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Prototype Screening / Triage Form

User Information


Not specified.

Author/Developer / Address:

Richard Dembo, Ph.D., and Associates.
Dr. Richard Dembo
Department of Criminology,
SOC 107
University of South Florida
4202 E. Fowler Avenue
FL 33620
(813) 931-3345

Publication dates:


Description / Type of Assessment:

Face-to-face Interview (semi-structured).

Primary use / Purpose:

To assess adolescent's overall risk and service needs, their current situation and their patterns of drug use and delinquency/crime over time.

Domains measured / Life Areas / Problems Assessed:

  1. Admission and demographic,
  2. Education, employment, Home/living situation
  3. Other personal information:
  4. Alcohol and Substance use
  5. Sexual abuse history
  6. Physical abuse history
  7. Family history
  8. Psychological/medical history
  9. Mental health information.


Adolescents within juvenile detention centres.

Administration / Completion Time:

45 minutes approximately, depending on the problems areas identified.

Scoring Procedures:

Not specified.

Scoring Time:

Up to 20 minutes, depending on the problems areas identified.


Interviewers should be skilled for role playing, mock interviews, and rapport-building techniques.

Source of Psychometrics:

Appendix A lists a number of articles and a book chapter reporting findings obtained from psychometrics.



Availability / Inquiries:

Dr. Richard Dembo
Department of Criminology,
SOC 107
University of South Florida
4202 E. Fowler Avenue
FL 33620
(813) 931-3345


This instrument is a public domain form, and it is for anyone's use without costs.

Practicability / usefulness:

Thoughtful use of this instrument has proven valuable in understanding the needs of detained juveniles, and in addressing their problems.
It covers a wide range of juvenile problem areas which assists in the identification of high-risk youth and their potential service needs. Rapport building with clients and use of the instrument in non-adversarial circumstances improve reliability.Limited used to date.


The instrument is designed to be a screening tool to identify youths who appear to be in need of further, detailed evaluation for an alcohol / other drug use or mental health problem. It is not intended to serve as a substitute for this detailed assessment process.
The confidentiality of information needs to be considered in regard to its influence on the truthfulness of the youths' reports. It is important also that objective data be obtained on the youth's alcohol and other drugs use (by urine testing or hair analysis).


Page last updated: Thursday, 15 July 2004