MILD - My child does not have prior treatment history and/or their symptoms have limited impact on daily life
MODERATE - My child has symptoms that are negatively impacting their daily life in at least one area (school, home, relationships).
SEVERE - My child's behavioral difficulties are highly disruptive at home, in school and/or in the community; my child has a significant psychiatric diagnosis and/or is at risk of out-of-home placement/hospitalization or is being discharged from a hospital or out-of-home placement and we will need a high level of theraputic support
Yes
No
Drug and/or Alcohol Use
Problem Sexual Behavior - Taking advantage of or assaulting others sexually.
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.
Getting into trouble with the law
Other
