EXPANDED VERSION – Parents

Concerns about Autism

MODERATE - My child has symptoms that are negatively impacting their daily life in at least one area (school, home, relationships).

SEVERE - My child's emotional/behavioral difficulties are highly disruptive at home, in school and/or in the community. Concerns may include: my child has been arrested and/or is on probation; 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 therapeutic support

Yes

No

Increasing SUICIDAL thoughts (but NOT IMMEDIATE threat) NOTE: If immediate threat, call 988 for CRISIS assistance

Disordered thinking/Psychosis - Such as: hallucinations (seeing/hearing/smelling things that are not there); delusions (odd/false beliefs that seem real to them); high level of suspicion or mistrust.

Legal Issues- My child is court involved and/or is on probation.

Problem Sexual Behavior e.g. 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)

My child has been diagnosed with autism

My child has been diagnosed with other developmental or intellectual disability

None of the above apply

Yes

No

MILD - My child is using drugs or alcohol, but the use is not frequent and/or there have not been any serious consequences.

MODERATE- My child's use of drugs or alcohol is causing problems in at least one area (at school, with peers, at home).

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

Yes

No

Yes

No

MODERATE My child's drug and/or alcohol use and other problem behaviors have been increasing; there is quite a bit of tension at home.

SEVERE My child is at 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 returning to community from placement

Substance use primary, behavioral acting out secondary

Behavioral acting out primary, substance use secondary

Yes

No my child has been diagnosed and/or is/has been in treatment for disordered thinking/psychosis

Yes

No

Child's behavior is safe, but they need therapy to help with their adjustment at home or school. (wording to make this parent friendly?)

Child is able to be kept safe with increased support, but is showing increasingly challenging behavior that is seriously impacting school or hoe life such as self-injury, aggression, property destruction, and/or school refusal.