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Controlled Tool

Brief Participant Pre/Post Evaluation

Use the same version before and after the defined program period. Adapt reading level and response method by population. Do not claim clinical improvement from this brief tool.

Every standard gets a tool; every tool gets a data boundary.
ClassificationImplementation Tool
Operating statusPrint-only / authorized system required
Release gateComplete only in the approved system of record
The practical question

Every standard gets a tool; every tool gets a data boundary.

Use this page as a controlled working guide. Adapt language and activities to the population, verify local resources, assign ownership, and preserve the clinical and life-safety boundaries described throughout the model.

STRIDE presenting a prevention roadmap connecting safety, community, growth, learning, and care.
Controlled Form BPTC-F-005
SEC-47

Brief participant pre/post evaluation

BPTC-F-005Participant evaluation
Print-only / authorized system requiredThis participant-level form does not save in the browser and is excluded from export. Complete it in the authorized EHR, evaluation, or case-record system.

Use the same version before and after the defined program period. Adapt reading level and response method by population. Do not claim clinical improvement from this brief tool.

Rate each statement: 1 = not yet true, 5 = consistently true

Statement12345
I know at least one person I can contact when I need help.
I notice signals in my body or emotions before I react.
I can name at least two healthy ways to handle pressure.
I can say no, leave, delay, or ask for support in a risky situation.
I understand when a concern requires professional or emergency help.
I have a goal, role, relationship, or future I want to protect.
I feel that people in this program treat me with dignity.
I know what my next step is.
Deidentified planning only