AI-IMPACT

Semi-Structured Interview Guide

A semi-structured interviewing tool for exploring AI’s role in presenting concerns

Developer

Gina Beaman, PsyD

Organization

AI Literacy Learning Hub, LLC

Version

Version 1

Age Range

Adolescents & Adults (self-report); Children under 13 (clinician-administered)

Purpose

A semi-structured, flexible interviewing tool to explore whether AI use is a contributing, maintaining, or complicating factor in the presenting picture

Use Statement & Disclaimer
  • This tool is for guided interviewing and case conceptualization only.
  • It has not yet been psychometrically validated, normed, or established as a rating scale.
  • The 0–3 anchors are response descriptors, not validated severity scores or cutoffs.
  • Responses should be interpreted through professional judgment, developmental context, family/school/work context, and cultural context.
  • This tool should not be used as the sole basis for diagnosis, placement, discipline, disability determination, safety determination, or treatment decisions.
  • If responses suggest self-harm, suicidality, psychosis, abuse, exploitation, or acute risk — follow standard school, legal, and crisis-response procedures immediately.
Administration

Adolescents and adults — Give the client the Self-Report Version to complete independently, or read each item aloud and record their response.

Children under 13 — Ask casual conversational questions naturally during session. The child never sees the form. Score based on what they say, how they say it, and what you observe.

Instructions for Use

1. Navigating the domains — Five domains. You do not need to ask every question. If one domain appears elevated, prioritize deeper probing there while briefly screening others.

2. The probing technique — Use how and what follow-up questions to explore frequency, affect during vs. after AI use, and function (comfort, avoidance, reassurance, companionship, scaffolding).

3. Integrating findings — Use gathered information to inform your case formulation. Determine if AI-mediated issues are a standalone concern or a modern manifestation of traditional pathologies (like depression, OCD, or social anxiety).

Distinguishing AI use from AI-mediated symptom maintenance — Someone using AI daily for work is not necessarily impaired. The concern is when AI use becomes:

  • Compulsive
  • Emotionally necessary
  • Avoidance-based
  • Reassurance-driven
  • Identity-shaping
  • Relationally substitutive
  • Functionally impairing
Scoring

Each item is marked 0–3. These are response descriptors only — not validated severity scores. Do not compute a total score.

ScoreLabelWhat it means in practice
0Not at allThe client does not recognize this as part of their experience.
1RarelyRecognizes this occasionally. Worth a brief probe but not a primary focus.
2SometimesHappening enough to be worth exploring further.
3Often or alwaysFrequent, hard to manage, or affecting functioning. Make it a focus.

Built-in follow-up questions — Items scored 2 or 3 automatically show a suggested follow-up. There are 2–3 options per item selected at random each session. No internet needed.

Safety — If responses suggest self-harm, suicidality, abuse, exploitation, psychosis, or acute risk — follow your standard procedures immediately.
Using this tool — for clinicians

A single self-contained file. No internet connection, no app store, no login, no special software. Everything is built in.

Using it on an iPadSave to your Files app or email it to yourself. Tap to open in Safari. Works completely offline.
Hosting on your websiteUpload this HTML file to your website and share the link.
Internet connection needed?No. All follow-up questions are pre-written and built into this file.
PrivacyNothing you type is sent anywhere. All data is deleted when you close the tab.
What is a CDN?An internet server that delivers files like fonts. This tool does not use one — everything is embedded in this file.
AI-IMPACT Semi-Structured Interview Guide  |  Version 1  |  Not for distribution without developer authorization
Gina Beaman, PsyD  ·  AI Literacy Learning Hub, LLC  ·  Confidential — For Professional Use Only
AI Literacy Learning Hub, LLCVersion 1

AI-IMPACT Semi-Structured Interview Guide

For professional use only

🔒Privacy notice — This tool runs entirely in your browser. Nothing you enter is transmitted or stored anywhere. All data is deleted when you close this tab.
Who is completing this?
Age group
0 of 29 items scoredInterviewer · Adolescent & adult
The 0–3 anchors are response descriptors only — not validated severity scores. Do not compute a total score. If responses suggest self-harm, suicidality, psychosis, abuse, exploitation, or acute risk — follow standard procedures immediately.  ·  Gina Beaman, PsyD  ·  AI Literacy Learning Hub, LLC