Initial Psychological Assessment - Contributor

Thank you for completing and returning your consent form. This will enable us to undertake an initial screening assessment for the production you are currently being cast in. Before completing this assessment you may wish to review that consent document again.

By undertaking this psychological assessment you are further confirming your consent to the terms and conditions outlined in the consent document that you signed.

We would suggest completing this assessment in one sitting, rather than stopping and starting. This will ensure that the form does not time out and you loose the data you have entered. It might be helpful to set aside 15-30 minutes, in order to complete this.

Please ensure that you answer the following questions, with as much detail as possible, to enable us to fully assess your suitability. Upon reviewing your initial screening assessment we may contact you to undertake a more in-depth assessment.

1. What was your motivation for applying to be part of this production? *

2. In what way do you feel this production might impact your life? *

3. How might you handle comments about you, both positive and/or negative within the media (e.g. newspapers/magazines, social media, radio/TV interviews etc)? *

4. Have you any concerns being involved in this production? *

5. When you experience any difficulties or challenges in your life, who would you normally turn to for support? Please also specify what characteristics this person(s) has which you find supportive? *

6. How have others reacted to you applying to be part of this production e.g. family, carers, friends?*

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1. Please specify who your main care-givers were growing up – i.e. biological parent(s), foster carer(s), other member(s) of your extended family. *

2. Please describe in a few sentences your relationship with your main care-giver(s) growing up.*

3. Would any of your main care-giver(s) have used alcohol or drugs excessively when you were growing up? *

4. If you have a sibling(s), please list them here in this section, including their age and gender. Also, provide a sentence or two around how you view your relationship to be with them growing up and currently. *

5. During childhood (between ages 0-18) have you ever experienced neglect, physical, sexual and/or emotional abuse? *

Yes

If you answered YES, to question five, please specify which type of abuse you feel you were subjected to, but DO NOT provide any details of who this was at this stage or any identifiable information.

6. During childhood (between ages 0-18) have you ever experienced bullying or being excluded from your peer group(s)?*

Yes

If you answered YES, to question six, please provide further details below.

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1. Have you ever experienced any symptoms of anxiety, depression or trauma?*

Yes

If you answered YES, to question one above, please provide further details below.

2. Have you ever accessed any mental health support in the past? E.g. attended appointments with any of the following professionals – psychiatrist, mental health social worker, community psychiatric nurse (CPN), occupational therapist, psychologist, counsellor.*

Yes

If you answered YES, to question two above, please provide further details below.

3. Have you ever been prescribed medication in the past for any psychological conditions?*

Yes

If you answered YES, to question three above, please provide further details below.

4. Have you ever experienced a time in your life where you had thoughts of life not worth living, that you felt you would be better off dead or thoughts around causing yourself any harm or injury? *

Yes

If you answered YES, to question four above, please provide further details below.

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Initial Psychological Assessment – Contributor