Assessment (Adult Version)

Adult Version

Directions: Read each item carefully. Using the scale shown below, please select the number that best describes YOU and put that number in the blank provided.

Question Title

* 1. Date of Assessment

Date / Time

Date

Question Title

* 2. Intake/Discharge

Question Title

* 3. First Name

Question Title

* 4. Last Name

Question Title

* 5.
Answer the following questions listed below:

	Definitely False	Mostly False	Somewhat False	Slightly False	Slightly True	Somewhat True	Mostly True	Definitely True
I can think of many ways to get out of a jam.	I can think of many ways to get out of a jam. Definitely False	I can think of many ways to get out of a jam. Mostly False	I can think of many ways to get out of a jam. Somewhat False	I can think of many ways to get out of a jam. Slightly False	I can think of many ways to get out of a jam. Slightly True	I can think of many ways to get out of a jam. Somewhat True	I can think of many ways to get out of a jam. Mostly True	I can think of many ways to get out of a jam. Definitely True
I energetically pursue my goals.	I energetically pursue my goals. Definitely False	I energetically pursue my goals. Mostly False	I energetically pursue my goals. Somewhat False	I energetically pursue my goals. Slightly False	I energetically pursue my goals. Slightly True	I energetically pursue my goals. Somewhat True	I energetically pursue my goals. Mostly True	I energetically pursue my goals. Definitely True
I feel tired most of the time.	I feel tired most of the time. Definitely False	I feel tired most of the time. Mostly False	I feel tired most of the time. Somewhat False	I feel tired most of the time. Slightly False	I feel tired most of the time. Slightly True	I feel tired most of the time. Somewhat True	I feel tired most of the time. Mostly True	I feel tired most of the time. Definitely True
There are lots of ways around any problem.	There are lots of ways around any problem. Definitely False	There are lots of ways around any problem. Mostly False	There are lots of ways around any problem. Somewhat False	There are lots of ways around any problem. Slightly False	There are lots of ways around any problem. Slightly True	There are lots of ways around any problem. Somewhat True	There are lots of ways around any problem. Mostly True	There are lots of ways around any problem. Definitely True
I am easily downed in an argument.	I am easily downed in an argument. Definitely False	I am easily downed in an argument. Mostly False	I am easily downed in an argument. Somewhat False	I am easily downed in an argument. Slightly False	I am easily downed in an argument. Slightly True	I am easily downed in an argument. Somewhat True	I am easily downed in an argument. Mostly True	I am easily downed in an argument. Definitely True
I can think of many ways to get the things in life that are important to me.	I can think of many ways to get the things in life that are important to me. Definitely False	I can think of many ways to get the things in life that are important to me. Mostly False	I can think of many ways to get the things in life that are important to me. Somewhat False	I can think of many ways to get the things in life that are important to me. Slightly False	I can think of many ways to get the things in life that are important to me. Slightly True	I can think of many ways to get the things in life that are important to me. Somewhat True	I can think of many ways to get the things in life that are important to me. Mostly True	I can think of many ways to get the things in life that are important to me. Definitely True
I worry about my health.	I worry about my health. Definitely False	I worry about my health. Mostly False	I worry about my health. Somewhat False	I worry about my health. Slightly False	I worry about my health. Slightly True	I worry about my health. Somewhat True	I worry about my health. Mostly True	I worry about my health. Definitely True
Even when others get discouraged, I know I can find a way to solve the problem.	Even when others get discouraged, I know I can find a way to solve the problem. Definitely False	Even when others get discouraged, I know I can find a way to solve the problem. Mostly False	Even when others get discouraged, I know I can find a way to solve the problem. Somewhat False	Even when others get discouraged, I know I can find a way to solve the problem. Slightly False	Even when others get discouraged, I know I can find a way to solve the problem. Slightly True	Even when others get discouraged, I know I can find a way to solve the problem. Somewhat True	Even when others get discouraged, I know I can find a way to solve the problem. Mostly True	Even when others get discouraged, I know I can find a way to solve the problem. Definitely True
My past experiences have prepared me well for my future.	My past experiences have prepared me well for my future. Definitely False	My past experiences have prepared me well for my future. Mostly False	My past experiences have prepared me well for my future. Somewhat False	My past experiences have prepared me well for my future. Slightly False	My past experiences have prepared me well for my future. Slightly True	My past experiences have prepared me well for my future. Somewhat True	My past experiences have prepared me well for my future. Mostly True	My past experiences have prepared me well for my future. Definitely True
I've been pretty successful in life.	I've been pretty successful in life. Definitely False	I've been pretty successful in life. Mostly False	I've been pretty successful in life. Somewhat False	I've been pretty successful in life. Slightly False	I've been pretty successful in life. Slightly True	I've been pretty successful in life. Somewhat True	I've been pretty successful in life. Mostly True	I've been pretty successful in life. Definitely True
I usually find myself worrying about something.	I usually find myself worrying about something. Definitely False	I usually find myself worrying about something. Mostly False	I usually find myself worrying about something. Somewhat False	I usually find myself worrying about something. Slightly False	I usually find myself worrying about something. Slightly True	I usually find myself worrying about something. Somewhat True	I usually find myself worrying about something. Mostly True	I usually find myself worrying about something. Definitely True
I meet the goals that I set for myself.	I meet the goals that I set for myself. Definitely False	I meet the goals that I set for myself. Mostly False	I meet the goals that I set for myself. Somewhat False	I meet the goals that I set for myself. Slightly False	I meet the goals that I set for myself. Slightly True	I meet the goals that I set for myself. Somewhat True	I meet the goals that I set for myself. Mostly True	I meet the goals that I set for myself. Definitely True