Children's Hospital: C3Change Care Tool
These surveys assess the symptoms and emotional and social well being of children with life-limiting illnesses.
Clinical Care Tools - Clinical Assessment
Children's Hospital and Regional Medical Center
Pediatric Palliative Care Project
Mail Stop CM - 11
4800 Sand Point Way, N.E.
Seattle, WA 98105
How the grantee used this instrument:
Self-administered by parent and/or patient with in-person assistance from Consultant at the pre-enrollment home visit, or agency case manager on a per request basis. Self-administered by physician at or immediately after the enrollment clinic visit. Parent and/or patient responds to telephone interview every three months.
pediatrics, emotional well-being, psychosocial assessment
To use this tool:
You may print and copy this tool for your own use from this site. Please credit source.
Developed specifically for this project by the project team with input from a parent focus group.
Information/References on Validity and Reliability:
Measures pain and symptoms for children with life-limiting illnesses and includes spiritual and quality of life domains.
To view this tool:
Left click on the download link to view the PDF document in your Web browser. Right-click on the download link to save the document to your computer. (Viewing PDF files requires downloading and installation of the free Adobe Acrobat Reader.)
Posted September 2003
Children's Hospital and Regional Medical Center overview page
# CHRMC8, type:clinical_assessment
Promoting Excellence in End-of-Life Care was a national program of the Robert Wood Johnson Foundation dedicated to long-term changes in health care institutions to substantially improve care for dying persons and their families. Visit PromotingExcellence.org for more resources.