(IS-20)© for all caregivers with children ages 0-3

Ingram Screening Perinatal Mental Health Risk Assessment (IS-20©)**

For any parent or caregiver of a child ages 0–3. This assessment includes 20 statements and takes less than 5 minutes to complete. Please read each statement and check the response that best reflects how much you agree or disagree based on how you’ve felt over the past two weeks. There are no right or wrong answers; choose what feels most true for you.

FIRST AND LAST NAME

WHO IS FILLING THIS IN?

EMAIL (TO SEND RESULTS)

example@example.com

DUE DATE OR CHILD/CHILDREN'S AGES

TODAY'S DATE

Date

1. I feel emotionally distant or disconnected, even from the people I care about most.

2. Things feel different lately, and I don't feel as grounded or connected to how I usually show up in the world.

3. Even simple things, like getting dressed or eating, can feel heavy or pointless.

4. I feel like I'm constantly on edge, like something bad could happen at any moment.

5. My mind jumps quickly from one worry to the next, and it's hard to stop.

6. Even when everything seems fine, I can't relax or feel safe.

7. Sometimes, out of nowhere, I feel a rush of fear or dread that takes over my body.

8. There are times when my body reacts with things like a racing heart, tight chest, or difficulty breathing, even without a clear reason.

9. I make an effort to avoid certain places, people, or situations because of fear they could cause intense physical or emotional discomfort.

10. Some things I see or hear bring back strong emotional reactions from a difficult or upsetting experience related to my child's birth or early care.

11. I've had disturbing dreams or nightmares that feel related to something upsetting, and I notice myself feeling more irritable or easily triggered than usual.

12. At times, it feels like I'm reliving parts of a past experience like I'm back in it, even when I know I'm not.

13. I feel intense pressure to manage everything just right, especially when it comes to safety and how I'm seen as a parent.

14. I feel the need to repeatedly check on things, such as my child's well-being or home safety, to prevent something bad from happening.

15. Repeating certain actions like washing, checking, or organizing helps reduce a sense of worry that something could go wrong.

16. There have been times when I felt unusually energized, upbeat, or unstoppable for several days, and there were times when those close to me commented that I seemed different.

17. I've gone through stretches where I made big decisions, took risks, or acted in ways that didn't feel like me because I felt confident, excited, or unusually driven.

18. After feeling unusually motivated or upbeat for a few days, I've sometimes experienced a sharp drop in energy, mood, or interest in things I usually care about.

19. I've had long stretches where I felt emotionally weighed down or stuck, and at other times, I noticed sudden bursts of energy, motivation, or confidence that didn't last very long.

20. I've had thoughts that life feels too hard to keep going or that others might be better off without me.

**For assessment purposes only. This tool does not diagnose or treat any condition and must never replace a licensed clinician's professional assessment or judgment.

We will send a results report within 24 hours of completion.