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Developed by the Pathways to Wellness project and generously funded by Robert Wood Johnson Foundation, Bill and Melinda Gates Foundation, United Way of King County, Medina Foundation, The Seattle Foundation, Boeing Employees Community Fund and

M.J. Murdock Charitable Trust.

© 2013 Pathways to Wellness: Integrating Refugee Health and Well-Being

Pathways to Wellness: Integrating Refugee Health and Well-Being is a project of Lutheran Community Services Northwest, Asian Counseling and Referral Service, Public Health Seattle & King County, and Michael Hollifield, M.D. of Pacific Institute for Research & Evaluation. For more information, please contact The Pathways Project at 206-816-3253 or pathways@lcsnw.org.

DEMOGRAPHIC INFORMATION

Administered by: Date of Screen:

Name: Date of Birth:

Gender: Date of Arrival: Health ID:

Bilingual versions of the RHS-15 have been translated by an iterative process involving experts in the field, professional translators, and members of the refugee community so that each question is asked correctly according to language and culture. The English text is provided for reference only; using the English alone negates the sensitivity of this instrument.

Refugee Health Screener-15 (RHS-15)

Farsi Version

(2)

Developed by the Pathways to Wellness project and generously funded by Robert Wood Johnson Foundation, Bill and Melinda Gates Foundation, United Way of King County, Medina Foundation, The Seattle Foundation, Boeing Employees Community Fund and M.J. Murdock Charitable Trust.

© 2013 Pathways to Wellness: Integrating Refugee Health and Well-Being

Pathways to Wellness: Integrating Refugee Health and Well-Being is a project of Lutheran Community Services Northwest, Asian Counseling and Referral Service, Public Health Seattle & King County, and Michael Hollifield, M.D. of Pacific Institute for Research & Evaluation. For more

information, please contact The Pathways Project at 206-816-3253 or pathways@lcsnw.org.

ار ماش هزادنا هچ ات هتشذگ هام کی رد یحور ای یمسج میلاع نیا دییانم صخشم ،فیدر ره رد جردنم سایقم زا هدافتسا اب ًافطل :لمعلاروتسد هجاوم نآ اب هتشذگ هام کی رد هک دراد دوجو یئملاع ای هناشن رگا .دیراذگب ردبضر تملاع دوخ یحور لاح اب بسانتم ،همادا رد .تسا هداد رازآ دیراذگب ردبضر »ًلاصا« هنیزگ یور دیا هدشن

INSTRUCTIONS: Using the scale beside each symptom, please indicate the degree to which the symptom has been bothersome to you over the past month. Place a mark in the appropriate column. If the symptom has not been bothersome to you during the past month, circle “NOT AT ALL.”

دیدش رایسب

EXTREMELY

یدح ات

QUITE A BIT

طس وتم ر وطب

MODERATELY

مک

A LITTLE BIT

لاصا

NOT AT ALL

یحور ای یمسج مئلاع

SYMPTOMS

4 3 2 1 0 یلصفم ای یناوختسا ،ینلاضع یاهدرد  

.1

Muscle, bone, joint pain s

4 3 2 1 0 عقاوم ثرکا رد یگدسرفا ای ،هودنا ،یگلصوح یب ساسحا 

.2

Feeling down, sad, or blue most of the time

4 3 2 1 0 تنشاد سر رد یدایز راکفا ای ندرک رکف دایز  

.3

Too much thinking or too many thoughts

4 3 2 1 0 یگدنامرد ساسحا  

.4

Feeling helpless

 

4 3 2 1 0 لیلد یب و یناهگان سرت  

.5

Suddenly scared for no reason

4 3 2 1 0 فعض ای ،هجیگسر ،یتسس  

.6

Faintness, dizziness, or weakness

4 3 2 1 0 ینورد شزرل ای تیبصع  

.7

Nervousness or shakiness inside

4 3 2 1 0 تنشادن رارق و مارآ ،یرارق یب سح  

.8

Feeling restless, can’t sit still

4 3 2 1 0 نداتفا هیرگ هب یناسآ هب 

.9

Crying easily

.

( 15 سا چا رآ(-هدنهانپ تملاس یرگلابرغ

REFUGEE HEALTH SCREENER-15 (RHS-15)

:ییاسانش هرماش

/ #ID

:خیرات

/ DATE

(3)

Developed by the Pathways to Wellness project and generously funded by Robert Wood Johnson Foundation, Bill and Melinda Gates Foundation, United Way of King County, Medina Foundation, The Seattle Foundation, Boeing Employees Community Fund and M.J. Murdock Charitable Trust.

© 2013 Pathways to Wellness: Integrating Refugee Health and Well-Being

Pathways to Wellness: Integrating Refugee Health and Well-Being is a project of Lutheran Community Services Northwest, Asian Counseling and Referral Service, Public Health Seattle & King County, and Michael Hollifield, M.D. of Pacific Institute for Research & Evaluation. For more

information, please contact The Pathways Project at 206-816-3253 or pathways@lcsnw.org.

دیدش رایسب

EXTREMELY

یدح ات

QUITE A BIT

طس وتم ر وطب

MODERATELY

مک

A LITTLE BIT

لاصا

NOT AT ALL

یحور ای یمسج مئلاع

SYMPTOMS

4 3 2 1 0

یگدید بیسآ هب رجنم قافتا هک دیا هدش وربور هبرجت نیا اب ایآ  

.10

هک دییانم ساسحا ای دینک راتفر یروط و دوش هدنز ناتیارب هرابود

؟تسا هداد خر ناتیارب هرابود قافتا نآ راگنا

Had the experience of reliving the trauma; acting or feeling as if it were happening again?

4 3 2 1 0

قرغ سیخ ًلاثم( ینماسج یاه شنکاو قافتا نآ یروآدای اب ایآ  

.11

؟دیا هتشاد )بلق دنت نابضر ای ،ندش

Been having physical reactions (for example, break out in a sweat, heart beats fast) when reminded of the trauma?

4 3 2 1 0

نیگمغ دینک ساسحا ًلاثم( دیا هدش هجاوم یساسحا یتخرک اب ایآ  

.12

هناتسود تاساسحا دیناوت ینم ای ،دینک هیرگ دیناوت ینم اما دیتسه

؟)دیهد ناشن ار دوخ

Felt emotionally numb (for example, feel sad but can’t cry, unable to have loving feelings)?

4 3 2 1 0

ًلاثم( ،دیوش یم ساره راچد ترعیسر ای دیرپ یم اج زا ترشیب  

.13

؟)دور یم هار ماش سر تشپ یسک یتقو

Been jumpier, more easily startled (for example, when someone walks up behind you)

.تسا هدش یحور بیسآ ببس هک دشاب ترجاهم و گنج نارود رد یقافتا اب طبترم دیاب دیآ یم لیذ رد هک یئملاع :دیا هدش هجاوم لیذ دراوم اب هزادنا هچ ات هتشذگ هام رد

The following symptoms may be related to traumatic experiences during war and migration. How much in the past month have you:

( 15 سا چا رآ(-هدنهانپ تملاس یرگلابرغ

REFUGEE HEALTH SCREENER-15 (RHS-15)

:ییاسانش هرماش

/ #ID

:خیرات

/ DATE

(4)

SCREENING IS POSITIVE IF: 1 ITEMS 1–14 IS 12 OR 2 DISTRESS THERMOMETER IS 5 SELF-ADMINISTERED NOT SELF-ADMINISTERED CHECK ONE: POSITIVE NEGATIVE

SCORING

LEGAL NOTICE 2013 © Pathways to Wellness: Integrating Refugee Health and Wellbeing. Pathways to Wellness is a partnership of Lutheran Community Services Northwest, Asian Counseling and Referral Service, Public Health Seattle and King County and Michael Hollifield, MD of Pacific

Institute for Research and Evaluation. All Rights Reserved.

10 9 8 7 6 5 4 3 2 1 0

هتفه رد ار ماش بارطضا نازیم هک (10 ات 0( ددع رود ًافطل هریاد دیانم یم فیصوت لکش نیترهب هب ،زورما لماش ،هتشذگ دیشکب.

Please circle the number (0 –10) that best describes how much distress you have been experiencing in the past week, including today.

)میایب رانک نآ اب( موش وربور زیچ همه اب مناوت یم

Able to handle (cope with) anything

0

)میایب رانک نآ اب( موش وربور اهزیچ ترشیب اب مناوت یم

Able to handle (cope with) most things

1

یقافتا ره اب هن یلو ،)میایب رانک نآ اب( موش وربور میگدنز تاقافتا یضعب اب طقف مناوت یم

Able to handle (cope with) some things, but not able to cope with other things

2

میایب رانک میگدنز تاقافتا ثرکا اب مناوت ینم

Unable to cope with most things

3

رمیایب رانک میگدنز تاقافتا زا کیچیه اب مناوت ینم

Unable to cope with anything

4

دیدش بارطضا

»تسا دب لماح هشیمه لثم«

EXTREME DISTRESS

“I feel as bad as I ever have”

بارطضا نودب

»تسا بوخ زیچ همه«

NO DISTRESS

“Things are good”

:هک دینک یم ساسحا ایآ .دیشکب هریاد باوج نیترهب رود ریز رد

.14

Circle the one best response below. Do you feel that you are:

یناشیرپ نازیم شجنس

15. Distress Thermometer Add Total Score of items 1–14

( 15 سا چا رآ(-هدنهانپ تملاس یرگلابرغ

REFUGEE HEALTH SCREENER-15 (RHS-15)

:ییاسانش هرماش

/ #ID

:خیرات

/ DATE

References

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