concussion and can be used in athletes aged from 13 years and older. | Clinician Tools |
Sport Concussion Assessment Tool ™ - 6 Child Immediate Assessment /Neuro Screen | Child Sport Concussion Assessment Tool ™ - 6 is a standardized tool for evaluating injured athletes for concussion and can be used in athletes aged from 12 years and younger. | Clinician Tools |
Sport Concussion Assessment Tool ™ - 6 Athlete Information and Concussion History | Sport Concussion Assessment Tool ™ - 6 is a standardized tool for evaluating injured athletes for concussion and can be used in athletes aged from 13 years and older. | Clinician Tools |
Sport Concussion Assessment Tool ™ - 6 Child Athlete Information and Concussion History | Child Sport Concussion Assessment Tool ™ - 6 is a standardized tool for evaluating injured athletes for concussion and can be used in athletes aged from 12 years and younger. | Clinician Tools |
Sport Concussion Assessment Tool ™ - 6 Child Off-Field Assessment | Child Sport Concussion Assessment Tool ™ - 6 is a standardized tool for evaluating injured athletes for concussion and can be used in athletes aged from 12 years and younger. | Clinician Tools |
Sport Concussion Assessment Tool - 3rd edition: Clinician tool for patients 13 years and older | A tool to assist in the evaluation of injured athletes for concussion. | Clinician Tools |
Sport Concussion Assessment Tool - 3rd edition: Clinician tool for patients 5 to 12 years old | The Child SCAT3 is a standardized tool for evaluating injured athletes for concussion and can be used in athletes aged from 5-12 years of age. | Clinician Tools |
Sport Concussion Assessment Tool - 3rd edition: Parent symptom evaluation for patients 5 to 12 years old | A tool to assist in the evaluation of injured athletes for concussion. | General Medical - Sports |
Sport Concussion Assessment Tool - 3rd edition: Self administered background and symptom evaluation for patients 13 years and older | A tool to assist in the evaluation of injured athletes for concussion. | General Medical - Sports |
Sport Concussion Assessment Tool - 3rd edition: Self administered symptom evaluation for patients 5 to 12 years old | A tool to assist in the evaluation of injured athletes for concussion. | General Medical - Sports |
Sport Concussion Assessment Tool 2: Symptom Evaluation | A tool to assist in the evaluation of injured athletes for concussion. | General Medical - Sports |
Sports Participation Questionnaire | A clinical tool consisting of a physical examination for participation in sports. | General Medical - Sports |
Sports Participation Questionnaire (Illinois) | A clinical tool consisting of a physical examination for participation in sports. | Clinician Tools |
Sports Physical Clinical Tool | A clinical tool consisting of a physical examination for participation in sports. | Clinician Tools |
STEADI Questionnaire - Stopping Elderly Accidents Deaths & Injuries | Part of the Medicare Falls Assessment - A 12 item validated fall risk self-assessment tool. | General Medical - Adult |
Strengths and Difficulties Questionnaire (SDQ) Parent Version, Ages 11-17* | Assesses general emotional behavioral functioning across 5 domains: emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior | Mental Health - Teen/Parent Administered |
Strengths and Difficulties Questionnaire (SDQ) Parent Version, Ages 3-4* | Assesses general emotional behavioral functioning across 5 domains: emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior | Mental Health - Preschool Screeners |
Strengths and Difficulties Questionnaire (SDQ) Self Report Version* | Assesses general emotional behavioral functioning across 5 domains: emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior | Mental Health - Teen Administered |
Strengths and Difficulties Questionnaire (SDQ) Teacher Version (3-4; 4-10; 11-17)* | Assesses general emotional behavioral functioning across 5 domains: emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior | Educator/Teacher Administered |
Strengths and Difficulties Questionnaire Functional Assessment: Child Follow-Up for Ages 11 and up* | Assesses difficulties with emotions, concentration, behavior, and social skills that may affect the child and family. | Mental Health - Teen Administered |
Strengths and Difficulties Questionnaire Functional Assessment: Child Initial for Ages 11 and up* | Assesses difficulties with emotions, concentration, behavior, and social skills that may affect the child and family. | Mental Health - Teen Administered |
Strengths and Difficulties Questionnaire Functional Assessment: Parent Follow-Up* | Brief parent-report follow-up questionnaire for parents of children ages 2-4. Assesses difficulties with children's emotions, concentration, behavior, and social skills that may affect the child and family. | Mental Health - Preschool Screeners |
Strengths and Difficulties Questionnaire Functional Assessment: Parent Follow-Up for Ages 4+* | Brief parent-report follow-up questionnaire. Assesses difficulties with children's emotions, concentration, behavior, and social skills that may affect the child and family. | Mental Health - Preschool Screeners |
Strengths and Difficulties Questionnaire Functional Assessment: Parent Initial* | Brief parent-report questionnaire for parents of children ages 0-3. Assesses difficulties with children's emotions, concentration, behavior, and social skills that may affect the child and family. | Mental Health - Preschool Screeners |
Strengths and Difficulties Questionnaire Functional Assessment: Parent Version for Ages 4-10* | Brief parent-report follow-up questionnaire. Assesses difficulties with children's emotions, concentration, behavior, and social skills that may affect the child and family. | Mental Health - School Aged Screeners |
Strengths and Difficulties Questionnaire Parent Version for Ages 4-10 (SDQ Parent: Age 4-10)* | Assesses general emotional behavioral functioning across 5 domains: emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior | Mental Health - School Aged Screeners |
Strengths and Difficulties Questionnaire (SDQ) Teacher Version for ages 2-4 (SDQ Teacher: Age 2-4)* | Assesses general emotional behavioral functioning across 5 domains: emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior | Educator/Teacher Administered |
Strengths and Difficulties Questionnaire (SDQ) Teacher Version for ages 4-10 (SDQ Teacher: Age 4-10)* | Assesses general emotional behavioral functioning across 5 domains: emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior | Educator/Teacher Administered |
Strengths and Difficulties Questionnaire (SDQ) Teacher Version for ages 11-17 (SDQ Teacher: Age 11-17)* | Assesses general emotional behavioral functioning across 5 domains: emotional symptoms, conduct problems, hyperactivity, peer problems, and prosocial behavior | Educator/Teacher Administered |
SWYC - Survey of Well-being of Young Children V1.07 | A set of screening tools including developmental milestones, pediatric symptoms, social interaction, parental concerns, and family risk. (1-3 months through 59-65 months) | Development - Screening |
Teacher's Report Form for Ages 6-18 (TRF 6-18)* | A tool to assess behavioral issues in wide range of domains including school, social, activities, depression, anxiety, somatic complaints, ADHD, defiance, and conduct.Completed by teachers and other school staff. | Educator/Teacher Administered |
Teacher Caregiver Therapist Form | Teacher report of child's academic and behavioral strengths and weaknesses in that setting | Educator/Teacher Administered |
Teen Check-In with Moods and Feelings Questionnaire: Short Version | A check-in on teen responses pertaining to teen's last annual medical visit and parent assessment of whether teen ever got help with issues of mood or feelings. | Mental Health - Teen Administered |
Teen Check-In with Moods and Feelings Questionnaire: Short Version C | A check-in on teen responses pertaining to teen's last annual medical visit and parent assessment of whether teen ever got help with issues of mood or feelings. | Mental Health - Teen Administered |
Tennessee Lead Screening Evaluation | Tennessee EPSDT-required questions for lead exposure/poisoning screening | General Medical - EPSDT |
Tennessee Tuberculosis Screening Evaluation | A six item screen for Tuberculosis testing. | General Medical - EPSDT |
Tennessee Tuberculosis Screening Evaluation (Revised) | A six item screen for Tuberculosis testing. | General Medical - EPSDT |
Test for Respiratory and Asthma Control in Kids TRACK | 5-question screening tool developed by AstraZeneca to help parents evaluate severity of asthma symptoms in their children. | General Medical - Asthma |
The 7 Up 7 Down Inventory | 14-item measure of manic and depressive tendencies | Mental Health - Depression/Mood Disorders/Suicide |
The ChildHealth Center Well Visit Form 0-5 Months | The ChildHealth Center Well Visit Form 0-5 Months | General Medical Care |
The ChildHealth Center Well Visit Form 6-12 Months | The ChildHealth Center Well Visit Form 6-12 Months | General Medical Care |
The ChildHealth Center Well Visit Form 13-36 Months | The ChildHealth Center Well Visit Form 13-36 Months | General Medical Care |
The ChildHealth Center Well Visit Form 4 to 12 Years | The ChildHealth Center Well Visit Form 4 to 12 Years | General Medical Care |
The Hunger Vital Sign | This 2-question validated screening tool based on the US Household Food Security Scale to identify young children in households at risk of food insecurity. | General Medical - Social Determinants of Health |
Theory of Mind | A Child-Friendly Theory of Mind False-Belief Task | Clinician Tools |
Transition Readiness Assessment Questionnaire (TRAQ) | A tool to assess the readiness to transfer from the pediatric health care system to the adult health care system | General Medical - Special Health Care Needs |
Trauma Responsive School Implementation Assessment | The TRS-IA is an evidence-informed self-assessment that can quickly and efficiently to identify trauma responsive programming and policy domains of strengths, as well as areas with greater room for improvement. | Adolescent Self-Administered |
Trauma-Sensitive Efficacy Scale | Respondent indicates how effective they feel they are regarding trauma-informed practices in the classroom/school using a 5-item Likert scale with options "Not at all" through "A great deal". | Adolescent Self-Administered |
Treatment Acceptability Rating Form (TAR-F) | Quality Monitoring/Satisfaction | |
Tuberculosis (TB) Screener - General (TB Screening Questionnaire) | Six item screen for Tuberculosis testing. | General Medical - EPSDT |
Tuberculosis Risk Assessment (BCHP) | Tuberculosis (TB) screening tool | General Medical - EPSDT |
Tuberculosis Screening Evaluation | Tuberculosis (TB) screening tool | General Medical - EPSDT |
Tuberculosis Screening Questionnaire - TX | A six item screen for Tuberculosis testing. | General Medical - EPSDT |
UCLA Loneliness Scale Version 3 | 20-item scale designed to measure one's subjective feelings of loneliness as well as feelings of social isolation. | Mental Health - General Adult
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Vanderbilt Follow-Up Parent Informant | A tool to diagnose and track ADHD symptoms over time as well as screen for comorbid problems, including conduct disorder, oppositional defiant disorder, and anxiety and depression. | Mental Health - ADHD |
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