Ohio Scales Youth (rev 20220607) (revised 20220607) Step 1 of 2 50% Ohio Mental Health Consumer Outcomes System Ohio Youth Problem, Functioning, and Satisfaction Scales Youth Rating – Short Form (Ages 12-18)Name* First Last Date* MM slash DD slash YYYY Grade*Enter grade numberDate of Birth* MM slash DD slash YYYY Sex* Male Female Race* Please rate the degree to which you have experienced the following problems in the past 30 days.1. Arguing with others* All of the time Most of the time Often Several times Once or twice Not at all 2. Getting into fights* All of the time Most of the time Often Several times Once or twice Not at all 3. Yelling, swearing, or screaming at others* All of the time Most of the time Often Several times Once or twice Not at all 4. Fits of anger* All of the time Most of the time Often Several times Once or twice Not at all 5. Refusing to do things teachers or parents ask* All of the time Most of the time Often Several times Once or twice Not at all 6. Causing trouble for no reason* All of the time Most of the time Often Several times Once or twice Not at all 7. Using drugs or alcohol* All of the time Most of the time Often Several times Once or twice Not at all 8. Breaking rules or breaking the law (out past curfew, stealing)* All of the time Most of the time Often Several times Once or twice Not at all 9. Skipping school or classes* All of the time Most of the time Often Several times Once or twice Not at all 10. Lying* All of the time Most of the time Often Several times Once or twice Not at all 11. Can't seem to sit still, having too much energy* All the time Most of the time Often Several times Once or twice Not at all 12. Hurting self (cutting or scratching self, taking pills)* All of the time Most of the time Often Several times Once or twice Not at all 13. Taking or thinking about death* All of the time Most of the time often Several times Once or twice Not at all 14. Feeling worthless or useless* All of the time Most of the time Often Several times Once or twice Not at all 15. Feeling lonely and having no friends* All of the time Most of the time Often Several times Once or twice Not at all 16. Feeling anxious or fearful* All of the time Most of the time Often Several times Once or twice Not at all 17. Worrying that something bad is going to happen* All of the time Most of the time Often Several times Once or twice Not at all 18. Feeling sad or depressed* All of the time Most of the time Often Several times Once or twice Not at all 19. Nightmares* All of the time Most of the time Often Several times Once in a while Not at all 20. Eating problems* All of the time Most of the time Often Several times Once or twice Not at all Problem totalCalculated- do not edit Instructions: Please select your response to each question.1. Overall, how satisfied are you with your life right now?* Extremely satisifed Moderately satisfied Somewhat satisifed Somewhat dissatisfied Moderately dissatisfied Extremely dissatisfied 2. How energetic and healthy do you feel right now?* Extremely healthy Moderately healthy Somewhat healthy Somewhat unhealthy Moderately unhealthy Extremely unhealthy 3. How much stress or pressure is in your life right now?* Very little stress Some stress Quite a bit of stress A moderate amount of stress A great deal of stress Unbearable amount of stress 4. How optimistic are you about the future?* The future looks very bright The future looks somewhat bright The future looks OK The future looks both good and bad The future looks bad The future looks very bad Hopefulness totalCalculated- do not editPlease select your response to each question.1. How satisfied are you with the mental health services you have received so far?* Extremely satisfied Moderately satisfied Somewhat satisfied Somewhat dissatisfied Moderately dissatisfied Extremely dissatisfied 2. How much are you included in deciding your treatment?* A great deal Moderately Quite a bit Somewhat A little Not at all 3. Mental health workers involved in my case listen to me and know what I want.* A great deal Moderately Quite a bit Somewhat A little Not at all 4. I have a lot to say about what happens in my treatment.* A great deal Moderately Quite a bit Somewhat A little Not at all Treatment satisfaction totalCalculated- do not editBelow are some ways your problems might get in the way of your ability to do everyday activities. Read each item and select the response that best describes your situation.1. Getting along with friends* Doing very well OK Some trouble Quite a few troubles Extreme troubles 2. Getting along with family* Doing very well OK Some troubles Quite a few troubles Extreme troubles 3. Dating or developing relationships with boyfriends or girlfriends* Doing very well OK Some troubles Quite a few troubles Extreme troubles 4. Getting along with adults outside the family (teachers, principal)* Doing very well OK Some troubles Quite a few troubles Extreme troubles 5. Keeping neat and clean, look good* Doing very well OK Some troubles Quite a few troubles Extreme troubles 6. Caring for the health needs and keeping good health habits (taking medicines or brushing teeth)* Doing very well OK Some troubles Quite a few troubles Extreme troubles 7. Controlling emotions and staying out of trouble* Doing very well OK Some troubles Quite a few troubles Extreme troubles 8. Being motivated and finishing projects* Doing very well OK Some troubles Quite a few troubles Extreme troubles 9. Participating in hobbies (baseball cards, coins, stamps, art)* Doing very well OK Some troubles Quite a few troubles Extreme troubles 10. Participating in recreational activities (sports, swimming, bike riding)* Doing very well OK Some troubles Quite a few troubles Extreme troubles 11. Completing household chores (cleaning room, other chores)* Doing very well OK Some troubles Quite a few troubles Extreme troubles 12. Attending school and getting passing grades in school* Doing very well OK Some toubles Quite a few troubles Extreme troubles 13. Learning skills that will be useful for future jobs* Doing very well OK Some troubles Quite a few troubles Extreme troubles 14. Feeling good about self* Doing very well OK Some troubles Quite a few troubles Extreme troubles 15. Thinking clearly and making good decisions* Doing very well OK Some troubles Quite a few troubles Extreme troubles 16. Concentrating, paying attention, and completing tasks* Doing very wel OK Some troubles Quite a few troubles Extreme troubles 17. Earning money and learning how to use money wisely* Doing very well OK Some troubles Quite a few troubles Extreme troubles 18. Doing things without supervision or restrictions* Doing very well OK Some troubles Quite a few troubles Extreme troubles 19. Accepting responsibility for actions* Doing very well OK Some troubles Quite a few troubles Extreme troubles 20. Ability to express feelings* Doing very well OK Some troubles Quite a few troubles Extreme troubles Functioning totalCalculated- do not edit
