Office of the Chief Clinical Officer • Controlled Working Tool • Version 1.0 • July 19, 2026

Survey, Assessment, and Outcomes Book

One offline clinical workbook for immediate assessment, phase and transition planning, measurement-based care, prior authorization, continued-stay review, treatment-plan linkage, and outcome trending.

Core BatteryCBEIMaslow + 8 DimensionsPhase ReadinessTransition ReadinessPA SummaryOffline / No External Libraries
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Protected-health-information warningThis standalone HTML is not itself an EHR or HIPAA-compliant storage system. It does not transmit data, but browser storage, downloads, backups, and shared devices can expose PHI. Use only on an organization-approved encrypted device, export to an approved record system, and clear the browser draft after transfer.
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Clinical-use boundaryScores support—not replace—licensed assessment, diagnosis, ASAM/LOC determination, suicide-risk formulation, emergency response, or individualized level-of-care decisions. Every positive safety screen requires a documented clinical response.
Control center

Client, Encounter, and Required Battery

Set the population and decision context. The protocol matrix will identify the expected core and conditional measures.

Population and Trigger Flags

0Measures expectedBased on flags and context
0Results recordedIn the outcome history
0%Battery completionRequired measures only
0Active clinical flagsSafety, severity, and urgent needs
AssessmentStatusWho / WhenLatest ResultCadence
Immediate clinical control

Clinical Flags and Required Responses

Flags are generated by scored instruments and urgent needs. They do not make a disposition decision.

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No current automated flags.Score the applicable instruments. Document clinical judgment even when automated flags are absent.
Core assessment

Comprehensive Reassessment and Mental Status Examination

Use this as a concise outcomes-book summary. Complete the full organizational biopsychosocial assessment when required.

Core • All Clients

Mental Status Examination

Completion: Not scored.
Level of care

ASAM Multidimensional Assessment Result and Evidence Shell

Records dimensional ratings and rationale without reproducing proprietary ASAM placement algorithms. Use the current authorized ASAM Criteria and trained clinical judgment.

Required for SUD / Co-occurring
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Protected-criteria controlThis book does not automate ASAM level placement. The 0–4 values below are Cornerstone evidence ratings used to make severity visible; they are not a substitute for the current ASAM decision rules.
Dimension0–4 Evidence RatingCurrent EvidenceTreatment / Monitoring Implication
Result: Enter dimensional evidence and calculate.
Immediate safety

Columbia Suicide Severity Rating Scale — Outpatient Screener + Clinical Response

Use the approved organizational version and follow exact training. This embedded screen supports the recent outpatient pathway and requires clinical risk formulation.

Core • All Clients
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Hard stopAny positive finding must be evaluated in context. Imminent risk requires immediate emergency/safety procedure—not completion of the routine book first.
Result: Complete items and calculate.
Depression

Patient Health Questionnaire — 9 (PHQ-9)

Over the last two weeks, how often has the client been bothered by each problem?

Core when Depression Relevant
Score: Not calculated.
Anxiety

Generalized Anxiety Disorder — 7 (GAD-7)

Over the last two weeks, how often has the client been bothered by each problem?

Core when Anxiety Relevant
Score: Not calculated.
Substance use and recovery

Brief Addiction Monitor — IOP, Past 7 Days

Produces separate Use, Risk, and Protective scores. There is no single validated total or universal cutoff; interpret change over time and item-level clinical meaning.

Core for SUD / Co-occurring
Item 7 — Substance-specific days used (not included in BAM Use composite)
Scores: Not calculated.
Function

WHODAS 2.0 — 12-Item Authorized Score Entry

Enter the twelve item scores from the authorized WHO/CMS form. This book calculates the simple raw sum; it does not reproduce the protected questionnaire text or WHO IRT algorithm.

Core • All Clients
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Authorized-form requirementAdminister the approved WHODAS form under your organization’s permissions. Enter each score here: 0 none, 1 mild, 2 moderate, 3 severe, 4 extreme/cannot do.
Score: Not calculated.
Internal functional formulation

CBEI Functional Capacity Survey

Cornerstone’s internal planning measure for Confidence, Boundaries, and Emotional Intelligence. It is not a validated diagnostic, risk, or level-of-care instrument.

Core • All Clients
Scores: Not calculated.
Priority sequencing

Maslow and Eight Dimensions of Wellness Needs Assessment

Rate barrier severity: 0 none/stable, 1 mild, 2 moderate, 3 severe/blocks progress, 4 urgent or immediate safety/access issue. Assign action, owner, due date, and verification.

Core • All Clients

Maslow Priority Tiers

TierNeed / BarrierSeverity 0–4Action / ReferralOwnerDue

Eight Dimensions of Wellness

DimensionNeed / BarrierSeverity 0–4Action / ReferralOwnerDue
Result: Not calculated.
Recovery-development readiness

Phase Readiness Review

Rate observable evidence: 0 not established/unsafe, 1 rarely, 2 partial/inconsistent, 3 usually demonstrated, 4 consistent and independently demonstrated.

Core • All Clients
Result: Not calculated.
Long-stay and outpatient transition

Transition Barriers and Outpatient Readiness Assessment

Rate each domain: 0 unstable/not established, 1 partial/in progress, 2 ready/active. Any hard stop overrides the numerical band.

Required for 90+ Days / Priority Transition
Readiness Domain0–2Barrier / EvidenceActionOwnerDueVerification

Closed-Loop Handoff Milestones

Result: Not calculated.
Conditional trauma outcome

PTSD Checklist for DSM-5 — PCL-5

Keeping the worst event in mind, rate how much each problem bothered the client in the past month: 0 not at all to 4 extremely.

Conditional
Score: Not calculated.
Conditional alcohol screening

AUDIT-C

Three-item alcohol-use screen. The positive threshold is configurable because programs and payers may use different cut points.

Conditional
Score: Not calculated.
Conditional drug screening

Drug Abuse Screening Test — 10 (DAST-10)

Past 12 months. “Drug” excludes alcohol and tobacco and includes nonmedical use of prescribed or over-the-counter medications.

Conditional • Attribution Required
Score: Not calculated.
Conditional recovery capital

BARC-10 Authorized Score Entry

Enter ratings from the authorized Brief Assessment of Recovery Capital instrument. Short cues below are navigation aids and do not replace official item wording.

Conditional • Authorized Form
Score: Not calculated.
Protected / authorized instruments

LOCUS and TAPS Result-Entry Forms

Record outputs from the authorized instrument or licensed platform. This book does not reproduce protected items or decision rules.

Conditional
LOCUS — Authorized Result Entry
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LOCUS licensing controlComplete LOCUS using the organization’s authorized instrument/platform and trained staff. Enter the result—not copied criteria—below.
Result: Enter authorized result.
TAPS — Authorized Result Entry
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TAPS controlAdminister the official NIDA TAPS tool. Record the resulting screening/risk scores here.
Focused health and safety screening

Conditional Specialty Screen Matrix

Each positive screen must create a response: referral/action, owner, due date, verification, and treatment-plan linkage.

As Indicated
DomainScreen / FindingStatusAction / ReferralOwnerDue
Result: Not calculated.
Measurement-based care

Outcome History and Trend

Add scored results from each assessment. Export the client record to JSON after each review and move it to an approved storage location.

DateContextMeasureScoreInterpretationBaseline ΔNotesAction
Utilization review

Prior-Authorization / Continued-Stay Medical-Necessity Summary

Build the six-sentence decision record: why this level, why now, why not lower, why not higher, why this frequency, and what proves continued need or readiness.

Golden thread

Assessment-to-Treatment-Plan Crosswalk

Each active service lane should show the assessed need, measurable client objective, distinct provider intervention, frequency, target, and outcome evidence.

Service / Objective LaneAssessed Need / ScoreMeasurable Client ObjectiveProvider InterventionResponsible DisciplineFrequencyTarget / Evidence
Governance

Administration, Scoring, Source, and Licensing Notes

Confirm current payer rules, instrument versions, licenses, and organizational policies before controlled deployment.

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Three instrument classes
Embedded: PHQ-9, GAD-7, C-SSRS outpatient screener, PCL-5, BAM-IOP, AUDIT-C, DAST-10 under stated terms, and Cornerstone internal tools. Authorized score entry: WHODAS, BARC-10, LOCUS, and TAPS where permissions or exact authorized administration matter. Protected clinical framework: ASAM evidence shell only; no placement algorithm.
  • PHQ-9 / GAD-7: Patient Health Questionnaire and Generalized Anxiety Disorder tools; use current official English forms and scoring. The instrument publisher states the PHQ and GAD tools may be used without copyright restriction.
  • PCL-5: Weathers et al., National Center for PTSD. Public-domain instrument intended for qualified health professionals and researchers. Total score 0–80; local provisional threshold must be selected for the population and purpose.
  • BAM-IOP: U.S. Department of Veterans Affairs, past-seven-day version. Use = items 4–6; Risk = 1,2,3,8,11,15; Protective = 9,10,12,13,14,16. Item 14 is converted to 0/4 for the protective composite. No universal cutoff.
  • C-SSRS: Columbia Lighthouse Project outpatient screener. Use exact organizational training, clinical judgment, and local emergency procedure. The automated prompt in this book mirrors the outpatient triage structure but does not replace risk formulation.
  • WHODAS 2.0: World Health Organization / authorized implementation. This book contains score-entry fields and simple summation only, not the item text or IRT scoring algorithm.
  • ASAM: American Society of Addiction Medicine. Proprietary criteria and decision rules are not reproduced. Use the current authorized edition and document the selected level and evidence.
  • LOCUS: American Association for Community Psychiatry. Use an authorized version/platform. Enter only the completed result.
  • DAST-10: Harvey A. Skinner / Centre for Addiction and Mental Health. Reproduction is limited by the instrument’s stated terms; preserve attribution and confirm organizational use.
  • BARC-10: Brief Assessment of Recovery Capital. Use the authorized instrument wording; this book provides score-entry cues and total calculation.
  • CBEI, Maslow/Wellness, Phase Readiness, and Transition Readiness: Cornerstone internal planning instruments. They are not validated diagnostic, suicide-risk, ASAM, LOCUS, or payer-authorization substitutes.

Official Reference Links

Clinical flag