Dari Version Produced in conjunction between Pathways to Wellness and AMIR

Refugee Health Screener-15 (RHS-15)

Dari Version

Produced in conjunction between Pathways to Wellness and AMIR (Assessment of Mental Health and Early Intervention for Refugees) at the department of psychology, Midsweden University

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.

DEMOGRAPHIC INFORMATION

Name: Date of Birth:

Gender: Date of Arrival: Health ID: Administered by:

Date of Screen:

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.

REFUGEE HEALTH SCREENER-15 (RHS-15) /#ID

ﮫﻣﺎﻧﺳﺎﻧﺷ هرﺎﻣﺷ

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.

/DATE

ﺦﯾرﺎﺗ

:تﺎﯾادھ

صﺧﺷﻣ هدوﺑ هدﻧھدرازآ نﺎﺗﯾارﺑ ﮫﺗﺷذﮔ هﺎﻣ لوط رد ﮫﮐ ار مﯾﻼﻋ بﺗارﻣ ﺎﯾ و رادﻘﻣ ﺎﻔطﻟ ﮫطوﺑرﻣ مﯾﻼﻋ لﺑﺎﻘﻣ رد سﺎﯾﻘﻣ زا هدﺎﻔﺗﺳا ﺎﺑ

ر "ﻼﺻا ﮫﻧ" ﮫﻧﯾزﮔ ،دﺷﺎﺑ هدوﺑﻧ هدﻧھدرازآ نﺎﺗﯾارﺑ ﮫﺗﺷذﮔ هﺎﻣ رد درد مﯾﻼﻋ ﮫﮑﯾﺗروﺻ رد .دﯾراذﮕﺑ تﻣﻼﻋ ﮫطوﺑرﻣ نوﺗﺳ رد ﺎﻔطﻟ .دﯾﯾﺎﻣﻧ ﺧﺗﻧا ا

بﺎ .دﯾﻧﮐ

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

EXTREMELY

دﺎﯾ ز ﯽﻣ ﮐ

QUITE A BIT

طﺳ وﺗﻣ

MODERATELY

ﯽﻣﮐ

A LITTLE BIT

ﻼﺻ ا ﮫﻧ

NOT AT ALL

مﯾﻼﻋ

SYMPTOMS

4 3 2 1 0 لﺻﺎﻔﻣ و ناوﺧﺗﺳا ،تﻼﺿﻋ یﺎھدرد

Muscle, bone, joint pains .1

4 3 2 1 0 ندﺮﮐ ﯽﮕﻠﺻﻮﺣ ﻢﮐ و ﯽﻨﯿﮕﻤﻏ ،ﯽﻟﺎﺣ ﯽﺑ سﺎﺴﺣا تﺎﻗوا ﺮﺘﺸﯿﺑ

Feeling down, sad, or blue most of the time .2

4 3 2 1 0 ﺪﺣ زا ﺶﯿﺑ ترﺎﮑﻔﺗ ﺎﯾ ندﺮﮐ ﺮﮑﻓ ﺪﺣ زا ﺶﯿﺑ

Too much thinking or too many thoughts .3

4 3 2 1 0

سﺎﺳﺣا ﯽﻧاوﺗﺎﻧ

Feeling helpless .4

4 3 2 1 0 ﭻﯾھ نودﺑ ﯽﻧﺎﮭﮔﺎﻧ سرﺗ

Suddenly scared for no reason .5

لﯾﻟد

4 3 2 1 0 فﻌﺿ و ﯽﺟﯾﮔ ،ﯽﻟﺎﺣ ﯽﺑ سﺎﺳﺣا

Faintness, dizziness, or weakness .6

4 3 2 1 0 ﯽﻧورد هزرﻟ ﺎﯾ تﯾﻧﺎﺑﺻﻋ سﺎﺳﺣا

Nervousness or shakiness inside .7

4 3 2 1 0 ندرﮐ تﺣارﺗﺳا ﯽﯾﺎﻧاوﺗ مدﻋ ، یرارﻘﯾﺑ سﺎﺳﺣا

Feeling restless, can’t sit still .8

4 3 2 1 0 ندرﮐ ﮫﯾرﮔ ﯽﻧﺎﺳآ ﮫﺑ رﺎﯾﺳﺑ

Crying easily .9

REFUGEE HEALTH SCREENER-15 (RHS-15) /#ID

ﮫﻣﺎﻧﺳﺎﻧﺷ هرﺎﻣﺷ

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.

/DATE

ﺦﯾرﺎﺗ

لﯾذ مﯾﻼﻋ هدﻧھد نﺎﮑﺗ تﺎﯾﺑرﺟﺗ ﺎﺑ طﺑﺗرﻣ

ﺎﯾ و هﺎﻣ رد لﯾذ دراوﻣ زا .دﺷﺎﺑ ﯽﻣ دﯾا هدوﻣﻧ ﮫﺑرﺟﺗ ترﺟﺎﮭﻣ و ﮓﻧﺟ لوط رد ﮫﮐ از بﯾﺳآ

ﮫﺗﺷذﮔ :دﯾا هدرﮐ ﮫﺑرﺟﺗ رادﻘﻣ ﮫﭼ

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

دﯾدﺷ

EXTREMELY

دﺎﯾ ز ﯽﻣ ﮐ

QUITE A BIT

طﺳ وﺗﻣ

MODERATELY

ﯽﻣﮐ

A LITTLE BIT

ﻼﺻ ا ﮫﻧ

NOT AT ALL

مﯾﻼﻋ

SYMPTOMS

4 3 2 1 0

:بﯾﺳآ ﺎﯾ ﺎﻣورﺗ عوﻗو زا ﮫﺑرﺟﺗ نﺗﺷاد دﯾﻧﮐ سﺎﺳﺣا ﺎﯾ رﺎﺗﻓر یروط

ﮫﮐ آ ن هرﺎﺑود دﺗﻓا ﯽﻣ قﺎﻔﺗا .

Had the experience of reliving the trauma; acting or feeling as if it were happening again? .10

4 3 2 1 0

بﯾﺳآ ﮫﮑﯾﻧﺎﻣز ﯽﮑﯾزﻓ یﺎھ لﻣﻌﻟا سﮑﻋ ﺎﯾآ دﯾروآ ﯽﻣ دﺎﯾﺑ ار

؟دﯾا ﮫﺗﺷاد (بﻠﻗ نﺎﺑرﺿ ندﺷ ﻊﯾرﺳ ،ندرﮐ قرﻋ ،دﻧﻧﺎﻣ)

Been having physical reactions (for example, break out in a sweat, heart beats fast) when reminded of the trauma? .11

4 3 2 1 0

ﺎﻣا ﯽﻧﯾﮕﻣﻏ سﺎﺳﺣا ،دﻧﻧﺎﻣ) دﯾا هدوﻣﻧ ﯽﺳﺣ ﯽﺑ سﺎﺳﺣا ﯽﻔطﺎﻋ ظﺎﺣﻟ ﮫﺑ دﯾﻧﮐ ﮫﯾرﮔ دﯾﺗﺳﻧاوﺗﻧ

٫ ﮫﻗﻼﻋو قﺷﻋ ﯽﯾﺎﻧاوﺗ مدﻋ سﺎﺳﺣا

؟ (

Felt emotionally numb (for example, feel sad but can’t cry, unable to have loving feelings)? .12

4 3 2 1 0 ،دﻧزﺑ ادﺻ بﻘﻋ زا ار ﺎﻣﺷ ﯽﺳﮐ ﮫﮑﯾﺗﻗو ْﻼﺛﻣ ) دﯾﺳرﺗ ﯽﻣ ﯽﻧﺎﺳآ ﮫﺑ

.دﯾﺷﺎﺑ ﮫﺗﺷادﻧ ارﻧآ رﺎظﺗﻧا ﺎﻣﺷ ﮫﮐ یروط (

Been jumpier, more easily startled (for example, when someone walks up behind you)? .13

REFUGEE HEALTH SCREENER-15 (RHS-15) /#ID

ﮫﻣﺎﻧﺳﺎﻧﺷ هرﺎﻣﺷ

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.

/DATE

ﺦﯾرﺎﺗ

:دﯾراد ار لﯾذ سﺎﺳﺣا ﺎﯾآ .دﯾﻧﮐ هرﯾاد ار لﯾذ باوﺟ نﯾرﺗﮭﺑ

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

ﺎﺑ ﮫﻠﺑﺎﻘﻣ ﯽﯾﺎﻧاوﺗ ا ﮫﻠٴﺳﻣ رھ

Able to handle (cope with) anything

ﯽﯾ 0 ﺎﺑ ﮫﻠﺑﺎﻘﻣ ﯽﯾﺎﻧاوﺗ لﯾﺎﺳﻣرﺗﺷﯾﺑ

Able to handle (cope with) most things

1 دﯾﻧاوﺗ ﯽﻣﻧ ﮫﻠﺑﺎﻘﻣ رﮕﯾد لﯾﺎﺳﻣ ﯽﺿﻌﺑ ﺎﺑ ﺎﻣا ،لﯾﺎﺳﻣ ﯽﺿﻌﺑ ﮫﺑ ﮫﻠﺑﺎﻘﻣ ﯽﯾﺎﻧاوﺗ

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

2 رﺗﺷﯾﺑ ﺎﺑ ﮫﻠﺑﺎﻘﻣ ﯽﯾﺎﻧاوﺗ مدﻋ لﯾﺎﺳﻣ

Unable to cope with most things

3 ﯽﯾﺎﻧاوﺗ مدﻋ ﮫﻠﺑﺎﻘﻣ

ﻠٴﺳﻣ رھ ﺎﺑ ﯽﯾا ﮫ

Unable to cope with anything

4

10 9 8 7 6 5 4 3 2 1 0

رﺗﯾﻣﺎﻣرﺗ ﯽﻧﺎﺷﯾرﭘ

15. Distress Thermometer

ﺎﻔطﻟ رود ﮫﺑ ) تارﻣﻧ 0-10 دﯾﺎﻣﻧ ﮫﻘﻠﺣ ( ﺎﺗ

نﯾرﺗﮭﺑ ﮫﺑ وﺣﻧ نازﯾﻣ

ﮫﮐ ارﻧﺎﺗ ﯽﻧﺎﺷﯾرﭘ زورﻣا لوﻣﺷ ﮫﺑ ﮫﺗﺷذﮔ ﮫﺗﻔھ رد

دﯾا هدوﻣﻧ ﮫﺑرﺟﺗ

دﻧﮐ فﯾﺻوﺗ .

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

LEGAL NOTICE 2013 © Pathways to Wellness: Integrating Refugee Health and Wellbeing. Pathways to Wellness is a partnership of Lutheran

دﯾدﺷ ﯽﻧﺎﺷﯾرﭘ

"مراد دﺑ سﺎﺳﺣا ﮫﺷﯾﻣھ لﺛﻣ"

EXTREME DISTRESS

“I feel as bad as I ever have”

نوﺪﺑ ﯽﻧﺎﺸﯾﺮﭘ

"ﺖﺳا بﻮﺧ ﺰﯿﭼ ﮫﻤھ"

NO DISTRESS

“Things are good”