Expanded Tool For Providers – CLONED for OEC
Focus of Service
Service Type
Are there concerns about parental substance use?
Current / Anticipated DCF Status
Primary Intervention Need for Parent
Is there concern about substance use?
Is there DCF involvement due to child safety concerns?
Level of child safety concern? (Refers to protective service risk levels from Structured Decision Making (SDM) tool)
Peer/Specialized Supports for Parents:
Level of child safety concern? (Refers to protective service risk levels from Structured Decision Making (SDM) tool)
Are there children in the home, or a plan for reunification within the next 30 days?
Age of Index Child in the home
Age of child:
What best describes your main concern for the child?
My child has been diagnosed with
What best describes your main behavioral health concern/need for the child?
Current / Anticipated DCF Involvement
Severity of Concern
Is the child currently receiving treatment?
Do you have any of the following specific areas of concern:
Is there any Opioid use?
Severity of Concern
Is there any Opioid use?
Severity of concern
Consider either: Multisystemic Therapy (MST) or Multidimensional Family Therapy (MDFT)
Is this a new concern?
Does the child currently have a diagnosis of Autism?
Which best describes current concerns:
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