Fillable Teb los ntawm Tus Neeg Tu Xyuas Kev (ACEs Aware)

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Teb los ntawm Tus Neeg Tu Xyuas Kev (ACEs Aware)

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Hmong&2020&
Kev Ntsuas Me Nyuam Tau Ntsib Xwm Txheej (Phem thiab Cov Kev Muaj Feem Xyuam Rau Lub Neej
(Pediatric ACEs and Relevant Life Events Screener) (PEARLS) – Lus Ceeb Toom Txog Kev Tu Xyuas Neeg Hluas
(Teenage Caregiver Report)
Hnub Tim Hnub No:
Me Nyuam Npe: Hnub Yug:
Koj Lub Npe: Kev Sib Txheeb Nrog Tus Me Nyuam:
Ntau cov tsev neeg ntsib kev ntxhov siab hauv lub neej. Ntev mus cov kev ntxhov siab no puas tau rau koj tus
me nyuam txoj kev noj qab haus huv thiab kev noj qab nyob zoo. Peb xav nug koj txog koj tus me nyuam kom
peb pom qab pab kom lawv noj qab haus huv li tsim nyog.
Txij li thaum yug koj tus me nyuam los, koj tus me nyuam puas tau pom los yog nyob ntawd thaum cov xwm
nram no tshwm sim? Thov xam cov muaj yav dhau los thiab cov muaj tam sim no. Thov faj seeb, qee cov lus nug
muaj ntau tshaj ib ntu uas yog cais los ntawm lo lus "LOS YOG"." Yog ib ntu ntawm nqe lus nug ntawd yeej teb lo lus
“Tau/Muaj/Xav,” ces teb tag nrho nqe lus nug ntawd ua “Tau/Muaj/Xav.”
Ntu 1 Thov kos “Tau/Muaj/Xav” rau nqe uas raug.
Koj tus me nyuam puas tau nyob nrog tus niam txiv/neeg tu xyuas uas raug mus kaw txim/kaw qhov taub
dhau los?
Tau
☐
Tsis tau
☐
Koj puas xav tias koj tus me nyuam xav tau tias tsis muaj kev txhawb, tsis muaj kev hlub/los yog tsis muaj
kev tiv thaiv rau nws?
Xav
☐
Tsis xav
☐
Koj tus me nyuam puas tau nyob nrog tus niam txiv/neeg tu xyuas uas muaj cov teeb meem kev puas siab
ntsws/puas hlwb? (piv txwv, kev nyuab siab, schizophrenia (lub hlwb coj ob tug yam ntxwv), bipolar disorder
(chim taus heev heev, zoo siab heev heev), PTSD, los yog ib yam kev ntxhov siab)
Tau
☐
Tsis tau
☐
Tus niam txiv/neeg saib xyuas puas tau thuam, rhuav ntsej muag los yog txoj hwm chim ntawm koj tus me
nyuam?
Tau
☐
Tsis tau
☐
Tus me nyuam leej niam leej txiv yug los yog txhua tus neeg tu xyuas puas tau muaj teeb meem kev quav
dej caw, quav tshuaj yeeb los yog quav tshuaj sau yav dhau los los sis tam sim no?
Tau
☐
Tsis tau
☐
Koj tus me nyuam puas tau ntsib kev tu xyuas tsis zoo tsim nyog los ntawm ib tug neeg tu xyuas twg (piv
txwv, tsis tiv thaiv nws ntawm cov xwm txheej tsis nyab xeeb, los yog tsis saib xyuas thaum muaj mob los
yog raug mob txawm tias yeej muaj tej kev pab nyob nrog ncig)?
Tau
☐
Tsis tau
☐
Koj tus me nyuam puas tau pom los yog hnov niam txiv/neeg saib xyuas qw, nthe lus dev, thuam los yog
rhuav lwm tus neeg laus ntsej muag? LOS YOG Koj tus me nyuam puas tau pom los yog hnov tus niam
txiv/neeg saib xyuas raug ncuav pias, ncaws, ntaus los yog raug ib yam khoom ua mob rau nws?
Tau
☐
Tsis tau
☐
Puas muaj ib tug neeg laus hauv lub tsev tau muab los yog nquag tau muab koj tus me nyuam thawb,
ntsiab, rho ncuav pias rau los yog txawb dab tsi rau? LOS YOG
Puas muaj ib tug neeg laus hauv lub tsev tau ntaus koj tus me nyuam sib zog heev uas nws nqaij siav doog
los yog raug mob? LOS YOG
Puas muaj ib tug neeg laus hauv lub tsev tau hawv yuav ua mob rau koj tus me nyuam los yog coj tus yam
ntxwv ua rau koj tus me nyuam ntshai tsam nws raug mob?
Muaj
☐
Tsis muaj
☐
Koj tus me nyuam puas tau ntsib kev ua dev ua npua? Piv txwv, puas muaj leej twg tau chwv koj tus me
nyuam los yog hais kom koj tus me nyuam chwv tus neeg ntawd yam koj tus me nyuam tsis nyiam, los yog
tsis xis, los yog puas muaj leej twg sim los yog yeej tau deev koj tus me nyuam ntawm qhov ncauj, qhov
quav los yog qhov chaw mos?
Muaj
☐
Tsis muaj
☐
Puas tau muaj kev hloov loj heev rau txoj kev txij nkawm sib txheeb ntawm us (cov) neeg tu xyuas tus me
nyuam? Piv txwv, tus niam txiv/neeg saib xyuas sib nrauj los yog sib cais, los yog ib tug khub tsiv los los sis
tsiv tawm?
Muaj
☐
Tsis muaj
☐
Koj teb pes tsawg nqe “Tau/Muaj/Xav” hauv Ntu 1?
Thov txuas mus rau sab nraum qab rau cov nqe lus nug ntxiv.
Teen (Parent/Caregiver Report) - Identified
Teb los ntawm Tus Neeg Tu Xyuas
Ntu 2 Thov kos “Tau” rau nqe uas raug.
Koj tus me nyuam puas tau pom, hnov los yog raug ib txoj kev ua phem rau nyob hauv koj ib puag ncig chaw
nyob, lub zej zog neeg, los yog lub tsev kawm ntawv? (piv txwv, kev txhob txwm thab plaub, ntaus los yog coj
yam ntxwv ua phem, tsov rog, los yog kev lim hiam rau pej xeem)
Tau
☐
Tsis tau
☐
Koj tus me nyuam puas tau ntsib kev ntxub ntxaug (piv txwv, raug zes los yog txo hwj chim los yog raug cais
vim yog nws haiv neeg, hom neeg, zeej xeeb, kev yeem nyiam poj niam los txiv neej, kev cai dab qhuas, cov
kev kawm txawv, los yog cov kev tsis taus)?
Tau
☐
Tsis tau
☐
Koj tus me nyuam puas tau ntsib cov teeb meem vaj tse nyob (piv txwv li tsis muaj vaj tse nyob, tsis muaj qhov
chaw ruaj nyob rau, tsiv tsev ntau tshaj ob zaug hauv rau lub hlis twg, raug ncaws tawm tsev los yog vaj tse
poob them tsis taus nqi txais, los yog raug nyob nrog ntau yim neeg los yog nyob nrog cov txheeb ze)?
Tau
☐
Tsis tau
☐
Koj puas tau txhawj tsam koj tus me nyuam tsis tau noj haus txaus los yog cov khoom noj khoom haus rau koj
tus me nyuam tas ua ntej koj muas tau ntxiv?
Tau
☐
Tsis tau
☐
Koj tus me nyuam puas tau raug cais tawm ntawm nws niam nws txiv los yog tus neeg saib xyuas vim yog txoj
kev muab mus rau niam qhuav txiv qhuav tu los yog kev tsiv teb chaws?
Tau
☐
Tsis tau
☐
Koj tus me nyuam puas tau nyob nrog tus niam txiv/neeg saib xyuas uas muaj ib tug mob los yog ib txoj kev
tsis taus loj heev?
Tau
☐
Tsis tau
☐
Koj tus me nyuam puas tau nyob nrog ib tug niam txiv los yog neeg saib xyuas uas tau tuag lawm?
Tau
☐
Tsis tau
☐
Koj tus me nyuam puas tau raug txhom, ntes los yog kaw?
Tau
☐
Tsis tau
☐
Koj tus me nyuam puas tau raug cem phem los yog ntaus los yog hawv yuav ua phem rau los ntawm tus nws
hlub (piv txwv li tus hluas nraug los yog tus hluas nkauj)?
Tau
☐
Tsis tau
☐
Koj teb pes tsawg nqe “Tau” hauv Ntu 2?
Teen (Parent/Caregiver Report) - Identified
Hmong&2020&
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Teb los ntawm Tus Neeg Tu Xyuas Kev (ACEs Aware)

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Completed 19 May 2021

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