Clinical Guidelines
Guidelines for administering and interpreting the 49 screening assessments on the LetPsyc platform — 37 in the data-driven library across 11 categories, plus 12 legacy instruments detailed below.
Professional Use Only
Informed Consent
- Explain the purpose, nature, and expected duration of the assessment
- Discuss how results will be used and who will have access to them
- Inform patients of their right to refuse or discontinue at any time
- Obtain written consent before beginning assessment administration
Assessment Environment
- Ensure a quiet, comfortable, and private setting free from interruptions
- Maintain adequate lighting and temperature control
- Minimize distractions and external stimuli during administration
- Ensure technology is functioning properly before beginning
Cultural Competence
- Consider cultural, linguistic, and socioeconomic factors in interpretation
- Be aware of normative data limitations across diverse populations
- Adapt communication style to patient's cultural background and preferences
- Use interpreters when necessary and document their involvement
Administration Guidelines
The BDI-II is designed for individuals aged 13 and older. Responses are based on symptoms experienced during the past two weeks, including today.
- • Typical completion time: 5-10 minutes
- • Can be self-administered or clinician-administered
- • Ensure patient understands to select only one response per item
- • Score immediately to facilitate clinical discussion
Interpretation Guidelines
Normal mood variations; no clinical intervention typically needed
Monitor symptoms; consider brief interventions or psychoeducation
Clinical intervention recommended; psychotherapy and/or medication
Immediate intervention required; assess suicide risk; consider hospitalization
Suicide Risk Assessment
Administration Guidelines
The BAI measures severity of anxiety symptoms during the past week, including today. It's particularly useful for differentiating anxiety from depression.
- • Typical completion time: 5-10 minutes
- • Focus on physical and cognitive symptoms of anxiety
- • Distinguish between trait and state anxiety in interpretation
- • Consider medical conditions that may mimic anxiety symptoms
Clinical Interpretation
Within normal range; no clinical intervention needed
Monitor; consider stress management techniques and psychoeducation
Clinical intervention recommended; CBT or medication may be beneficial
Significant impairment; comprehensive treatment plan required
Administration Guidelines
The Y-BOCS assesses obsessions and compulsions separately, evaluating time spent, interference, distress, resistance, and control over the past week.
- • Typical completion time: 10-15 minutes
- • First identify presence of obsessions and compulsions using symptom checklist
- • Rate severity only for symptoms identified as present
- • Distinguish between obsessions and worries about real-life problems
Score Interpretation
Below threshold for OCD diagnosis
Noticeable symptoms with some interference
Clear interference; treatment strongly recommended
Substantial impairment; intensive treatment needed
Debilitating symptoms; may require intensive outpatient or inpatient care
This is not a full MMSE
Administration Guidelines
Administer the Orientation items in person, in a standardized manner, and record the result as an orientation subscore — never as "the patient's MMSE score."
- • Typical completion time: 2-3 minutes (Orientation section only)
- • Ensure patient has glasses/hearing aids if needed
- • Follow standardized instructions precisely; do not provide cues beyond standard prompts
- • Document that this was a partial administration in the patient's chart
Score Interpretation
No severity judgement is attached to this number. Because four of the five MMSE sections are absent, a low orientation score cannot be equated with the impairment levels a full MMSE would imply — a patient could score the full 10/10 on Orientation and still have significant impairment elsewhere on the instrument that was never administered.
Important Note
Broad Screening & Triage
Cast a wide net at first contact. Screens many domains at once to show what warrants a focused assessment next.
Screens 19 psychological and psychosocial domains at once over the past 2 weeks, to show which of them warrant a focused assessment next.
Respondent: Patient self-report · ~8 min
Cut-off: No total-score bands, deliberately. The framework supplied by the developer states the 0-100 total is not a diagnostic severity score and must not be read as mild/moderate/severe or converted into a probability - it is a longitudinal monitoring figure only. The clinical output is the domain signal profile: a domain reads Positive when any item mapped to it scores 1 or more.
Caution: Item 18 (thoughts of self-harm) is a red flag at any endorsement, independent of the total. Item 13 (marital/sexual satisfaction) is positively worded: it is reverse-scored into the total but reports its raw value in its own domain, and is skippable for unmarried respondents. A Positive signal is not a diagnosis and a Negative signal does not rule one out. Developed by Dr. Muhammad Zafar Iqbal.
Depression & Mood
Screen for and grade depressive symptoms, including perinatal and older-adult presentations.
Screens for and grades the severity of depression in adults over the past 2 weeks.
Respondent: Patient self-report · ~3 min
Cut-off: 0–4 Minimal, 5–9 Mild, 10–14 Moderate, 15–19 Moderately severe, 20–27 Severe (range 0–27).
Caution: Item 9 (thoughts of self-harm) fires a risk flag at any endorsement — always follow with a full suicide risk assessment regardless of the total score.
Measures depression, anxiety and stress as three independent 7-item subscales over the past week.
Respondent: Patient self-report · ~5 min
Cut-off: Each subscale is doubled and banded separately — Depression: 0–9 Normal / 10–13 Mild / 14–20 Moderate / 21–27 Severe / 28–42 Extremely severe. Anxiety and Stress use the same five labels at different thresholds (see the instrument definition).
Caution: There is no published cut-off for the combined total. Interpret the three subscales separately — never the sum of all 21 items.
Brief non-specific psychological distress screen over the past 4 weeks.
Respondent: Patient self-report (or read aloud) · ~2 min
Cut-off: 10–19 Likely to be well, 20–24 Likely mild disorder, 25–29 Likely moderate disorder, 30–50 Likely severe disorder.
Caution: Two items may be auto-scored 1 if the preceding item was answered "none of the time" — the clinician decides whether those were actually asked.
Screens for emotional distress and depression during pregnancy and the postnatal period, past 7 days.
Respondent: Patient self-report (pregnant / postnatal) · ~5 min
Cut-off: 0–9 Possible mild/transient symptoms, 10–12 Symptoms of distress — repeat in 2 weeks, 13–30 High likelihood of depression.
Caution: Item 10 (self-harm thoughts) fires a mandatory risk flag at any endorsement.
Screens for depression in older adults over the past week.
Respondent: Patient self-report (older adults) · ~5 min
Cut-off: Single published cut-off only: 0–4 Normal range, 5–15 suggests depression.
Caution: No finer severity grading beyond the single 5+ cut-off is published for this form.
Anxiety & Stress
Generalised worry, social anxiety, childhood anxiety and perceived stress.
Measures how stressful life has felt over the past month.
Respondent: Patient self-report · ~3 min
Cut-off: 0–13 Low stress, 14–26 Moderate stress, 27–40 High perceived stress.
Caution: The source is explicit that this is not diagnostic — a self-assessment tool only, not tied to any disorder.
Measures the trait tendency to worry excessively, uncontrollably and generally.
Respondent: Patient self-report · ~5 min
Cut-off: No cut-off is declared (range 16–80, raw score only). The source document gives scoring only, not severity bands, and a commonly-cited secondary figure is not held here with source-level confidence.
Caution: Report the raw score — do not describe any total as "clinically significant worry" without a source-verified cut-off.
Screens children for panic/somatic, generalized, separation and social anxiety plus school avoidance, past 3 months.
Respondent: Child self-report · ~10 min
Cut-off: Total: ≥25 may indicate an anxiety disorder, >30 is more specific. Subscale cut-offs: Panic/Somatic ≥7, Generalized Anxiety ≥9, Separation Anxiety ≥5, Social Anxiety ≥8, School Avoidance ≥3.
Caution: For children aged 8–11, have an adult sit with the child during completion in case questions arise.
Measures the severity of social anxiety symptoms over the past week.
Respondent: Patient self-report · ~5 min
Cut-off: 0–18 Below cut-off, ≥19 probable social anxiety disorder (range 0–68).
Caution: Copyright Jonathan Davidson — the response scale and cut-off come from the validation study, not the item sheet itself.
Suicide & Risk
Structured suicide-risk screening. Always followed by clinical interview.
Four-item screen for lifetime and current suicide risk — ideation, planning, communication and future likelihood.
Respondent: Patient self-report · ~2 min
Cut-off: Range 3–18. Cut-off 7 in the general population; cut-off 8 in psychiatric inpatients. Both are shown, since which applies is a clinical judgement.
Caution: Any endorsement of a past attempt or plan fires an immediate risk flag regardless of total score. A score below the cut-off never rules out risk — always follow with clinical interview.
Trauma & Dissociation
PTSD symptoms, adverse childhood experiences and dissociative phenomena.
Screens for and monitors the 20 DSM-5 symptoms of PTSD in adults with a known stressful experience, past month.
Respondent: Patient self-report · ~5 min
Cut-off: 0–32 Below screening cutoff, ≥33 probable PTSD (published range 31–33; range 0–80).
Caution: The cutoff is not printed on the item sheet — it is published National Center for PTSD guidance. Treat scores of 31–33 as "probable, confirm clinically" rather than a hard line.
Counts categories of adverse childhood experiences (before age 18) associated with later health risk.
Respondent: Patient self-report · ~4 min
Cut-off: No severity bands (range 0–10). Reported and discussed as a raw dose-response count, not a classified score.
Caution: Do not attach a severity label to the total — report it as a count of adversity categories.
Measures the frequency of dissociative experiences in daily life.
Respondent: Patient self-report · ~10 min
Cut-off: Mean of 28 items, 0–100 scale. Below 30: below the dissociative-disorder screening cut-off. 30 or above: further evaluation for a dissociative disorder is indicated (Carlson & Putnam, 1993).
Caution: Scored as a MEAN of the 28 items, not a sum — the cut-off applies to the mean.
Substance Use
Drug and alcohol screening, plus withdrawal severity monitoring.
Screens for drug abuse, excluding alcohol, over the past 12 months.
Respondent: Patient self-report · ~3 min
Cut-off: 0 No problems reported, 1–2 Low level, 3–5 Moderate level, 6–8 Substantial level, 9–10 Severe level.
Caution: Screening only — bands indicate degree of reported problems and suggested action, not a diagnosis.
Quantifies the severity of alcohol withdrawal to guide pharmacotherapy and monitor its course.
Respondent: Clinician-rated (observation and interview) · ~5 min
Cut-off: 0–9 Minimal to no withdrawal, 10–14 Moderate withdrawal, 15–67 Severe withdrawal (impending delirium tremens, increased seizure risk).
Caution: Guides pharmacotherapy — it is not a diagnostic tool. Pulse and blood pressure should still be recorded even though they do not contribute to the score.
Screens for lifetime alcohol-related problems and alcohol dependence.
Respondent: Patient self-report · ~5 min
Cut-off: 0–2 No apparent problem, 3–5 Early or middle problem drinker, 6–22 Problem drinker.
Caution: This 22-item reproduction is not the classic differentially-weighted MAST — every item here is worth one uniform point, per this source's own scoring key.
Screens for problematic use across 10 illicit/prescription drug classes, plus injecting drug use.
Respondent: Clinician-administered interview · ~8 min
Cut-off: Per substance: 0–3 (0–4 for cannabis) brief education, 4–26 (5–26 for cannabis) brief intervention, 27+ brief intervention with treatment options offered.
Caution: This adaptation does NOT screen tobacco or alcohol — use AUDIT or the full WHO ASSIST v3.0 for those.
Neurodevelopmental
ADHD and autism screening across toddlers, children and adults.
WHO screener for adult ADHD. Only the 6-item Part A is scored; Part B (12 items) is recorded for discussion only.
Respondent: Patient self-report · ~5 min
Cut-off: 4 or more of the 6 Part A items in the "shaded" range (items 1–3 at Sometimes+, items 4–6 at Often+) = screen positive.
Caution: Part B is never scored, per the source's own instructions. A positive Part A screen still requires further clinical investigation, not a diagnosis.
Parent-report screen for autism spectrum disorder risk in toddlers aged 16–30 months.
Respondent: Parent report · ~5 min
Cut-off: 0–2 Low risk, 3–7 Medium risk (administer the Follow-Up), 8–20 High risk (refer for diagnostic evaluation).
Caution: Must be used in its entirety — the source states subsets of items lack adequate psychometric properties. The © 2009 Robins, Fein & Barton copyright line must appear on every printed output.
Screens for ADHD subtypes plus co-morbid oppositional-defiant, conduct and anxiety/depression symptoms, ages 6–12.
Respondent: Parent report · ~10 min
Cut-off: Each subtype screen is positive only when its DSM-IV symptom-count threshold is met AND at least one of 8 performance items is rated "Somewhat of a problem" or "Problematic".
Caution: The source is explicit: never use this scale alone to make a diagnosis — combine it with information from other sources.
Self-report screen to assist the diagnosis of Autism Spectrum Disorder in adults.
Respondent: Patient self-report · ~25 min
Cut-off: 0–64 Below the screening cut-off, ≥65 consistent with ASD — warrants full diagnostic evaluation (range 0–240).
Caution: The four published subscales (Language, Social Relatedness, Sensory-Motor, Circumscribed Interests) are deliberately not reported — their item-by-item composition is not held with source-verified confidence. Only the total and its cut-off are shown.
Psychosis & Severe Illness
Clinician-rated symptom severity for psychotic and severe presentations.
Clinician-rated assessment of positive, negative and affective symptoms in psychotic disorders, especially schizophrenia.
Respondent: Clinician-rated · ~25 min
Cut-off: No severity cut-off is published (range 0–126). The source frames the total as a within-patient change-over-time measure across serial administrations.
Caution: Compare a given patient's score across visits to track treatment response — never against a fixed population threshold.
Personality & Coping
Traits, self-esteem, emotion regulation, mindfulness and coping style.
Profiles 14 distinct coping strategies used to deal with a current stressor, 2 items each.
Respondent: Patient self-report · ~8 min
Cut-off: No overall total is published (each of the 14 strategies sums to a 2–8 score). The instrument-level total shown is for completion tracking only.
Caution: Interpret each of the 14 two-item subscales individually — the sum of all 28 items has no clinical meaning.
Measures habitual use of two emotion regulation strategies: cognitive reappraisal (6 items) and expressive suppression (4 items).
Respondent: Patient self-report · ~4 min
Cut-off: No published clinical cut-off. Both subscales are reported as raw means (1–7) against normative sample means, not a diagnostic threshold.
Caution: Reappraisal and Suppression are independent strategies, not two ends of one dimension — there is no meaningful combined total.
Measures global self-worth through positive and negative feelings about oneself.
Respondent: Patient self-report · ~3 min
Cut-off: No cut-off is declared (range 0–30). The source states only that higher scores indicate higher self-esteem, with no interpretation table.
Caution: Report the raw score, not a severity label — no single cut-off is consistently agreed across the wider literature.
Measures alexithymia: difficulty identifying feelings, difficulty describing feelings, and externally-oriented thinking.
Respondent: Patient self-report · ~6 min
Cut-off: ≤51 No alexithymia, 52–60 Possible alexithymia, ≥61 Alexithymia present (range 20–100; Bagby, Parker & Taylor, 1994).
Caution: The cut-off is not printed on the item sheet itself — it is the published validation-study cut-off. Review the three subscales individually as well as the total.
Somatic & Eating
Physical symptom burden and eating-disorder screening.
Measures the range and severity of eating-disorder features — restraint, eating concern, shape concern, weight concern — over the past 28 days.
Respondent: Patient self-report · ~10 min
Cut-off: No published cut-off. Four subscale means plus a global score (mean of the four subscale means) are compared against normative community/clinical reference means, not a single diagnostic threshold.
Caution: Six behavioural-frequency items (e.g. self-induced vomiting episodes) are recorded for clinical review but never enter any score.
Brief measure of somatic symptom burden over the past 7 days.
Respondent: Patient self-report · ~2 min
Cut-off: 0–3 Minimal, 4–7 Low, 8–11 Medium, 12–15 High, 16–32 Very high somatic symptom burden.
Caution: Measures burden only — it is not a diagnostic tool for any specific somatic condition.
Functioning & Wellbeing
Day-to-day impairment, disability, life satisfaction and social support. Best repeated to track change.
Measures how much a problem impairs day-to-day functioning across five life domains.
Respondent: Patient self-report · ~2 min
Cut-off: 0–9 Subclinical range, 10–20 Significant functional impairment, 21–40 Moderately severe or worse psychopathology (range 0–40).
Caution: Item 1 (work) may legitimately be skipped by patients who are retired or not working for unrelated reasons — note a partial administration on the report.
Measures the trait tendency toward receptive, present-moment attention and awareness.
Respondent: Patient self-report · ~5 min
Cut-off: No clinical cut-off is published. Reported as a raw mean (1–6); lower means indicate more frequent lapses in moment-to-moment attention.
Caution: A trait-continuum measure normed to sample means, not a screening threshold.
Measures perceived adequacy of social support from family, friends and a significant other.
Respondent: Patient self-report · ~3 min
Cut-off: No published severity bands. Scores are reported as raw means (1–7) for the total and each of the three 4-item subscales.
Caution: Lower means indicate lower perceived support — there is no cut-off distinguishing "adequate" from "inadequate" support in the source material.
Measures global cognitive judgments of satisfaction with one's life.
Respondent: Patient self-report · ~2 min
Cut-off: Seven-tier interpretation (Diener's own published scoring guide): 31–35 Extremely satisfied down to 5–9 Extremely dissatisfied.
Caution: The true floor is 5, not 0, since all 5 items are answered on a 1–7 scale. The interpretation table is not printed on the item sheet itself.
Measures functioning and disability across six domains of daily life over the past 30 days.
Respondent: Patient self-report · ~10 min
Cut-off: No severity bands are published for the "simple" raw-score sum used here (range 0–144). WHO's population-normed "complex" score requires item-response-theory norm tables not held in the source material.
Caution: This is the full 36-item form, not the WHO 12-item short form — the 12-item form's exact item subset is not implemented, to avoid guessing which items belong in it.
Required Documentation Elements
- Date, time, and location of assessment administration
- Name and credentials of administering clinician
- Specific assessment instrument(s) used
- Raw scores, scaled scores, and severity interpretations
- Clinical impressions and diagnostic formulation
- Treatment recommendations and referrals made
- Patient's response to feedback and plan for follow-up
Data Security and Retention
- Store all assessment data in HIPAA-compliant encrypted systems
- Retain records according to state laws and professional standards (typically 7+ years)
- Implement access controls limiting who can view patient records
- Maintain audit logs of all access to assessment results
Professional Competence
Only administer and interpret assessments for which you have received appropriate training and maintain competence through continuing education.
Informed Consent and Confidentiality
Ensure patients understand the purpose of testing, how results will be used, and limitations of confidentiality. Obtain written consent and maintain patient privacy at all times.
Cultural Sensitivity
Be aware of how cultural, linguistic, and socioeconomic factors may influence test performance and interpretation. Avoid bias in clinical decision-making.
Test Security
Protect the integrity of assessment instruments by not sharing items or scoring methods with unauthorized individuals. Maintain test materials in secure locations.