CAMS Youth Questionnaire

Client ID Number
CAMS Youth Questionnaire Version: 10/08 Page 1
Client Date of Birth
/ /
Client's Last Name First Name MI
Date CAMS Completed
/ /
Unit Sub Unit Staff ID
Time Frame
01 = Intake 12 = 12 Months/1 Year 24 = 24 Months/2 Years
06 = 6 Months 18 = 18 Months 77 = Discharge Other = Enter the number of months
Instructions: Think about your behavior and how you have felt over the Last Two Months. Fill in the circle that
best describes you. Please fill in the circle completely. Example: Correct Incorrect
1. Destroyed property
2. Had poor appetite
3. Was unhappy and sad
4. Stole things
5. Behavior caused school problems
6. Had little or no energy
7. Had difficulty following directions
8. Interrupted others
9. Lied to get things I wanted
10. Had temper outbursts
11. Worrying prevented me from doing things
12. Threatened/bullied others
13. Expressed thoughts about hurting self
14. Felt worthless or inferior
15. Had difficulty making decisions
16. Deliberately started fights
17. Had difficulty waiting
18. Had trouble sleeping
19. Cruel/mean to others
20. Used dirty (impolite) language
21. Argued with adults
22. Had difficulty doing things quietly
23. Felt hopeless
24. Blamed others for own problems
25. Changed moods quickly
26. Held grudges
27. Fought with parents or friends
28. Easily annoyed by others
29. Was disobedient
30. Needed to be the center of attention
Never Sometimes Often
1 2 3

Client ID Number
CAMS Youth Questionnaire Version: 10/08 Page 2
Instructions: Think about the things you do and how you feel. Fill in the circle that best describes you.
Never Sometimes Often
1. I help others
2. I have 2 or more friends
3. I understand the consequences of my behavior
4. I have an interest in the future
5. I have good relationships with adults outside my family
6. I am confident (not easily embarrassed)
7. I have a good relationship with my family
8. I am able to concentrate/pay attention
9. I am able to plan and organize
10. I participate in activities (sports, arts, hobbies)
11. I take responsibility for tasks
12. I handle criticism well
5. How long have you had problems?
Less than a
1 - 3
month
months
1
© Doucette & Bickman, 2002 — SBI-Y (v1.0)
Instructions: Think about your behavior over the Last Two Months. Fill in the circle that best describes you.
1. Had contact with police
2. Used alcohol
3. Ran away
4. Used illegal drugs
5. Attempted suicide/hurt self
6. Set fires
7. Cruel to animals
Instructions:
8. Hurt or cut myself.
Think about your behavior and whether it has caused problems for you. Fill in the circle that is most like you.
How often has your behavior caused problems in each of the following areas?
Never Sometimes Often Almost Always
1. Home and family
2. School
3. Friendships with peers
4. Leisure (free time) activities
4 - 6
months
7 - 12
months
No
13 - 17
months
Yes
0 1
1 2 3 4
18 - 24
months
More than
two years
1 2 3 4 5 6 7
Instructions: Think about your life and how you are feeling about the future. Fill in the circle that best describes you.
Never Sometimes Often
1
1. I am happy with my life
2 3
2. I have what I need in life
3. My life is going well
4. I have all the support from my family or friends that I need
5. I am able to accomplish the things I want to do in my life
6. I feel good about what's going on in my life right now
7. I wish my life was different than it is right now
8. I am able to do the kinds of things that other kids my age can do
9. There are people I can count on to help me out if I need it
10. I have more stress and pressure in my life than I can handle