Birth to 5
5-18
18-22
Concerns about development - (physical, language, cognitive/learning, social)
Emotional/Behavioral - (Fussiness/irritability; hard to comfort or calm; cries a lot; difficulty falling or staying asleep; has a hard time with new people, places or changes; hard to keep on a schedule or routine; high level of aggression with or avoids other children; concerns about behavior from daycare/preschool)
Yes
No
MILD - Child exhibits a few of those behaviors, some of the time.
MODERATE - Child shows several of those behaviors or some of the behaviors seem extreme.
SEVERE Child's behavior is very difficult to handle, very stressful for parent; or parent and/or child has experienced trauma
Crisis - The child is in IMMEDIATE danger; talking about hurting themselves or someone else
Care Coordination to help parent access/match/connect to services for complex behavioral health need of the child
Emotional/Behavioral - Symptoms such as: increased sadness, frequent tearfulness, excessive worry, irritability, not enjoying things they used to, grief/loss, reaction to trauma, acting out behaviors, not following rules, destroying things, angry outbursts, hitting or threatening, running away, high family conflict)
Substance Use (Including misuse of prescription medication)
Both emotional/behavioral concern(s) AND substance use (including misuse of prescription medication)
Unusual thoughts (question about disordered thinking/psychosis): For example: Confused thinking, odd/false beliefs that seem real to them, seeing/hearing/smelling things that are not there, high level of suspicion or mistrust
Eating Problems
Autism
No (or is closing in next 30 days)
MILD - Child does not have prior treatment history and/or their symptoms have limited impact on daily life.
MODERATE - Child has symptoms that negatively impact daily functioning in at least one area (school, home, relationships).
SEVERE - Child's emotional/behavioral difficulties are highly disruptive at home, in school and/or in the community. Concerns may include extreme emotional dysregulation; explosive behaviors; very high family conflict; frequent aggressive or destructive behaviors; extreme defiance; breaking the law; at risk of out-of-home placement/hospitalization or is being discharged from a hospital or out-of-home placement and will need a high level of therapeutic support.
Increasing SUICIDAL Thoughts (but NOT IMMEDIATE threat) - NOTE: If immediate threat call or text 9-8-8 for CRISIS assistance.
Disordered thinking/Psychosis - Such as: Hallucinations, delusions, high level of suspicion or mistrust.
Problem Sexual Behavior - Such as: Taking advantage of others sexually; forcing sexual contact; sexualized threats; repeated engagement in risky sexual behavior/activities on social media or text; receiving money or goods for sex; arrested or at risk of arrest for sexual behavior; voyeurism (exposing self or spying on others).
Legal Issues - Child is court involved and/or on probation.
Child has been diagnosed with Autism
Child has been diagnosed with an Intellectual Disability
None of the above apply
MILD - Substance use is present and a concern; however, there is not an immediate risk for adverse outcome
MODERATE - Substance use is having a negative effect on at least one aspect of daily living (academic, social, behavioral)
SEVERE - Substance use is negatively impacting multiple areas of life; there is a high risk for adverse outcomes such as injury, juvenile justice involvement, school dropout, or risk of an overdose event. There may be evidence of an inability to control or stop using.
MODERATE - Drug and/or alochol use and other problem behaviors have been increasing; there is quite a bit of tension at home.
SEVERE - Youth is at high risk of adverse outcomes including injury, criminal justice involvement , school drop out, risk of drug overdose event, any opioid use; high risk of out-of-home placement or returning to community from placement
Substance use primary, behavioral acting out secondary
Behavioral acting out primary, substance use secondary
No - Child has been diagnosed and/or is/has been in treatment for disordered thinking/psychosis
Child's behavior is safe, but they need therapy to help with their adjustment at home or school
Child is able to be kept safe with increased support, but is showing increasingly challenging behavior that is seriously impacting school or home life such as self-injury, aggression, property destruction, school refusal
