16BRIGHT FUTURES TOOL FOR PROFESSIONALSINSTRUCTIONS FOR USEPediatric Symptom Checklistappropriate interventions can be initiated as early as possible Included hereYPSC The YPSC can be administered t ID: 884903
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1 16 www.brightfutures.org BRIGHT FUTURES
16 www.brightfutures.org BRIGHT FUTURES TOOL FOR PROFESSIONALS INSTRUCTIONS FOR USE Pediatric Symptom Checklistappropriate interventions can be initiated as early as possible. Included here(Y-PSC). The Y-PSC can be administered to adolescents ages 11 and up.The PSC consists of 35 items that are rated as ÒNever,Ó ÒSometimes,Ó orÒOftenÓ present and scored 0, 1, and 2, respectively. The total score is calculat-higher (Little et al., 1994; Pagano et al., 1996). The cutoff score for the Y-PSCis 30 or higher. Items that are left blank are simply ignored (i.e., score equalsA positive score on the PSC or Y-PSC suggests the need for further evaluationby a qualified health (e.g., M.D., R.N.) or mental health (e.g., Ph.D., L.I.C.S.W.)professional. Both false positives and false negatives occur, and only an experi-enced health professional should interpret a positive PSC or Y-PSC score as any-from past studies using the PSC and Y-PSC indicate that two out of three chil-dren and adolescents who screen positive on the PSC or Y-PSC will be correctlyidentified as having moderate to serious impairment in psychosocial function-ing. The one child or adolescent ÒincorrectlyÓ identified usually has at leastmild impairment, although a small percentage of children and adolescents turnout to have very little or no impairment (e.g., an adequately functioning childor adolescent of an overly anxious parent). Data on PSC and Y-PSC negativescreens indicate 95 percent accuracy, which, although statistically adequate,quately may actually be impaired. The inevitability of both false-positive andents or other laypeople who administer the form to consult with a licensedprofessional if their child receives a PSC or Y-PSC positive score. For more information, visit the Web site: http://psc.partners.org.(PSC) to screen for psychosocial problems in pediatric primary care: A national feas-ability study. Archives of Pediatric and Adolescent Medicine Journal of Pediatricspsychosocial dysfunction: A preliminary study with the Pediatric Symptom Checklist.Journal of Developmental and Behavioral Pediatrics4Ð5 year olds during routine EPSDT examinations: Validity and reliability in aMex
2 ican-American sample. INSTRUCTIONS FOR
ican-American sample. INSTRUCTIONS FOR HOW TO INTERPRET THEPSC OR Y-PSC REFERENCES childÕs behavior, emotions, or learning, you may help your child get the best care possible by answering these questions.Please mark under the heading that best describes your child:NeverSometimesOften1.Complains of aches and pains1_____________________2.Spends more time alone2_____________________3.Tires easily, has little energy3_____________________4.Fidgety, unable to sit still4_____________________5.Has trouble with teacher5_____________________6.Less interested in school6_____________________7.Acts as if driven by a motor7_____________________8.Daydreams too much8_____________________9.Distracted easily9_____________________10.Is afraid of new situations10_____________________11.Feels sad, unhappy11_____________________12.Is irritable, angry12_____________________13.Feels hopeless13_____________________14.Has trouble concentrating14_____________________15.Less interested in friends15_____________________16.Fights with other children16_____________________17.Absent from school17_____________________18.School grades dropping18_____________________19.Is down on him or herself19_____________________20.Visits the doctor with doctor finding nothing wrong20_____________________21.Has trouble sleeping21_____________________22.Worries a lot22_____________________23.Wants to be with you more than before23_____________________24.Feels he or she is bad24_____________________25.Takes unnecessary risks25_____________________26.Gets hurt frequently26_____________________27.Seems to be having less fun27_____________________28.Acts younger than children his or her age28_____________________29.Does not listen to rules29_____________________30.Does not show feelings30_____________________31.Does not understand other peopleÕs feelings31_____________________32.Teases others32_____________________33.Blames others for his or her troubles33_____________________34.Takes things that do not belong to him or her34_____________________35.Refuses to share35_____________________Does your child have any emotional or behavioral problems for which she or he needs help?( )N( )YAre t
3 here any services that you would like yo
here any services that you would like your child to receive for these problems? ( )N( )YIf yes, what services?______________________________________________________________________________________________ 17 BRIGHT FUTURES TOOL FOR PROFESSIONALS www.brightfutures.org Pediatric Symptom ChecklistÑYouth Report (Y-PSC) 18 www.brightfutures.org BRIGHT FUTURES TOOL FOR PROFESSIONALS Please mark under the heading that best fits you:NeverSometimesOften1.Complain of aches or pains1_____________________2.Spend more time alone2_____________________3.Tire easily, little energy3_____________________4.Fidgety, unable to sit still4_____________________5.Have trouble with teacher5_____________________6.Less interested in school6_____________________7.Act as if driven by motor7_____________________8.Daydream too much8_____________________9.Distract easily9_____________________10.Are afraid of new situations10_____________________11.Feel sad, unhappy11_____________________12.Are irritable, angry12_____________________13.Feel hopeless13_____________________14.Have trouble concentrating14_____________________15.Less interested in friends15_____________________16.Fight with other children16_____________________17.Absent from school17_____________________18.School grades dropping18_____________________19.Down on yourself19_____________________20.Visit doctor with doctor finding nothing wrong20_____________________21.Have trouble sleeping21_____________________22.Worry a lot22_____________________23.Want to be with parent more than before23_____________________24.Feel that you are bad24_____________________25.Take unnecessary risks25_____________________26.Get hurt frequently26_____________________27.Seem to be having less fun27_____________________28.Act younger than children your age28_____________________29.Do not listen to rules29_____________________30.Do not show feelings30_____________________31.Do not understand other peopleÕs feelings31_____________________32.Tease others32_____________________33.Blame others for your troubles33_____________________34.Take things that do not belong to you34_____________________35.Refuse to share 35___________________