1. Rutgers Health University Behavioral Health Care
Introducing the PSC - 35
A Children’s Outcome Assessment Tool
During the past year, a work group was set up to find an assessment tool for children that would allow us to evaluate change in outcome over time, and would replace the Child Behavior Scale (CBS) which had been in use for children/youth under 15.

2. Measurement Based
In keeping with revised Joint Commission Standard, we undertook an effort to find a well researched tool that would adhere to the revised Element of Performance in the Joint Commission’s Standard CTS , stating: The organization uses a standardized tool or instrument to monitors the individual’s progress in achieving his or her care, treatment, or service goals.
Our goal was to find a tool that was well researched for its psychometric properties, meaning that its reliability and validity had been sufficiently demonstrated.

3. UBHC Team
Input from a full range of UBHC program areas occurred. A standardized tool was chosen that had very strong evidence for its psychometric properties relative to others, had ease of use, and was available in the public domain.

4. Pediatric Symptom Checklist-35 (PSC-35) Scoring
PSC-35 consists of 35-items that are rated as: “Never”, “Sometimes”, or “Often” scored 0, 1, and 2, respectively. Item scores are summed so that the total score is calculated by adding together the score for each of the 35 items, with a possible range of scores from 0-70.
The Pediatric Symptom Checklist -35 (PSC-35) is used widely to both screen/assess for problem areas as an instrument to measure change in outcome.

5. PSC-35 Scoring (continued)
For school age children, generally ages six through eighteen, the cut-off score is 28 (28 or above = impaired; 27 or below = not impaired). For non-school age children (3-5), the scores on school related items 5, 6, 17 and 18 are marked as never/scored as zero so that the cut-off score for these younger children as impaired is 24 or greater.
The scores should be used as a guide in assessing problems and should be taken into consideration as part of a full evaluation—but useful in establishing concrete markers in for the purpose of establishing change in outcome.

6. PSC-35 Parent Report
Emotional and physical health go together in children. Because parents are often the first to notice a problem with their child’s behavior, emotions, or learning, you may help your child get the best care possible by answering these questions.
Please indicate which statements best describe your child.
Program:____________
Client ID _____________
Client Name: _____________
Date: ____/____/_____
Never Sometimes Often 1. 2. 3. 4. 5. 6. 7. 8. 9.
10.
11.
12.
13.
14.
15.
16.
17.
Complains of aches and pains
Spends more time alone
Tires easily, little energy
Fidgety, unable to sit still
Has trouble with teacher
Less interested in school
Acts as if driven by a motor
Daydreams too much
Distracted easily
Is afraid of new situations
Feels sad, unhappy
Is irritable, angry
Feels hopeless
Has trouble concentrating
Less interested in friends
Fights with other children
Absent from School
Refused: ___Yes ___No
Spanish : ___Yes ___No
We are using a PSC-35 “Parent Report”, and a “Youth Report”. The 2 versions differ only slightly--in wording. Generally the Parent Report would be completed by parents/caregivers for children under 11 or where it is deemed appropriate for older children based on intellectual functioning, language ability issues, etc.

7. PSC-35 Parent Report _cont.
Never Sometimes Often
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36. 37
School grades dropping
Is down on him or herself
Visits the doctor with doctor finding nothing wrong
Has trouble sleeping
Worries a lot
Wants to be with parent more than before
Feels he or she is bad
Takes unnecessary risks
Gets hurt frequently
Seems to be having less fun
Acts younger than children your age
Does not listen to rules
Does not show feelings
Does not understand other people’s feelings
Teases others
Blames others for your troubles
Takes things that do not belong to you
Refuses to share
Thinking about ending his/her life
Thinking about harming others
Does your child have any emotional or behavioral problems for which he or she needs help? ___Yes ___No
Are there any services that you would like your child to receive for these problems? ___Yes ___No
If yes, what services? (use the back of this form.)
Visit Type: 1=Intake 2=Mid treatment 3= Discharge Form sent: ___Yes ___No
Who completed the form: 1=Consumer; 2=Parent; 3=Other relative; 4=Foster parent; 5= Staff; 6=Other
Visit_no: ______________
Thank you!

8. Program:____________
Client ID _____________
Client Name:________________
Date: ____/____/_____
PSC-35 Youth Report
Please mark the response that best fits you:
Never Sometimes Often 1. 2. 3. 4. 5. 6. 7. 8. 9.
10.
11.
12.
13.
14.
15.
16.
17.
Complain of aches and pains
Spend more time alone
Tire easily, little energy
Fidgety, unable to sit still
Have trouble with teacher
Less interested in school
Acts as if driven by motor
Daydream too much
Distract easily
Are afraid of new situations
Feel sad, unhappy
Are irritable, angry
Feel hopeless
Have trouble concentrating
Less interested in friends
Fight with other children
Absent from School
Refused: ___Yes ___No
Spanish: ___Yes ___No
Generally, the “Youth Report” then would be completed by those 11 and up, serving as a self report up to age 15. We will continue to use the BASIS-24, a standardized tool as well, for those 15 through adult years.

9. PSC-35 Youth Report Thank you! Never Sometimes Often 18. 19. 20. 21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
32.
33.
34.
35.
36.
37.
School grades dropping
Down on yourself
Visit doctor with doctor finding nothing wrong
Have trouble sleeping
Worry a lot
Want to be with parent more than before
Feel that you are bad
Take unnecessary risks
Get hurt frequently
Seem to be having less fun
Act younger than children your age
Do not listen to rules
Do not show feelings
Do not understand other people’s feelings
Tease others
Blame others for your troubles
Take things that do not belong to you
Refuse to share
Thinking about ending your life
Thinking about harming others
Visit Type: 1=Intake 2=Mid treatment 3= Discharge Form sent: ___Yes ___No
Who completed the form: 1=Consumer; 2=Parent; 3=Other relative; 4-Foster parent; 5= Staff; 6=Other
Visit_no: ______________
Thank you!

10. Subscales-Cognition The PSC Attention Subscale consists of 5 items:
4. Fidgety, unable to sit
7. Acts as if driven by a motor
8. Daydreams too much
9. Distracted easily
14. Has trouble concentrating
AT RISK - Children/Youth with scores of 7 or higher on this subscale typically have significant impairments in attention.
There are three subscales that pertain to the domains of cognition, emotion/mood, and behavior.

11. Subscale-Emotion The PSC Internalizing Subscale consists of 5 items:
11. Feels Sad
13. Feels Hopeless
19. Is down on self
22. Worries a lot
27. Seems to have less fun
 AT RISK - Children/Youth with scores of 5 or higher on this subscale typically have significant impairments with anxiety and/or depression .

12. Subscale-Behavior The PSC Externalizing Subscale consists of 7 items:
16. Fights with other children
29. Does not listen to rules
31. Does not understand others feelings
32. Teases others
33. Blames others for his troubles
34. Takes things that do not belong to him
35. Refuses to share
AT RISK - Children/Youth with scores of 7 or higher on this subscale may be determined to have significant problems with conduct.

13. The slide here provides a color-coded overview of the 3 subscales/domains, with Cognition/Attention in red, Emotion/Internalizing blue, and Behavior/Externalizing in green. As you can see from the actual forms to be used and the guide on this slide: 2 items were added, but they do not figure into the overall scoring or subscales: Item 36 relates to self harm, item 37 to harming others. These were added by the workgroup so as to provide a quick read for the assessor regarding dangerousness/at-risk status, though not as a full evaluation of same and/or to replace other tools such as the Columbia Scale or C-SSRS.

15. Sources/References
Joint Commission California Report PSC-35 Additional Research: (PSC-17)
Referenced on this slide is an extensive study done by the UCLA Center for Health Policy Research which the Workgroup group used extensively as a source for finalizing a tool. Additional information on the tool is also available on the MassGeneral.Org website as noted, with information on the tool from its developers. A related tool, the PSCS-17 is similar to the PSC-35, but is comprised solely of the 17 items pertaining to the 3 domains.