Birth to 5
5-18
18-22
Delays in development compared to other children their age - (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 - ****DO WE want to add something for "SEVERE"...e.g. "I have consulted with my child's pediatrician but remain very concerned that my child needs further evaluation...ALSO*** do we want to capture his parent distress/multiple stressors...e.g.: I am finding it very difficult to meet my childs needs and or because of trauma that I and/or my child have experienced"
ADD Descriptors for Headstart, Child First, Birth to Three and Healthy Families America
Crisis - The child is in IMMEDIATE danger; talking about hurting themselves or someone else
Care Coordination to help 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)
Drug/Alcohol Use (including misuse of prescription drugs)
Both Drug/Alcohol use (including misuse of prescriptions) AND emotional/behavioral health concern(s)
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
Concerns about Developmental Disability and/or Autism
No DCF Involvement or case is closing in next 30 days
Referral through careline (Formerly Voluntary Services)
Ongoing Services
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 - 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 Child has a significant psychiatric diagnosis and/or is at risk of out-of-home placement/hospitalization or is being referred from hospital/out-of-home placement
Increasing SUICIDAL Thoughts (but NOT IMMEDIATE threat) - NOTE: If immediate threat call 9-8-8 for CRISIS assistance.
Disordered thinking/Psychosis - Such as: Hallucinations, delusions, high level of suspicion or mistrust.
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).
Legal Issues - Child has been arrested and/or is court involved and/or on probation.
Child has been diagnosed with a developmental delay, intellectual or developmental disability, and/or autism
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, criminal 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
MILD
MODERATE/SEVERE
