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Client Feedback Form (CFF)

Questionnaire Normal/Mild Distress (25%) Moderate Distress (50%) Severe Distress (25%)
CFF-Adult 0-1.4 1.5-2.5 2.6-4
CFF-Youth 0-1 1.1-1.8 1.9-4
CFF-Child 0-1.2 1.3-1.9 2-4

Adult items (GDS indicates item is included in the Global Distress Scale)

  • Symptoms
    • feel unhappy or sad? (GDS)
    • have little or no energy? (GDS)
    • feel tense or nervous? (GDS)
    • feel hopeless about the future? (GDS)
    • have problems with sleep (too much or too little)? (GDS)
  • Self Harm
    • think about harming yourself? (GDS)
  • Work/School
    • feel unproductive at work or other daily activities? (GDS)
    • have a hard time paying attention? (GDS)
  • Social
    • have a hard time getting along with family or friends? (GDS)
    • feel lonely? (GDS)
  • Substance Abuse
    • have someone express concern about your alcohol or drug use?
    • have five or more drinks of alcohol at one time?
    • have a problem at work, school or home because of drug or alcohol use?

Youth & Child Items (GDS indicates item is included in the Global Distress Scale)

  • Symptoms
    • eat a lot more or a lot less than usual? (GDS)
    • feel unhappy or sad? (GDS)
    • have a hard time controlling your temper? (GDS)
    • worry about a lot of things? (GDS)
    • feel worthless? (GDS)
    • have a hard time having fun? (GDS)
    • have a hard time sleeping because you were worried? (GDS)
    • cry easily? (GDS)
    • have a hard time controlling your temper? (GDS)
  • Function (Work/School)
    • have a hard time waiting your turn? (GDS)
    • have a hard time paying attention? (GDS)
    • lose things you need? (GDS)
    • have a hard time sitting still? (GDS)
  • Social
    • get into trouble? (GDS)
    • argue with adults? (GDS)
    • interrupt others? (GDS)
    • lie to get things you wanted? (GDS)
    • hang out with kids who get into trouble? (GDS)
    • feel nervous and/or shy around other people? (GDS)
    • get into fights with family members and/or friends? (GDS)
    • annoy other people on purpose? (GDS)
    • argue with adults? (GDS)
    • think that you don't have any friends? (GDS)
  • Substance Abuse
    • drink alcohol (beer, wine, hard liquor)?

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