YQOL_R_xsample_instrumentx

YQOL_R_xsample_instrumentx - ID # _ DESCRIBING YOUR LIFE...

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ID # _____________ D ESCRIBING Y OUR L IFE University of Washington Department of Health Services 146 North Canal Street, Suite 313 Seattle, Washington 98103-8652 (800) 291-2193 Note: Do not reproduce without permission of the authors. COMPLETED BY INTERVIEWER - ADMINISTRATION MODE (CIRCLE THE NUMBER): 1 In-person - Self administered 2 In-person - Interviewer read items 3 In-person - Interviewer read items and marked responses 4 Mail - Self administered Copyright © 1997 University of Washington, YQOL-R 1.1
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To all participants: Many teenagers are taking part in this important survey. This survey will help us understand your thoughts and concerns so that better programs can be developed to improve the lives of teenagers. The questions in this survey ask about a wide range of concerns and feelings. Some of these may or may not be important to you. This is NOT a test, there are no right or wrong answers. Please answer as honestly as you can. Your responses will be kept strictly secret. Thank you for your help!
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Page 1 Describing Your Life Following are some statements that you might make about yourself. Please circle the one answer for each statement that best describes how closely the statement applies to you. There are no right or wrong answers, we are only interested in how you feel about your life. 1. During the past 4 weeks , how often did you have a conversation with an adult about something that is important to you? (please circle your answer) 0 NEVER 1 ALMOST NEVER 2 SOMETIMES 3 FAIRLY OFTEN 4 VERY OFTEN 2. During the past 4 weeks , how often did you help someone who needed it? (please circle your answer) 0 NEVER 1 ALMOST NEVER 2 SOMETIMES 3 FAIRLY OFTEN 4 VERY OFTEN 3. During the past 4 weeks , how often have your parents or guardians let you make your own decisions about what time you go to bed? (please circle your answer) 0 NEVER 1 ALMOST NEVER 2 SOMETIMES 3 FAIRLY OFTEN 4 VERY OFTEN 4. During the past 4 weeks , how often has your behavior caused problems with your family? (please circle your answer) 0 NEVER 1 ALMOST NEVER 2 SOMETIMES 3 FAIRLY OFTEN 4 VERY OFTEN 5. During the past 4 weeks , how often did you spend time with a friend having a good time outside of school? (please circle your answer) 0 NEVER 1 ALMOST NEVER 2 SOMETIMES 3 FAIRLY OFTEN 4 VERY OFTEN 6. During the past 4 weeks , how often have you had serious emotional or mental health problems that you felt you needed help with? (please circle your answer) 0 NEVER 1 ALMOST NEVER 2 SOMETIMES 3 FAIRLY OFTEN 4 VERY OFTEN 7. During the past 4 weeks , how often did you feel that you could not shake off the blues, even with help from your family and friends? (please circle your answer) 0 NEVER 1 ALMOST NEVER 2 SOMETIMES 3 FAIRLY OFTEN 4 VERY OFTEN
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Page 2 8. During the past 4 weeks , how often have any of your family members had serious arguments with one another? (please circle your answer) 1 3 4 0 2 ALMOST NEVER FAIRLY OFTEN VERY OFTEN NEVER SOMETIMES 9. During the past 4 weeks , how often
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YQOL_R_xsample_instrumentx - ID # _ DESCRIBING YOUR LIFE...

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