Crisis My child is in IMMEDIATE danger; talking about hurting themselves or someone
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.
Emotional Distress and/or Behavioral Problems - Depression, anxiety, tearfulness, excessive worry, irritability, not enjoying things they used to, acting out behaviors, not following rules for safety, destroying things, angry outbursts, hitting or threatening
Substance use
Both emotional/behavioral health concern(s) AND drug/alcohol use
Eating Problems
MILD- No prior therapy and/or a new concern that I'm noticing: the symptoms have limited impact on daily life
MODERATE- Symptoms are negatively impacting daily functioning(activities?) at home, school, and/or work
SEVERE - My child's behavior or emotional distress is highly disruptive at home, school, work and/or in the community; my child has a significant psychiatric diagnosis and/or is at risk of or has had multiple hospitalizations or is being discharged from a hospital and will need a high level of therapeutic support
Yes
No
Intellectual Disability
Autism Spectrum Disorder
Both Intellectual Disability and Autism spectrum disorder
MILD - My child is using drugs or alcohol, but the use is not frequent and/or there have not been any serious consequences.
MODERATE- Use of drugs and/or alcohol is causing problems in at least one area of life (school, work, home, relationships)
SEVERE - Use of drugs and/or alcohol is frequent and is creating problems in multiple areas such as: school or work attendance/performance; relationships with peers or family; illegal activities; high risk behaviors; or I am concerned that my child would not be able to stop using even if they wanted to
MILD
MODERATE - The drug and/or alcohol use and other problem behaviors have been increasing; (draw language from ASAM)
SEVERE - high risk for negative 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 is just returning to community from placement and is need of a high level of support
MODERATE
SEVERE
