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    EHN Virtual Intensive Treatment Program Screener

  • After completing our assessment, you will be directed towards the program that best suits your needs based on your results. Please provide your contact details in order to communicate these results.

  • Contact Information

  • Format: (000) 000-0000.

  • Privacy of information

    The information you share is available only to those who need to know to provide advice and care. The privacy and confidentiality of the information collected is protected in accordance with the Personal Health Information Protection Act (PHIPA) and The Personal Information Protection and Electronic Documents Act (PIPEDA).

    By providing your contact information, you agree to receive electronic communications including but not limited to informational emails and/or calls from EHN Canada. You can unsubscribe at any time.

  • Status
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  • Self-Assessment

    In order for us to place you in the right program, please answer the questions below as truthfully as possible.

  • In the last two weeks:

  • Do you have little interest or pleasure in doing things?*
  • Are you feeling down, depressed, or hopeless?*
  • Are you having trouble falling asleep, staying asleep, or are sleeping too much?*
  • Are you feeling tired or finding yourself having little energy?*
  • Do you have a poor appetite or are overeating?*
  • Are you feeling bad about yourself – or that you are a failure or have let yourself or your family down?*
  • Are you having trouble concentrating on things, such as reading the newspaper or watching television?*
  • Are you moving or speaking so slowly that other people could have noticed? Or the opposite – being so fidgety or restless that you have been moving around a lot more than usual?*
  • Are you having thoughts that you would be better off dead or of hurting yourself in some way?*

  • In addition:

  • Have you experienced a traumatic event which has the ability to alter your mood and/or thought processes? (i.e., thinking about the event causes distress, anxiety, or unsettling flashbacks).*
  • Do you regularly (2+ times per week) use alcohol or drugs to help cope with your mood or situation?*
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  • Self-Assessment

    Great job! Just a few more questions...

  • In the last month:

  • Do you find yourself thinking about when you will next be able to have another drink or take drugs?*
  • Is drinking or taking drugs more important than anything else you might do during the day?*
  • Do you feel your need for drink or drugs is too strong to control?*
  • Do you plan your days around getting and taking drink or drugs?*
  • Do you drink or take drugs in a particular way in order to increase the effect it gives you?*
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  • Self-Assessment

  • In the last month:

  • Do you drink or take drugs morning, afternoon, and evening?*
  • Do you feel you have to carry on drinking or taking drugs once you have started?*
  • Is getting the effect you want more important than the particular drink or drug that you use?*
  • Do you want to take more drink or drugs when the effect starts to wear off?*
  • Do you find it difficult to cope with life without drink or drugs?*
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  • Self-Assessment

  • Do you have access to a tablet, laptop, or desktop computer, and secure internet access in a private space to participate in programming?*
  • Are you a current resident of Canada?*
  • What language are you fluent in?*
  • Have you had any psychiatric hospitalizations within the last 6 months?*
  • Please select any of the following which you are experiencing or have experienced in the past.*
  • Which type of treatment have you accessed in the past, or are currently accessing? (Select all that apply)
  • Do you currently have a reliable support network (such as a friend or family member who is aware of your current situation)?*
  • Are you currently employed?*
  • Do you have a return to work plan?*
  • Have you experienced suicidal thoughts within the past year?*
  • Do you have a plan to harm yourself or someone else?*
  • Do you have the means to carry out this plan? (i.e.: access to a weapon)*
  • Do you plan on carrying out this plan?*

  • You may be at imminent risk. In order to keep yourself and others safe, please immediately reach out to a local crisis line and/or 911 for support.

  • Results

  • EHN FLAG
  • IOP Program

  • Thanks for taking our self-screener.

     

    Taking the time to stop and assess your current symptoms and resources is an excellent first step to finding the treatment that’s right for you.

    We were unable to determine a recommendation based on your responses. Please contact us to discuss what Virtual Intensive Treatment Program might be right for you.

    Please remember that this assessment does not replace the advice of a medical professional. Consult your physician if you are experiencing moderate or severe symptoms of addiction or a mental health disorder.

     

  • We have looked at your responses and have a recommendation.

    Based on your responses, we think you may be at risk for a moderate Mood, Depression, or Anxiety Disorder and could benefit from our Virtual Mood, Depression, and Anxiety Program.

    You can enrol in this program, or we can reach out to you with more information.

  • We have looked at your responses and have a recommendation.

    Based on your responses, we think you may be at risk for moderate Substance Use Disorder and could benefit from our Substance Use Disorder Virtual Intensive Outpatient Program.

    You can enrol in this program, or we can reach out to you with more information.

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