PCL-5, DES-II, PHQ-9, GAD-7, ACE, C-SSRS & more
Validated assessments
Pick a measure to administer in-session. It opens as a focused stepper — one item at a time, with a live score and safety flags. Save into the active session when done.
When to use each measure — and what the scores mean
Answer-first clinical guidance: the situations that call for each instrument, and the next step for every score band.
PHQ-9 — depressionUse the PHQ-9 at intake for any client presenting with low mood, fatigue, hopelessness, or loss of interest, and then every 2–4 weeks to track treatment response. It is the fastest validated way to establish depression severity and to see whether therapy is working.
Use the PHQ-9 at intake for any client presenting with low mood, fatigue, hopelessness, or loss of interest, and then every 2–4 weeks to track treatment response. It is the fastest validated way to establish depression severity and to see whether therapy is working.
- Intake screening for every new client, regardless of presenting concern
- A client reports low mood, anhedonia, sleep change, or fatigue
- Measurement-based care: tracking whether depression is improving across episodes of care
- Before and after a course of CBT, BA, or a medication change
- 0–4. Minimal or no depressive symptoms. No depression-specific treatment indicated. Re-screen if the presentation changes.
- 5–9. Mild depression. Watchful waiting, behavioral activation, sleep and exercise work; repeat in 2–4 weeks.
- 10–14. Moderate depression — the standard clinical threshold. Begin an active, structured treatment (CBT, BA, IPT) and consider a medication consult.
- 15–19. Moderately severe depression. Structured psychotherapy plus a psychiatric referral; increase session frequency and monitor safety.
- 20–27. Severe depression. Combined psychotherapy and pharmacotherapy, formal safety planning, and consider a higher level of care.
- You need to distinguish unipolar from bipolar depression — screen with the MDQ as well
- The client has a medical condition (thyroid, anemia, sleep apnea) that could account for somatic items — interpret cautiously
- You need a standalone suicide risk assessment — item 9 is a screen, not a risk formulation
Why this one: The PHQ-9 maps one-to-one onto the DSM criteria for major depressive disorder, so the score doubles as a symptom checklist you can review item by item. It is nine items, public domain, and has the largest normative base of any depression measure — which makes cross-setting comparison and reimbursement documentation straightforward.
Cadence: Every session or every 2–4 weeks. A 5-point drop is clinically meaningful improvement; a 5-point rise warrants re-formulation.
Pair with: GAD-7 (anxiety frequently co-occurs), MDQ (rule out bipolarity before starting an antidepressant), and WHODAS 2.0 (functional impact).
GAD-7 — anxietyUse the GAD-7 whenever worry, restlessness, or physical tension is part of the picture — at intake and then every 2–4 weeks. It takes under two minutes and gives you a defensible severity band plus a change score you can track.
Use the GAD-7 whenever worry, restlessness, or physical tension is part of the picture — at intake and then every 2–4 weeks. It takes under two minutes and gives you a defensible severity band plus a change score you can track.
- Intake screening alongside the PHQ-9
- The client describes uncontrollable worry, difficulty relaxing, or irritability
- Deciding whether anxiety or depression is the primary treatment target
- Tracking response to CBT for worry, exposure work, or an SSRI trial
- 0–4. Minimal anxiety. No anxiety-specific intervention needed; re-screen if symptoms emerge.
- 5–9. Mild anxiety. Psychoeducation, worry-time scheduling, and skills work; repeat in 2–4 weeks.
- 10–14. Moderate anxiety — threshold for probable GAD. Start structured CBT for worry; assess for panic, social anxiety, and trauma.
- 15–21. Severe anxiety. Intensive CBT plus a medication consult; check avoidance, sleep, and substance use as maintainers.
- You need to identify which anxiety disorder is present — follow a positive screen with a disorder-specific measure
- The primary problem is trauma-related; use the PCL-5
- Anxiety is situational and content-specific (e.g. a single phobia) — a SUDS hierarchy tracks change better
Why this one: The GAD-7 shares the PHQ-9's 0–3 two-week frequency anchors, so the two sit on one intake form and clients only learn one response format. Its ≥10 cutoff also functions as a reasonable screen for panic, social anxiety, and PTSD, which makes it a strong first-pass anxiety measure.
Cadence: Every 2–4 weeks. A ≥4-point reduction is the accepted marker of clinically meaningful improvement.
Pair with: PHQ-9 (comorbid depression), PCL-5 (if trauma is present), and K10 (general distress at intake).
PCL-5 — PTSDUse the PCL-5 when a client has a known or suspected index trauma and you need to quantify PTSD symptoms across the four DSM-5 clusters. Administer at intake after the trauma is identified, then every 4 weeks during trauma-focused treatment.
Use the PCL-5 when a client has a known or suspected index trauma and you need to quantify PTSD symptoms across the four DSM-5 clusters. Administer at intake after the trauma is identified, then every 4 weeks during trauma-focused treatment.
- A positive trauma screen or a disclosed index event
- Establishing a provisional PTSD diagnosis before starting EMDR, CPT, or PE
- Tracking symptom change across a trauma-focused protocol
- Distinguishing PTSD from depression or generalized anxiety when presentations overlap
- 0–30. Below the provisional diagnostic threshold in most settings. Treat the specific elevated clusters; consider whether depression or anxiety better explains the presentation.
- 31–40. At or above the provisional PTSD threshold (≥31–33). Offer a trauma-focused protocol (CPT, PE, EMDR) and build stabilization skills first if needed.
- 41–80. High symptom burden. Trauma-focused treatment with attention to sleep, dissociation, and safety; consider medication consult and paced sessions.
- No index trauma has been identified — screen for exposure first (e.g. LEC-5)
- You need a confirmed diagnosis for legal or disability purposes — use the CAPS-5 clinician interview
- The client is actively dissociating or unsafe; stabilize before detailed symptom inventory
Why this one: The PCL-5 is anchored to a specific index event and maps directly onto DSM-5 Criteria B–E, so a cluster-level read tells you which symptoms to target (intrusions vs avoidance vs negative cognitions vs hyperarousal). It is free, self-report, and the standard outcome measure in trauma trials.
Cadence: Every 4 weeks during active treatment. A 10-point change is considered clinically meaningful.
Pair with: ACE questionnaire (developmental adversity), PHQ-9 (comorbid depression), and AUDIT (substance use as avoidance).
AUDIT — alcohol useUse the AUDIT at intake with every adult client to quantify alcohol risk, and again whenever drinking is implicated in a setback. Scores sort clients into brief-intervention, monitoring, or full-assessment pathways.
Use the AUDIT at intake with every adult client to quantify alcohol risk, and again whenever drinking is implicated in a setback. Scores sort clients into brief-intervention, monitoring, or full-assessment pathways.
- Universal intake screening — most hazardous drinking is invisible without a measure
- Drinking is named as a coping strategy for anxiety, trauma, or insomnia
- Before starting a medication that interacts with alcohol
- Monitoring during recovery or a moderation plan
- 0–7. Low-risk drinking. Brief education on limits; no intervention indicated.
- 8–15. Hazardous or increasing-risk drinking. Deliver a brief motivational intervention and set a concrete reduction plan.
- 16–19. Higher-risk drinking with likely harm. Brief intervention plus structured monitoring and a return visit; consider specialist referral.
- 20+. Possible alcohol dependence. Refer for full diagnostic assessment and medical review; discuss withdrawal risk before any abrupt cessation.
- The concern is a non-alcohol substance — use the DUDIT or DAST
- You need a diagnosis of alcohol use disorder — this is a risk screen, not a diagnostic interview
- Withdrawal is suspected; that requires immediate medical assessment, not a questionnaire
Why this one: The AUDIT covers consumption, dependence symptoms, and consequences in ten items, so a single score maps to a defined WHO intervention tier. The AUDIT-C (first three items) works when time is short and still detects hazardous use well.
Cadence: Annually as routine screening, or monthly when drinking is an active treatment target.
Pair with: PHQ-9 and GAD-7 (self-medication patterns) and PCL-5 (trauma-driven use).
ACE — adverse childhood experiencesUse the ACE questionnaire when you are formulating developmental context — not as a routine screener and never early in a first session. It tells you about cumulative childhood adversity, which shapes risk, not about current symptoms.
Use the ACE questionnaire when you are formulating developmental context — not as a routine screener and never early in a first session. It tells you about cumulative childhood adversity, which shapes risk, not about current symptoms.
- Case formulation once the alliance is established and stabilization skills exist
- Explaining to a client why chronic stress responses make sense given their history
- Prevention and health-education conversations about long-term risk
- Population-level or program-level needs assessment
- 0. No reported adverse childhood experiences on this list. Remember the list is not exhaustive — bullying, poverty, racism, and medical trauma are not included.
- 1–3. Moderate adversity exposure. Explore which experiences remain active in the present and link them to current coping patterns.
- 4+. High adversity exposure — the threshold associated with markedly elevated health and mental-health risk. Prioritize trauma-informed pacing, nervous-system regulation, and screen for PTSD with the PCL-5.
- It is the first session, or you cannot contain what disclosure may open
- You want a symptom or severity measure — the ACE score is exposure, not distress
- You would use the score to predict this individual's outcome; it is an epidemiological risk index, not a prognosis
Why this one: The ACE score is the most widely replicated dose-response link between childhood adversity and adult health outcomes, which makes it a powerful psychoeducational and formulation tool. It is short, free, and instantly understandable to clients.
Cadence: Once. This is a historical measure — re-administration adds nothing and risks re-exposure.
Pair with: PCL-5 (current trauma symptoms) and a resilience or protective-factors conversation to balance the picture.
Y-BOCS — OCD severityUse the Y-BOCS once OCD is suspected or confirmed, to grade severity before treatment and to measure ERP response. It is clinician-administered, takes about 20 minutes, and is the benchmark outcome measure in OCD care.
Use the Y-BOCS once OCD is suspected or confirmed, to grade severity before treatment and to measure ERP response. It is clinician-administered, takes about 20 minutes, and is the benchmark outcome measure in OCD care.
- Baseline severity rating before starting exposure and response prevention
- Every 4 weeks during ERP or an SSRI trial to document response
- Deciding between outpatient ERP, intensive programs, or medication augmentation
- Separating obsession burden from compulsion burden to sequence exposures
- 0–7. Subclinical symptoms. Psychoeducation and relapse prevention; treat only if functional impact persists.
- 8–15. Mild OCD. Outpatient ERP; often responds well without medication.
- 16–23. Moderate OCD — the usual treatment threshold. Structured ERP with between-session exposure homework; consider an SSRI.
- 24–31. Severe OCD. Intensive ERP (twice weekly or a program), SSRI at OCD dosing, and family accommodation work.
- 32–40. Extreme OCD. Specialist intensive or residential care with medication management and functional support.
- You are screening an unselected caseload — use the OCI-R or a brief screen first
- Only 5 minutes are available; consider the Y-BOCS-SR self-report for between-session tracking
- The client is a child or adolescent — use the CY-BOCS
Why this one: Because the Y-BOCS rates time, interference, distress, resistance, and control rather than symptom content, the score stays valid no matter what the obsessions are about. That content-independence is why it is the standard in trials and why a 35% reduction is a recognized response criterion.
Cadence: Every 4 weeks during active treatment. A ≥35% reduction defines treatment response; remission is typically a total under 12.
Pair with: PHQ-9 (comorbid depression is the rule, not the exception) and WHODAS 2.0 (functional recovery).
ASRS — adult ADHDUse the ASRS v1.1 when an adult reports lifelong difficulty with focus, organization, deadlines, or restlessness. Part A's six items are the screen; four or more darkened boxes means a full ADHD evaluation is warranted.
Use the ASRS v1.1 when an adult reports lifelong difficulty with focus, organization, deadlines, or restlessness. Part A's six items are the screen; four or more darkened boxes means a full ADHD evaluation is warranted.
- An adult self-identifies attention, procrastination, or organization problems
- Chronic underachievement or job/relationship instability with a childhood-onset history
- Treatment-resistant anxiety or depression where executive dysfunction may be primary
- Before referring for diagnostic ADHD assessment, to document rationale
- Part A: 0–3 darkened. Negative screen. Look for other causes of attentional difficulty: sleep, mood, anxiety, trauma, substances.
- Part A: 4–6 darkened. Symptoms highly consistent with adult ADHD. Refer for a full diagnostic evaluation; review Part B for the symptom profile and start executive-function skills work in the meantime.
- You need a diagnosis — ADHD requires childhood-onset evidence, cross-setting impairment, and differential assessment
- Untreated depression, anxiety, trauma, sleep apnea, or substance use could explain the symptoms
- Assessing a child or adolescent — use Vanderbilt or Conners rating scales
Why this one: Part A's six items were selected specifically to maximize predictive power, so a very short screen carries most of the diagnostic signal. It is free, WHO-developed, and widely accepted as documentation for referral.
Cadence: Once for screening. Use symptom-specific tracking rather than re-screening to monitor treatment.
Pair with: PHQ-9 and GAD-7 (comorbid and confounding), plus a sleep review before attributing symptoms to ADHD.