19. Sexual Abuse Status
Has the youth ever experienced sexual abuse or ever been touched on his/her private parts or made to touch other’s privates? Has the youth ever witnessed sexual abuse, witnessed sexual activity or materials such as movies, pictures, etc., or had a sibling experience sexual abuse?
0 – No evidence that action is needed. There is no suspicion of any sexual abuse.
1 – Let’s watch/wait. Youth has been exposed to sexual material, has a sibling who has experienced sexual abuse, and/or has witnessed sexual abuse. Youth has experienced being touched and/or has been made to touch others in the past; or there is a suspicion of this occurring.
2 – Help is needed. Youth has experienced at least one occurrence of being sexually abused. Youth has not received any prior treatment and/or is still experiencing some difficulty because of the abuse.
3 – Help is needed now/immediately. Youth was severely sexually abused. There was penetration, may have involved more than one perpetrator, and/or the sexual abuse may have caused physical harm.
20. Physical Abuse Status
Has the youth ever been physically assaulted or abused by an adult over 18? Has the youth been physically assaulted or abused by anyone under 18? Has physical discipline caused bruising/abrasions/broken bones/other physical harm?
0 – No evidence that action is needed. Youth has never experienced any physical abuse or corporal punishment
1 – Let’s watch/wait. Youth may have been physically abused in the past or youth has experienced corporal punishment (spankings) that have not left marks. Corporal punishment did not include any objects (belts, switches, boards, cords, etc.) Youth may have been threatened with physical harm without having actual harm inflicted.
2 – Help is needed. Youth is experiencing or has recently experienced physical punishment/abuse (hitting, punching, use of objects such as belts, cords, etc.) on one or more occasions. Youth has recently been intentionally hurt where bruises or marks were left.
3 – Help is needed now/immediately. Youth is experiencing physical abuse that needs medical treatment.
21. Emotional Abuse
Has the youth been verbally put-down or made to feel bad about themselves by their caregiver? Has the caregiver consistently ignored the youth or denied the youth needed attention? Has the youth been intentionally left out of family activities?
0 – No evidence that action is needed. There is no evidence that the child or youth has experienced emotional abuse.
1 – Let’s watch/wait. Youth may have experienced occasional episodes of emotional abuse. Youth may have been called a name, referred to in a mean way, or may have been denied attention or support.
2 – Help is needed. Youth has experienced emotional abuse for a year or longer. Caregiver(s) have humiliated, insulted, denied attention or intentionally isolated the youth on a regular basis.
3 – Help is needed now/ immediately. Youth has experienced severe and repeated emotional abuse over an extended period of time (at least one year). Youth has been completely ignored, intimidated, and/or made to feel worthless by the caregiver.
Has there ever been a time when youth was left unattended for a long period? Has the youth gone without clothing, food or shelter? Has the youth been kept out of school? Has youth received all needed medical care?
0 – No evidence that action is needed. The youth has not experienced any neglect.
1 – Watch/prevent. Youth has a history of neglect or has experienced some occasional neglect. An example would be leaving the youth alone for an inappropriate amount of time based on age or developmental level of the youth.
2 – Help is needed. Youth was left alone overnight. Youth occasionally lacks food, clothing, and shelter. Youth is kept home from school or attendance is not enforced. Youth is experiencing minor health problems that have not been addressed.
3 – Help is needed now/immediately. Youth has been left alone for periods of time on several occasions or has been abandoned. Youth is left with unsafe individuals. Food, clothing and shelter are not regularly provided to the youth. Serious medical concerns are not addressed. Youth is not attending school or is kept home on a regular basis.
23. Traumatic Grief
Has the youth experienced the death of someone significant? Has the youth experienced loss from being separated from a close caregiver, sibling, or other person important to them? This loss could have been expected or sudden.
0 – No evidence that action is needed. Youth has not experienced traumatic loss, or the youth has adjusted well.
1 – Let’s watch/wait. Youth has experienced separation or loss of someone significant.
2 – Help is needed. Youth is having difficulty functioning in an area of their life due to grief. They may have depression, anxiety, symptoms of PTSD, or even some behavioral issues due to their loss or traumatic separation.
3 – Help is needed now/immediately. Youth is unable to function in most areas of life due to traumatic grief. Youth may have difficulty getting out of bed, eating, or interacting with others. Youth may be experiencing severe symptoms of depression, anxiety, or PTSD, such as flashbacks, re-experiencing, frightening thoughts, dissociation, etc.
24. Witness to Family, School or Community Violence
Has youth witnessed threats of or actual domestic violence? Has the youth witnessed fighting at school? Has the youth witnessed kids or teachers being a victim to threats of harm or actual harm? Has the youth witnessed harmful crimes, such as robberies, shootings, stabbings, or rape? Does the youth feel safe at home, at school, and in the community? Has the youth been a victim of any of the above
0 – No evidence that action is needed. Youth has not witnessed any violence.
1 – Let’s watch/wait. Youth has witnessed occasional fighting or mild violence. This exposure has been limited.
2 – Help is needed. Youth has experienced family, school and/or community violence on several occasions, or was a direct victim of a non-life threating act of violence. Youth has witnessed a person close to them harmed due to violence.
3 – Help is needed now/immediately. Youth has witnessed or experienced “severe” violence. Youth has witnessed the death of another person due to violence. Youth has experienced ongoing effects due to another person being injured from violence, which has left the person incapacitated.
25. Relationship with Primary Caregiver
The Primary Caregiver is the primary adult who has caregiver responsibilities, and who is included on the service plan. How do the youth and primary caregiver get along? Are there problems between youth and primary caregiver? How is the communication between the youth and the caretaker? Has there ever been any violence0- No action needed. The relationship is positive.
1 – Let’s watch/Wait. Youth and the caregiver have some mild relationship problems. Youth may have mild attachment problems with the caregiver. Youth has some inability to turn to this caregiver for comfort and/or guidance.
2 – Help is needed. Youth has a negative relationship with this caregiver. The youth has some attachment difficulties where they can’t turn to the primary caregiver for comfort and/or guidance. Communication is limited.
3 – Help is needed now/immediately. There is no ongoing relationship or there is an unstable relationship with the primary caregiver. Youth appears to be unable to attach to this caregiver. Violence between youth and primary caregiver has occurred.
NA- Youth is living in a congregate care environment.
Has youth had any difficulty with getting to or staying in school? Has the teacher or other school staff called you to talk about your youth’s behavior? How is the youth doing academically in school? Is youth having difficulty with any subjects? Is youth at risk of failing any classes?
0 – No evidence that action is needed. Youth is doing well and meeting expectations at school.
1 – Let’s Watch/Prevent. Youth may have some difficulties with getting to school, youth is passing most classes, and/or youth may have some conflict with peers/staff. Overall, youth is doing okay.
2 – Help is needed. Youth misses days at school, is doing poorly with grades/failing some subjects, and/or youth is having behavioral problems.
3 – Help is needed now/immediately. Youth is often truant or has dropped out of school. Youth is at risk of being expelled due to their behavior and/or being held back due to their grades.
NA – Youth has yet to begin school due to age or has graduated/received GED.
27. Medical/Physical Health
Does youth have any physical limitations (such as asthma where child cannot go to gym, or needs an inhaler)? Does the youth wear glasses? Are there any activities youth cannot do because of a physical or medical condition? How much does this interfere with his/her life?
0 – No action needed. Youth is physically fit and healthy.
1 – Let’s Watch/Prevent. Youth has some physical and/or medical problems and cannot do some activities or child has impaired hearing or vision.
2 – Help is needed. Youth has physical/medical problems that stop him/her from doing many activities, including blindness, deafness, or significant motor difficulties.
3 – Help is needed now/immediately. Youth has serious physical/medical problems that cause severe physical limitations.
Does youth’s development seem healthy? Has he/she reached appropriate developmental milestones (such as, walking, talking)? Has anyone ever said the youth may have developmental problems? Has the youth developed like others his/her age? Does youth receive additional help or receive special education services at school0- No action needed. Youth is up to speed with the other kids his/her age.
1 – Let’s watch/prevent. Youth is a little immature/acts younger than other youth his/her age; or youth has low IQ or a learning disability.
2 – Help is needed. Youth has limited abilities, is mildly delayed, or is intellectually disabled.
3 – Help is needed now/immediately. Youth has severe developmental delay(s) and/or intellectual disabilities. Youth has serious impairments and needs help to function daily.
29. Mental Health
Has the youth ever been to therapy or a psychiatrist? Has the youth ever been prescribed medicines for their mood or behavior? Is youth able to sit still for any length of time? Does youth act depressed or irritable? Does youth act frightened, afraid, or appear to worry a lot? Does youth seem to have trouble controlling his/her emotions? Does youth get upset or frustrated easily, or become physical when angry? Has youth ever talked about hearing, seeing or feeling something that others could not?
0 – No action needed. Youth is emotionally stable and has no mental health challenges.
1 -Let’s watch/wait. Youth has mild problems with moods or emotions; or youth is recovering from some emotional problems and is not required any medication.
2 – Help is needed. Youth has some emotional challenges or mental health diagnoses that sometimes make it difficult to function.
3 – Help is needed now/immediately. Youth has emotional challenges or mental health disorders, and they are unable to function in most areas of their life. Youth may require/is hospitalized for their emotional challenges.
30. Substance Use
Has youth ever used alcohol or any kind of substances/drugs? Is youth currently using any type of alcohol or substances/drugs? Does the youth use tobacco products? If youth uses alcohol or any substances, what type, how often, and for how long? Does the youth’s use of substance cause any problems for him/her? Can youth pass a drug test today
0 – No Action. There is no evidence that youth has ever used substances.
1 – Watch/try to prevent. Youth has a history of substance use, or others have a suspicion that the youth uses substances. Nicotine[AF8] or marijuana use would be scored here.
2 – Help is needed. Youth actively uses alcohol or drugs, but not daily. Substance use causes some problems for the youth or others.
3 – Help is needed now/immediately. Youth uses alcohol and/or drugs on a daily basis. Youth may require detoxification or is addicted to alcohol and/or drugs.
31. High Risk Behavior
Does the youth have suicidal thoughts or has the youth ever attempted suicide? How long ago? Is youth aggressive to themselves (cutting /burning themselves, etc.) or others (hitting, punching, kicking, homicidal thoughts)? Does the youth engage in reckless activities or activities that could end up hurting him/herself or others? Does youth ever runaway? Set fires? Does the youth have sexually reactive or sexually aggressive behaviors? Does the youth try to push adult’s buttons, knowing that it will lead to consequences? Does the youth engage in delinquent behaviors
0 – No Action. There is no evidence of high risk behaviors.
1 – Let’s watch/try to prevent. Youth has a history of high risk behaviors or others have suspicions that the youth engages in high risk behaviors.
2 – Help is needed. In the past 30 days, youth has engaged in behaviors that are high risk.
3 – Help is needed now/immediately. In the past 30 days, youth has engaged in behaviors that are high risk and have put self or others at risk of harm.
Has the youth ever run away? If so, when was the last occurrence and what was the duration of the flight? Where has the youth run to?
0 – No current need; no need for action or intervention Youth has no history of running away or ideation of escaping from current living situation.
1 – Identified need requires monitoring, watchful waiting, or preventive activities Youth has no recent history of running away but has not expressed ideation about escaping current living situation. Youth may have threatened running away on one or more occasions or has a history of running away but not in the recent past.
2 – Action or intervention is required to ensure that the identified need is addressed; need is interfering with youth’s functioning. Youth has run from home once or run from one treatment setting. Also rated here is a youth who has runaway to home (parental or relative).
3 – Problems are dangerous or disabling; requires immediate and/or intensive action Youth has run from home and/or treatment settings in the recent past and present an imminent flight risk. A youth who is currently a runaway is rated here.