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NEW HAMPSHIRE
CHILD & ADOLESCENT NEEDS AND STRENGTHS ASSESSMENT
(CANS)
An Information Integration Tool
New Hampshire Department of Health and Human Services
Division of Community Based Care Services
Bureau of Behavioral Health
December 2013
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A large number of individuals have collaborated in the development of the CANS. Along
with the CANS versions for developmental disabilities, juvenile justice, and child welfare,
this information integration tool is designed to support individual case planning and the
planning and evaluation of service systems. The CANS is an open domain tool for use in
service delivery systems that address the mental health of children, adolescents and
their families. The copyright is held by the Praed Foundation to ensure that it remains
free to use. For specific permission to use please contact the Praed Foundation. For
more information on the CANS assessment tool contact:
John S. Lyons, Ph.D.
University of Ottawa
Children’s Hospital of Eastern Ontario
401 Smyth Road, R1118
Ottawa, ON
[email protected]
Praed Foundation
550 N. Kingsbury Street, Suite 101
Chicago, IL 60654
[email protected]
www.praedfoundation.org
Copyright, 1999, 2011
The Copyright for the CANS Information Integration Tool is held by the Praed Foundation to ensure that it
remains an open tool, free for anyone to use. Information on guidelines for use and development can be
obtained by contacting the foundation at [email protected]
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TABLE OF CONTENTS
INTRODUCTION ..........................................................................................................7
SIX KEY PRINCIPLES OF THE CANS.................................................................................... 7
RATING NEEDS ................................................................................................................. 7
RATING STRENGTHS ........................................................................................................ 8
CHILD BEHAVIORAL/EMOTIONAL NEEDS .....................................................................9
1. PSYCHOSIS ................................................................................................................... 9
2. ATTENTION/IMPULSE .................................................................................................. 9
3. DEPRESSION ................................................................................................................. 9
4. ANXIETY ..................................................................................................................... 10
5. OPPOSITIONAL BEHAVIOR ......................................................................................... 10
6. CONDUCT BEHAVIOR ................................................................................................. 11
7. ADJUSTMENT TO TRAUMA ........................................................................................ 11
8. SUBSTANCE USE......................................................................................................... 11
9. AUTISM SPECTRUM ................................................................................................... 12
10. ANGER CONTROL ..................................................................................................... 12
11. EATING DISORDER ................................................................................................... 13
12. ATTACHMENT .......................................................................................................... 13
13. REGULATORY: BODY CONTROL/EMOTIONAL CONTROL ......................................... 14
LIFE DOMAIN FUNCTIONING...................................................................................... 14
1. FAMILY ....................................................................................................................... 14
2. LIVING SITUATION ..................................................................................................... 15
3. PEER RELATIONS ........................................................................................................ 15
4. ADULT RELATIONS ..................................................................................................... 16
5. LEGAL ......................................................................................................................... 16
6. ADLS/SELF CARE......................................................................................................... 16
7. SLEEP .......................................................................................................................... 17
8. SEXUAL DEVELOPMENT ............................................................................................. 17
9. SCHOOL ACHIEVEMENT ............................................................................................. 17
10. SCHOOL / DAYCARE BEHAVIOR ............................................................................... 18
11. SCHOOL ATTENDENCE ............................................................................................. 18
12. MEDICAL/PHYSICAL ................................................................................................. 18
13. INTELLECTUAL .......................................................................................................... 18
14. COMMUNICATION ................................................................................................... 19
15. CULTURE .................................................................................................................. 19
CHILD RISK BEHAVIORS ............................................................................................. 19
1. SELF-INJURIOUS BEHAVIOR ....................................................................................... 19
2. OTHER SELF HARM..................................................................................................... 20
3. DANGER TO SELF........................................................................................................ 20
4. DANGER TO OTHERS .................................................................................................. 20
5. SEXUAL AGGRESSION................................................................................................. 21
6. EXPLOITED ................................................................................................................. 21
7. BULLYING ................................................................................................................... 22
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8. ELOPEMENT/RUNAWAY ............................................................................................ 22
9. CRIME/DELINQUENCY ............................................................................................... 23
10. FIRESETTING ............................................................................................................ 23
11. ANIMAL CRUELTY..................................................................................................... 23
12. INTENTIONAL MISBEHAVIOR ................................................................................... 23
13. AGGRESSION ............................................................................................................ 24
CHILD STRENGTHS ..................................................................................................... 24
1. FAMILY ....................................................................................................................... 24
2. PEER SUPPORTS ......................................................................................................... 25
3. ADULT RELATIONSHIPS ........................................ ERROR! BOOKMARK NOT DEFINED.
4. EDUCATIONAL/SCHOOL CONNECTEDNESS ............................................................... 25
5. VOCATIONAL .............................................................................................................. 26
6. TALENTS & INTERESTS ............................................................................................... 26
7. SPIRITUAL/RELIGIOUS ................................................................................................ 27
8. COMMUNITY LIFE/RECREATIONAL ............................................................................ 27
9. RELATIONSHIP PERMANENCE.................................................................................... 27
10. OPTIMISM ................................................................................................................ 28
11. COPING & SAVORING .............................................................................................. 28
12. RESILIENCY ............................................................................................................... 29
13. RESOURCEFULNESS ................................................................................................. 29
14. YOUTH KNOWLEDGE ............................................................................................... 29
CAREGIVER’S STRENGTHS & NEEDS............................................................................ 30
1. SUPERVISION ............................................................................................................. 30
2. INVOLVEMENT ........................................................................................................... 30
3. KNOWLEDGE .............................................................................................................. 30
4. ORGANIZATION.......................................................................................................... 31
5. SOCIAL RESOURCES ................................................................................................... 31
6. RESIDENTIAL STABILITY.............................................................................................. 32
7. PHYSICAL/BEHAVIORAL HEALTH ............................................................................... 32
8. ACCESS TO CHILD CARE ....................................... ERROR! BOOKMARK NOT DEFINED.
9. MILITARY TRANSITIONS ............................................................................................. 32
10. CHILD SAFETY ........................................................................................................... 33
11. FAMILY STRESS......................................................................................................... 33
TRANSITION AGE MODULE (COMPLETE FOR ANY CHILD AGE 16+) ........................................ 34
1. CAREGIVING ROLE ..................................................................................................... 34
2. LIVING SKILLS ............................................................................................................. 34
3. MEDICATION ADHERENCE ......................................................................................... 34
4. EDUCATIONAL ATTAINMENT ..................................................................................... 35
5. PERSONALITY DISORDER/TRAITS ............................................................................... 35
6. JOB FUNCTIONING ..................................................................................................... 36
MODULE 1: TRAUMA................................................................................................. 37
1. SEXUAL ABUSE ........................................................................................................... 37
2. PHYSICAL ABUSE ........................................................................................................ 37
3. EMOTIONAL ABUSE ................................................................................................... 37
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4. MEDICAL TRAUMA..................................................................................................... 37
5. NATURAL DISASTER ................................................................................................... 38
6. WITNESS TO FAMILY VIOLENCE ................................................................................. 38
7. WITNESS TO COMMUNITY VIOLENCE ....................................................................... 38
8. WITNESS TO CRIMINAL ACTS ..................................................................................... 38
9. WAR AFFECTED .......................................................................................................... 39
10. TERRORISM AFFECTED............................................................................................. 39
11. EMOTIONAL CLOSENESS TO PERPETRATOR ............................................................ 40
12. FREQUENCY OF ABUSE ............................................................................................ 40
13. DURATION................................................................................................................ 40
14. FORCE ...................................................................................................................... 40
15. REACTION TO DISCLOSURE ...................................................................................... 40
16. AFFECT REGULATION ............................................................................................... 41
17. INTRUSIONS ............................................................................................................. 41
18. ATTACHMENT .......................................................................................................... 41
19. DISSOCIATION .......................................................................................................... 42
20. HYPERAROUSAL ....................................................................................................... 43
MODULE 2: SUBSTANCE USE ...................................................................................... 43
1. SEVERITY OF USE........................................................................................................ 43
2. DURATION OF USE ..................................................................................................... 44
3. STAGE OF RECOVERY ................................................................................................. 44
4. PEER INFLUENCES ...................................................................................................... 44
5. PARENTAL INFLUENCES ............................................................................................. 44
6. ENVIRONMENTAL INFLUENCES ................................................................................. 45
MODULE 3: LEGAL ..................................................................................................... 45
1. SERIOUSNESS ............................................................................................................. 45
2. HISTORY ..................................................................................................................... 45
3. ARRESTS ..................................................................................................................... 45
4. PLANNING .................................................................................................................. 46
5. COMMUNITY SAFETY ................................................................................................. 46
6. LEGAL COMPLIANCE .................................................................................................. 46
7. PEER INFLUENCES ...................................................................................................... 46
8. PARENTAL INFLUENCES ............................................................................................. 47
9. ENVIRONMENTAL INFLUENCES ................................................................................. 47
MODULE 4: ACCULTURATION .................................................................................... 47
1. LANGUAGE ................................................................................................................. 47
2. IDENTITY .................................................................................................................... 48
3. RITUAL........................................................................................................................ 48
4. CULTURAL STRESS ...................................................................................................... 48
MODULE 5: DANGER TO SELF ..................................................................................... 49
1. SUICIDE RISK .............................................................................................................. 49
2. IDEATION ................................................................................................................... 49
3. INTENT ....................................................................................................................... 49
4. PLANNING .................................................................................................................. 49
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5. HISTORY ..................................................................................................................... 50
MODULE 6: DANGER TO OTHERS ............................................................................... 50
1. FRUSTRATION MANAGEMENT .................................................................................. 50
2. HOSTILITY ................................................................................................................... 50
3. PARANOID THINKING................................................................................................. 50
4. SECONDARY GAINS FROM ANGER............................................................................. 51
5. VIOLENT THINKING .................................................................................................... 51
6. AWARENESS OF VIOLENCE POTENTIAL ..................................................................... 51
7. RESPONSE TO CONSEQUENCES ................................................................................. 52
8. COMMITMENT TO SELF-CONTROL ............................................................................ 52
9. TREATMENT INVOLVEMENT ...................................................................................... 52
MODULE 7: SEXUALLY AGGRESSIVE BEHAVIOR .......................................................... 53
1. RELATIONSHIP............................................................................................................ 53
2. PHYSICAL FORCE/THREAT .......................................................................................... 53
3. PLANNING .................................................................................................................. 53
4. AGE DIFFERENTIAL ..................................................................................................... 53
5. TYPE OF SEX ACT ........................................................................................................ 54
6. RESPONSE TO ACCUSATION ...................................................................................... 54
7. TEMPORAL CONSISTENCY.......................................................................................... 54
8. HISTORY OF SEXUAL BEHAVIOR (TOWARD OTHERS) ................................................ 54
9. SEVERITY OF SEXUAL ABUSE ...................................................................................... 55
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INTRODUCTION
The CANS is a multiple purpose information integration tool that is designed to be the
output of an assessment process. The purpose of the CANS is to accurately represent
the shared vision of the child serving system—children and families. As such, completion
of the CANS is accomplished in order to allow for the effective communication of this
shared vision for use at all levels of the system. Since its primary purpose is
communication, the CANS is designed based on communication theory rather than the
psychometric theories that have influenced most measurement development. There are
six key principles of a communimetric measure that apply to understanding the CANS.
SIX KEY PRINCIPLES OF THE CANS
1. Items were selected because they are each relevant to service/treatment
planning. An item exists because it might lead you down a different pathway in
terms of planning actions.
2. Each item uses a 4-level rating system. Those levels are designed to translate
immediately into action levels. Different action levels exist for needs and
strengths. For a description of these action levels please see below.
3. Rating should describe the child, not the child in services. If an intervention is
present that is masking a need, but must stay in place, this should be factored
into the rating consideration and would result in a rating of an “actionable” need
(e.g., “2” or “3”).
4. Development and culture should be considered prior to establishing the action
levels. Ratings should be completed considering the child’s developmental
and/or chronological age depending on the item. In other words, anger control is
not relevant for a very young child, but would be for an older child regardless of
developmental age. Alternatively, school achievement should be considered
within the framework of expectations based on the child’s developmental age.
Cultural sensitivity involves considering whether cultural factors are influencing
the expression of needs and strengths.
5. The ratings are generally “agnostic as to etiology.” In other words this is a
descriptive tool. It is about the “what” not the “why.” Only one item, Adjustment
to Trauma, has any cause-effect judgments.
6. A 30-day window is used for ratings in order to make sure assessments stay
“fresh” and relevant to the child or child’s present circumstances. However, the
action levels can be used to over-ride the 30-day rating period.
RATING NEEDS
0 – No Evidence of Need – This rating indicates there is no reason to believe a particular
need exists. Based on current assessment information there is no reason to assume this
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is a need. For example, “does Johnny smoke weed?” He says he doesn’t, his mother says
he doesn’t, no one else has expressed any concern – does this mean Johnny is not
smoking weed? NO, but we have no reason to believe that he does and we would
certainly not refer him to programming for substance related problems.
1 - Watchful Waiting/Prevention – This level of rating indicates that you need to keep
an eye on this area or think about putting in place some preventive actions to make sure
things do not get worse (e.g., a child who has been suicidal in the past). We know that
the best predictor of future behavior is past behavior, and that such behavior may recur
under stress, so we would want to keep an eye on it from a preventive point of view.
2 - Action Needed – This level of rating implies that something must be done to address
the identified need. The need is sufficiently problematic and is interfering in the child’s
or family’s life in a notable way.
3 - Immediate/Intensive Action Needed – This level rating indicates a need that
requires immediate or intensive effort to address. Dangerous or disabling levels of need
are rated with this level. A child who is not attending school at all or an acutely suicidal
child would be rated with a “3” on the relevant need.
RATING STRENGTHS
0 - Centerpiece Strength. This rating indicates a domain where strengths exist that can
be used as a centerpiece for a strength-based plan. In other words, the strength-based
plan can be organized around a specific strength in this area.
1 - Useful Strength. This rating indicates a domain where strengths exist and can be
included in a strength-based plan, but not as a centerpiece of the plan.
2 - Identified Strength. This rating indicates a domain where strengths have been
identified, but they require significant strength building efforts before they can be
effectively be utilized in a strength-based plan.
3 - No Strength Identified. This rating indicates a domain in which efforts are needed in
order to identify potential areas for strength building efforts.
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CHILD BEHAVIORAL/EMOTIONAL NEEDS
1. PSYCHOSIS
This rating is used to describe symptoms of psychiatric disorders with a known
neurological base. The common symptoms of these disorders include psychosis,
hallucinations, delusions, unusual thought processes, strange speech, and
bizarre/idiosyncratic behavior.
Ratings Anchor Definitions
0
This rating indicates a child with no evidence of thought disturbances. Both
thought process and content are within normal range.
1
This rating indicates a child with evidence of mild disruption in thought process
or content. The child may be somewhat tangential in speech or evidence
somewhat illogical thinking (age inappropriate). This also includes a history of
hallucinations, but none currently.
2
This rating indicates a child with evidence of moderate disturbance in thought
process or content. The child may be somewhat delusional, have brief
intermittent hallucinations or speech may be at times quite tangential or
illogical.
3
This rating indicates a child with a severe psychotic disorder. Child is fully
delusional, has ongoing hallucinations, high levels of paranoia. Unable to
engage in meaningful conversation. Symptoms are dangerous to the child or
others.
2. ATTENTION/IMPULSE
Symptoms of attention deficit and hyperactivity and/or impulse control would be rated
here. Inattention/distractibility not related to opposition would also be rated here.
Ratings Anchor Definitions
0
This rating is used to indicate a child with no evidence of impulse/hyperactivity
problems.
1
This rating is used to indicate a child with evidence of mild problems of
attention/hyperactivity. Child may have some difficulties staying on task for an
age appropriate time period.
2
This rating is used to indicate a child with moderate impulse/hyperactivity
problems that interfere with functioning.
3
This rating is used to indicate a child with severe loss of control of behavior.
Frequent impulsive behavior is observed and carries considerable safety risk
(e.g., running into the street, dangerous driving or bike riding). A child with
profound symptoms of ADHD would be rated here.
3. DEPRESSION
Symptoms included in this dimension are symptoms of depressed mood including sadness
or irritability.
Ratings Anchor Definitions
9
0
1
2
3
This rating is given to a child with no mood problems. No evidence of
depression.
This rating is given to a child with mild depression. This would include brief
duration of depression, irritability, or impairment of peer, family, or academic
function that does not lead to gross avoidance or inappropriate behavior.
This rating is given to a child with a moderate level of depression. This would
include anhedonia, episodes of mania, depression, social withdrawal or school
avoidance.
This rating is given to a child with a severe level of depression. This would
include a child whose emotional symptoms prevent appropriate participation
in school, friendship groups, or family life.
4. ANXIETY
Symptoms included in this dimension are those of social anxiety, obsessive-compulsive
disorder, panic attacks, phobias, and separation anxiety.
Ratings Anchor Definitions
0
This rating is given to a child with no emotional problems. No evidence of
anxiety.
1
This rating is given to a child with mild emotional problems. This would include
brief duration of anxiety causing mild impairment of peer, family, or academic
function that does not lead to gross avoidance behavior.
2
This rating is given to a child with a moderate level of emotional disturbance.
This could include frequent anxiety attacks, obsessions, rituals, or
hypervigilance, leading to impairment in functioning and social/school
avoidance.
3
This rating is given to a child with a severe level of emotional disturbance. This
would include a child who stays at home all day due to anxiety or one whose
emotional symptoms prevent any participation in school, friendship groups, or
family life.
5. OPPOSITIONAL BEHAVIOR
This rating is intended to capture how the child relates to authority. Oppositional
behavior is different from conduct disorder in that the emphasis of the behavior is on
non-compliance to authority rather than on seriously breaking social rules, norms and
laws.
Ratings Anchor Definitions
0
This rating indicates that the child is generally compliant.
1
This rating indicates that the child has mild problems with compliance to some
rules or adult instructions.
2
This rating indicates that the child has moderate problems with compliance to
rules or adult instructions.
3
This rating indicates that the child has severe problems with compliance to
rules and adult instructions. He/she would be almost always disobedient.
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6. CONDUCT BEHAVIOR
These symptoms include antisocial behaviors like shoplifting, lying, vandalism, cruelty to
animals, and assault.
Ratings Anchor Definitions
0
This rating indicates a child with no evidence of behavior disorder.
1
This rating indicates a child with a mild level of conduct problems. Some
antisocial behavior in school and/or home. Problems are recognizable, but not
notably deviant for age, sex, and community. This might include occasional
truancy, lying, or petty theft from family.
2
This rating indicates a child with a moderate level of conduct disorder. This
could include episodes of planned aggressive or other anti-social behavior.
3
This rating indicates a child with a severe antisocial behavior. This could include
frequent episodes of unprovoked, planned aggressive or other anti-social
behavior.
7. ADJUSTMENT TO TRAUMA
This rating covers the reactions of children and adolescents to any life experience that the
child/adolescent perceives as traumatic. This includes events such as abuse, neglect
and/or loss of a significant relationship, separation from family, death of family member
or witnessing violence. Adjustment disorders feature a psychological response to a single
or multiple identifiable stressors that results in the development of clinically significant
emotional and/or behavioral symptoms.
Ratings Anchor Definitions
0
Child has not experienced any significant traumatic life events.
1*
History of abuse, neglect, separation or loss to which child has adjusted well.
Child does not show any current significant physical or emotional impairment.
2*
Child has marked adjustment problems associated with past or ongoing abuse,
neglect, trauma or stressor. Child has notable symptoms of grief, depression,
anxiety or disturbances in conduct related to adjustment difficulties. May
experience intrusive thoughts related to trauma or flashbacks.
3*
Child functioning is severely impaired by prolonged or severe levels of grief,
depression, anxiety or disturbances in conduct directly related to abuse,
trauma or stressors experienced. Frequent and debilitating flashbacks or
dissociative episodes would be rated here.
* This rating triggers completion of extension module #1 “Adjustment to Trauma”
8. SUBSTANCE USE
These symptoms include use of alcohol and illegal drugs, the misuse of prescription
medications and the inhalation of any substance for recreational purposes.
Ratings Anchor Definitions
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0
This rating is for a child who has no substance use difficulties at the present
time. If the child is in recovery for greater than 1 year, they should be coded
here, although this is unlikely for a child or adolescent.
1*
This rating is for a child with mild substance use problems that might
occasionally present problems for the child (intoxication, loss of memory,
reduced school performance, parental concern). This rating would be used for
a child early in recovery (less than 1 year) who is currently abstinent for at least
30 days.
2*
This rating is for a child with a moderate substance abuse problem that both
requires treatment and interacts with and exacerbates the psychiatric illness.
Substance abuse problems consistently interfere with the ability to function,
but do not completely preclude functioning in an unstructured setting.
3*
This rating is for a child with a severe substance dependence condition that
presents a significant complication to the coordination of care (e.g., need for
detoxification) of the child.
* This rating triggers completion of extension module #2 “Substance Use”
9. AUTISM SPECTRUM
This rating describes symptoms of pervasive developmental disorders.
Ratings Anchor Definitions
0
No evidence of a pervasive developmental disorder.
1
Evidence of a mild pervasive developmental disorder. A child may have
symptoms of a developmental disorder, but those symptoms are below the
threshold for a PDD diagnosis and do not have a significant effect on the child’s
development.
2
This rating indicates a child who meets criteria for a pervasive developmental
disorder including Autism, Aspergers, PDD NOS, Rett’s, and Child Disintegrative
Disorder. This child’s development creates significant challenges.
3
Severe pervasive developmental disorder. Child is unable to meet
developmental milestones.
10. ANGER CONTROL
This item captures the child’s ability to identify and manage their anger or to use his/her
anger in destructive ways with others.
Ratings Anchor Definitions
0
This rating is for a child with no evidence of any significant anger control
problems.
1
This rating indicates a child with some problems with controlling anger. He/she
may sometimes become verbally aggressive when frustrated. Peers and family
members are aware of and may attempt to avoid stimulating angry outbursts.
Child may have a history of physical aggression arising from inability to control
anger, but none within the last 3 months.
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2
3
This rating indicates a child with moderate anger control problems. His/her
temper has resulted in significant trouble with peers, family, and/or school.
This level may be associated with some physical violence, or increasing verbal
outbursts. Others are likely quite aware of anger potential.
This rating indicates a child with severe anger control problems. His/her
temper is likely associated with frequent fighting that is often physical. Others
likely fear him/her.
11. EATING DISORDER
These symptoms relate to problems with eating including disturbances in appetite and
intake as well as eating disturbances related to body image (e.g., refusal to maintain
normal body weight, recurrent episodes of binge eating, or purging).
Ratings Anchor Definitions
0
This rating is for a child with no evidence of eating disturbances.
1
This rating is for a child with a mild level of eating disturbance. This includes a
child that has a poor appetite or is a picky eater or a child that frequently
overeats. This could also include some preoccupation with weight, calorie
intake, body size, or type. This could also include some binge eating patterns.
2
This rating is for a child with a moderate level of eating disturbance. This
includes a child whose appetite/intake or lack thereof requires intervention
(refuses to eat, consistently overeating). This could also include a more intense
preoccupation with weight gain or becoming fat when underweight, restrictive
eating habits or excessive exercising in order to maintain below normal weight,
and/or emaciated body appearance. This level could also include more notable
binge eating episodes that are followed by compensatory behaviors in order to
prevent weight gain (e.g., vomiting, use of laxatives, excessive exercising).
3
This rating is for a child with a more severe form of an eating disturbance. This
could include significantly low weight/restricted intake/or excessive bingepurge behaviors (at least once per day), leading to a need for hospitalization.
12. ATTACHMENT
Please rate based on the last 30 days.
Ratings Anchor Definitions
0
No evidence of problems with attachment.
1
Mild problems with attachment are present. Children may appear
uncomfortable with caregivers, may resist touch, or appear anxious and clingy
some of the time. Caregivers feel disconnected from child. Older children may
seem overly reactive to separation or seem preoccupied with parent.
Boundaries may seem inappropriate with others.
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2
3
Moderate problems with attachment are present. Children may fail to
demonstrate stranger anxiety or have extreme reactions to separation
resulting in interference with development. Older children may have ongoing
problems with separation, may consistently avoid caregivers and have
inappropriate boundaries with others putting them at risk.
Severe problems with attachment are present. Infant is unable to use
caregivers to meet needs for safety and security. Older children present with
either an indiscriminate attachment pattern or a withdrawn inhibited
attachment pattern. A child that meets the criteria for Reactive Attachment
Disorder would be rated here.
13. REGULATORY: BODY CONTROL/EMOTIONAL CONTROL
This item refers to the child’s ability to control bodily functions such as eating, sleeping,
and elimination, as well as activity level/intensity and sensitivity to external stimulation.
The child’s ability to control and modulate intense emotions is also rated here. Please
rate based on the past 30 days.
Ratings Anchor Definitions
0
No evidence of regulatory problems.
1
Some problems with regulation are present. Infants may have unpredictable
patterns and be difficult to console. Older children may require a great deal of
structure and need more support than other children in coping with frustration
and difficult emotions.
2
Moderate problems with regulation are present. Infants may demonstrate
significant difficulties with transitions, and irritability such that consistent adult
intervention is necessary and disruptive to the family. Older children may
demonstrate severe reactions to sensory stimuli and emotions that interfere
with their functioning and ability to progress developmentally. Older children
may demonstrate such unpredictable patterns in their eating and sleeping
routines that the family is disrupted and distressed. Infant may be difficult to
sooth or may have difficulty with feeding.
3
Profound problems with regulation are present that place the child’s safety,
well being and/or development at risk.
LIFE DOMAIN FUNCTIONING
1. FAMILY
The definition of family should be from the perspective of the child (e.g., those individuals
who the child considers to be family). The family can include all biological relatives with
whom the child remains in some contact and individuals with relationship ties to these
relatives.
Ratings Anchor Definitions
14
0
1
2
3
The child’s family appears to be functioning adequately. There is no evidence
of problems in the family.
There is a mild to moderate level of family problems, including marital
difficulties or problems with siblings.
There is a significant level of family problems including frequent arguments,
separation and/or divorce, or siblings with significant mental health or juvenile
justice problems.
There is a profound level of family disruption including significant parental
substance abuse, criminality, or domestic violence.
2. LIVING SITUATION
This item describes how the child is functioning in the place where they live (e.g. where
head hits pillow). This might include a foster home, a group home or a residential
treatment center.
Ratings Anchor Definitions
0
No evidence of problems with functioning in current living environment.
1
Mild problems with functioning in current living situation. Caregivers
concerned about child’s behavior at home.
2
Moderate to severe problems with functioning in current living situation. Child
has difficulties maintaining his/her behavior in this setting creating significant
problems for others in the residence.
3
Profound problems with functioning in current living situation. Child is at
immediate risk of being removed from living situation due to his/her behaviors.
3. PEER RELATIONS
This item describes the child’s interactions with others. Evidence of problems in this
domain may include difficulties responding to peers, difficulty interacting with peers or in
social situations, lack of ability to play in groups, relate, or interact in a meaningful
manner, unresponsiveness to or unawareness of others, excessive arguing with peers,
excessive withdrawal, lack of joy or sustained interaction, aggression, etc.
Ratings Anchor Definitions
0
No evidence of problems in social functioning with same age peers.
1
The child is having some minor problems in social relationships with same age
peers.
2
The child is having moderate problems with his/her social relationships with
same age peers.
3
The child is experiencing severe disruptions in his/her social relationships,
showing an inability to interact in a meaningful manner with same age peers.
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4. ADULT RELATIONS
This item describes the child’s interactions with others. Evidence of problems in this
domain may include difficulties responding to adults, difficulty interacting with adults or
in social situations, lack of ability to relate, or interact in a meaningful manner,
unresponsiveness to or unawareness of others, excessive arguing with adults, excessive
withdrawal, lack of joy or sustained interaction, aggression, etc.
Ratings Anchor Definitions
0
No evidence of problems in social functioning with non-family adults.
1
The child is having some minor problems in social relationships with non-family
adults.
2
The child is having moderate problems with his/her social relationships with
non-family adults.
3
The child is experiencing severe disruptions in his/her social relationships,
showing an inability to interact in a meaningful manner with non-family adults.
5. LEGAL
This item describes the degree to which the child is court involved based on his/her own
behavior (e.g. juvenile justice).
Ratings Anchor Definitions
0
Child has no known legal difficulties.
1*
Child has a history of legal problems, but currently is not involved with the legal
system.
2*
Child has some legal problems and is currently involved in the legal system.
3*
Child has serious current or pending legal difficulties that place him/her at risk
for a court ordered out of home placement.
* This rating triggers completion of extension module #3 “Legal”
6. ADLS/SELF CARE
This item rates the ability of the child to perform activities of daily living (e.g., self-care,
including feeding, bathing, dressing, grooming, work, home-making, and leisure
activities).
Ratings Anchor Definitions
0
No evidence of problems with activities of daily living. The child is fully
independent across these areas, is developmentally appropriate.
1
Mild problems with activities of daily living. The child is generally good with
such activities, but may require some adult support to complete some specific
developmentally appropriate activities.
2
Moderate problems with activities of daily living. The child has difficulties with
developmentally appropriate activities.
3
Severe problems with activities of daily living. The child requires significant and
consistent adult support to complete developmentally appropriate activities.
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7. SLEEP
This rating applies to the child’s sleep pattern over the last 30 days.
Ratings Anchor Definitions
0
The child gets a full night of sleep each night.
1
The child has some problems sleeping. Generally gets a full night of sleep, but
has some sleep disturbances related to difficulty falling asleep, staying asleep,
nightmares or bedwetting.
2
The child has frequent problems with sleep. Sleep is often disrupted and the
child seldom obtains a full night of sleep.
3
The child has a persistent problem with sleep. Sleeping is difficult for the child
and he/she is rarely able to get a full night of sleep.
8. SEXUAL DEVELOPMENT
This rating describes issues related to sexual behavior including developmentally
inappropriate sexual behavior and problematic sexual behavior - not as perpetrator.
Ratings Anchor Definitions
0
Child shows no evidence of problems with sexual behavior in the past year.
1
Mild problems. For example, occasional inappropriate sexual behavior or
language, provocative dress, or language. Mild forms of sexualized behavior
might be rated here. Poor boundaries with regard to physical/sexual contact.
2
Moderate to serious problems. For example, frequent inappropriate sexual
behavior or disinhibition, including public disrobing or multiple older sexual
partners or frequent sexualized language. Age inappropriate sexualized
behaviors or experimentation or lack of physical/sexual boundaries would be
rated here.
3
Severe problems. Prostitution, exhibitionism, or other severe sexualized
behavior would be rated here.
9. SCHOOL ACHIEVEMENT
This item describes academic achievement based on school grades and compares this
child to other classmates in his/her school, taking into consideration if the child has an
Individual Education Plan (IEP), rather than comparing to national norms.
Ratings Anchor Definitions
0
The child is doing adequate in school.
1
The child struggles with some academics, but is passing with a C average and
no failed classes.
2
The child is having problems in school. He/she has a C average, but is failing
one subject.
3
The child is having severe academic problems. He/she is failing more than one
subject or is more than a year behind his/her peers at his/her school in
academic achievement.
17
10. SCHOOL / DAYCARE BEHAVIOR
This item describes the behavior of the child in school/daycare.
Ratings Anchor Definitions
0
No evidence of behavior problems at school/daycare. Child is behaving well.
1
Mild problem with school/daycare behavioral problems (e.g., sent out of class
or occasional detentions). Or, a child with an identified behavior problem who
is behaving well at school/daycare with supports in place would be rated here.
2
Child is having moderate behavioral difficulties at school/daycare. He/she is
disruptive and may receive sanctions including suspensions.
3
Child is having severe problems with behavior in school/daycare. He/she is
frequently or severely disruptive. School/daycare placement may be in
jeopardy due to behavior.
11. SCHOOL ATTENDENCE
This item describes the child’s attendance at school. If it is a vacation period, rate last
period where attendance was expected.
Ratings Anchor Definitions
0
No evidence of attendance problems. The child attends regularly.
1
The child has some problems attending school, although he/she generally goes
to school. He/she may have one or two excused absences per month.
2
The child is currently having problems with school attendance. He/she may
have one or two unexcused absences in a month.
3
The child is missing school on a weekly basis or more, whether excused or
unexcused.
12. MEDICAL/PHYSICAL
This rating describes both health problems and chronic/acute physical conditions.
Ratings Anchor Definitions
0
Child appears physically healthy. There is no reason to believe that the child
has any medical or physical problems.
1
Mild or well-managed physical or medical problems. This might include wellmanaged chronic conditions like juvenile diabetes or asthma.
2
Chronic physical or moderate medical problems.
3
Severe, life threatening physical or medical problems.
13. INTELLECTUAL
This rating describes the child's cognitive/intellectual functioning.
Ratings Anchor Definitions
0
The child’s intellectual functioning appears to be in normal range. There is no
reason to believe that the child has any problems with intellectual functioning.
1
Borderline to low average IQ (IQ between 70 and 85).
2
Mild to moderate delayed intellectual functioning (IQ between 50 and 70).
3
Severe or profound delayed intellectual functioning (IQ less than 50).
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14. COMMUNICATION
This item describes learning challenges involving receptive or expressive language.
Ratings Anchor Definitions
0
Child's receptive and expressive communication appears developmentally
appropriate. There is no reason to believe that the child has any problems
communicating.
1
Child has receptive communication skills, but limited expressive
communication skills.
2
Child has both limited receptive and expressive communication skills.
3
Child is unable to communicate.
15. CULTURE
This item describes any challenges involving culture including language, identity, access
to ritual in support of identify or stress from other’s reactions to the child’s cultural
identity.
Ratings Anchor Definitions
0
Child and family are acculturated.
1*
Child and family have some cultural differences resulting in their primary
environment that have created challenges in the past or might lead to future
challenges.
2*
Child and or significant family members have notable cultural differences
resulting in their primary environment that currently lead to functional
problems.
3*
Child and or significant family members have notable cultural differences in
their primary environment that are causing profound difficulties for the child
and/or family.
* This rating triggers completion of extension module #4 “Culture”
CHILD RISK BEHAVIORS
1. SELF-INJURIOUS BEHAVIOR
This rating is used for any intentional self-harming behavior that does not have a suicidal
intent. A rating of 3 indicates need for a safety plan.
Ratings Anchor Definitions
0
No history of self-injuring behavior.
1
A history of self-injuring behavior, but none within the past 30 days or minor
self-injuring behavior (e.g., scratching) in the last 30 days that does not require
any medical attention.
2
Moderate self-injuring behavior in the last 30 days requiring medical
assessment (cutting, burns, piercing skin with sharp objects, repeated head
banging) that has potential to cause safety risk to child.
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3
One or more incidents of self-injuring behavior in the last 30 days requiring
medical intervention (e.g., sutures, surgery) and that is significant enough to
put child’s health at risk.
2. OTHER SELF HARM
This item refers to reckless behavior that results or would likely result in physical harm.
Ratings Anchor Definitions
0
No evidence of behaviors (other than suicide or self-mutilation) that place the
child at risk of physical harm.
1
History of behavior (other than suicide or self-mutilation) that places child at
risk of physical harm. This includes reckless and risk-taking behavior that may
endanger the child.
2
Child has engaged in behavior (other than suicide or self-mutilation) that places
him/her in danger of physical harm. This includes reckless behavior or
intentional risk-taking behavior.
3
Child has engaged in behavior (other than suicide or self-mutilation) that places
him/her at immediate risk of death. This includes reckless behavior or
intentional risk-taking behavior.
3. DANGER TO SELF
A rating of ‘2’ or ‘3’ would indicate the need for a safety plan.
Ratings Anchor Definitions
0
No evidence or history of suicidal or self-injurious behaviors.
1*
The child has a history of suicidal or self-injurious behavior, but no selfinjurious behavior during the past 30 days.
2*
The child has expressed recent (last 30 days), but not acute (today) suicidal
ideation or gesture. Self-injurious behavior in the past 30 days (including
today) without suicidal ideation or intent.
3*
Current suicidal ideation and intent in the past 24 hours.
* This rating triggers completion of extension module #5 “Danger to Self”
4. DANGER TO OTHERS
This rating includes actual and threatened violence. Imagined violence, when extreme,
may be rated here. A rating of 2 or 3 would indicate the need for a safety plan.
Ratings Anchor Definitions
0
Child has no evidence or history of aggressive behaviors or significant verbal
aggression toward others (including people and animals).
1*
History of aggressive behavior or verbal aggression toward others, but no
aggression during the past 30 days. History of fire setting (not in past year)
would be rated here, or a child who communicates passive homicidal ideation
without clear intent or plan.
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2*
Occasional or moderate level of aggression towards others during the past 30
days. Or a child with no defined plan, but who has constant intrusive,
ruminating thoughts of homicide or extreme violence.
3*
Frequent or dangerous (significant harm) level of aggression to others. Any fire
setting within the past year would be rated here. Child is an immediate risk to
others. Verbalization of homicidal ideation with clear intent, means and/or a
plan.
* This rating triggers completion of extension module #6 “Danger to Others”
5. SEXUAL AGGRESSION
Sexually aggressive behavior includes both abusive sexual behavior and sexual behavior
in which the child or adolescent takes advantage of a younger or less powerful child
through seduction, coercion, or force. This rating refers to perpetrating the sexual
behavior.
Ratings Anchor Definitions
0
No evidence of problems with sexual behavior in the past year.
1*
Mild problems of sexually aggressive behavior. For example, some
inappropriate and aggressive sexual behavior or language directed at others,
without physical contact.
2*
Moderate problems with sexually abusive behavior, inappropriate sexual
behavior and language causing significant distress and/or discomfort for
others. Frequent disrobing would be rated here, if it was sexually provocative.
3*
Severe problems with sexual aggression/behavior. Unwanted or coerced sexual
activity would be rated here. This would include rape or sexual abuse of
another person.
* This rating triggers completion of extension module #7 “Sexual Aggression”
6. EXPLOITED
This refers to manipulation of the child to perform exploitive acts that serve only the
interests of the adult without concern for consequences for the child.
Ratings Anchor Definitions
0
No exploitation. Child is treated fairly and respectfully and engages in
appropriate responsibilities for household maintenance.
1
Mild level of exploitation. Child is asked to perform chores or errands that
serve only the interest of the adult, with no emotional harm or intent to do
harm. This may include running personal errands or occasionally performing
age inappropriate household responsibilities.
2
Moderate level of exploitation. Child is consistently asked to perform
inappropriate responsibilities that serve adult needs without concern for
physical or emotional consequences for the child. This may include assuming
consistently inappropriate responsibilities for sibling care or other household
responsibilities. Victimization by a bully that is interfering with functioning
would be rated here.
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3
Severe level of exploitation. This may include involvement in criminal activity
directed or supervised by adults, or involvement in sexual exploitation.
7. BULLYING
This item refers to the child who is the bully. The item describes whether the child has
exploited others in order to meet his/her own needs.
Ratings Anchor Definitions
0
Child has never engaged in bullying at school or in the community.
1
Child has been involved with groups that have bullied other children either in
school or the community; however, child has not had a leadership role in these
groups.
2
Child has bullied other children in school or community. Child has either
bullied another child individually or led a group that bullied a child.
3
Child has repeatedly utilized threats or used actual violence to bully a child in
school or community.
8. ELOPEMENT/RUNAWAY
This rating refers to any planned or impulsive running behavior that presents a risk to the
safety of the child. Factors to consider in determining level of risk include age of child,
frequency and duration of running episodes, choice and safety of destination,
involvement in risky activities while on the run, impulsivity, and involvement of others in
elopement plans.
Ratings Anchor Definitions
0
This rating is for a child with no history of running away and no ideation
involving escaping from the present living situation.
1
This rating is for a child with a history of running away, but none in the past
month. Or, a child who expresses ideation about escaping present living
situation or has threatened to run. This rating may also include a child who
impulsively leaves home/current living situation for a few hours, but returns
voluntarily prior to night.
2
This rating is for a child that has run away from home/current living situation
within the past 30 days. Running behavior creates concern for the safety of the
child.
3
This rating is for a child/child who has run away from home or living situation
within the last week; or run away from home setting and stayed away
overnight during the past 30 days. Destination is not a return to home of
parent or relative. Running behavior places the safety of the child at significant
risk.
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9. CRIME/DELINQUENCY
This rating includes both criminal behavior and delinquent behavior that may result from
child failing to follow required behavioral standards (e.g., truancy). Sexual offences
should be included as criminal behavior.
Ratings Anchor Definitions
0
Child shows no evidence or has no history of criminal or delinquent behavior.
1
History of criminal activity, but none in the past 30 days. No current
outstanding charges for serious offences committed more than 30 days ago.
Delinquent behavior (e.g., truancy, running away, behaviorally out of control)
in the last 30 days would be rated here.
2
Moderate level of criminal activity including charges or a high likelihood of
crimes committed in the last 30 days. Examples would include vandalism,
shoplifting, drug possession, or a child awaiting trial for serious charges.
3
Serious level of criminal activity in the last 30 days. Examples would include
assault, car theft, residential burglary, gang activity, sexual offences, etc.
10. FIRESETTING
Please rate using the timeframes provided in the anchors. Both intentional and
unintentional fire setting could be rated here but accidental fire setting may have a
shorter relevant history.
Ratings Anchor Definitions
0
No evidence.
1
History of fire setting, but not in the last 6 months.
2
Recent fire setting behavior (in the past 6 months), but not of the type that has
endangered the lives of others or repeated fire setting behavior over a period
of at least 2 years even if none has occurred in the last 6 months.
3
Acute threat of fire setting. Has set a fire that endangered the lives of others
(e.g., attempting to burn down a house).
11. ANIMAL CRUELTY
This rating includes any violence directed towards animals.
Ratings Anchor Definitions
0
The child has no evidence of cruel behavior directed toward animals.
1
History of cruelty to animals, but none during the past 30 days.
2
Occasional cruelty to animals during the past 30 days.
3
Frequent or dangerous (significant harm) level of cruelty to animals resulting in
significant injury or death to animals.
12. INTENTIONAL MISBEHAVIOR
This rating refers to a child who purposefully gets into trouble to select one sanction over
another.
Ratings Anchor Definitions
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0
1
2
3
Child shows no evidence of problematic social behaviors. This rating indicates
a child who is able to avoid or remove him/herself from potentially risky
situation.
Mild level of inappropriate social behaviors. This includes occasionally
inappropriate social behavior such as poor manners or boundaries,
inappropriate comments to strangers or unusual behavior in social settings.
This rating indicates a child who may go along with some risky peer behaviors.
Moderate level of inappropriate social behaviors such as frequent cursing in
public, discussion of personal details with strangers, frequent invasion of
other’s personal space. Easily influenced to engage in risky behaviors. Current
social behavior places the child at risk.
Severe levels of inappropriate social behaviors. This would be indicated by
frequent, seriously inappropriate or risky social behavior such as threatening or
touching strangers, willing to go with strangers, meet strangers from Internet,
or place themselves in situations which place them at high risk to be victimized.
13. AGGRESSION
This item describes the child/adolescent’s behavior that is dangerous to others.
Ratings Anchor Definitions
0
No evidence that the child/adolescent is aggressive beyond normal
developmental expectations.
1
Child/adolescent has a history of aggressive behavior that has injured others or
child/adolescent engages in somewhat elevated levels of aggression relative to
normal development.
2
Child/adolescent engages in aggressive behavior that places him/her at risk of
injury.
3
Child/adolescent engages in frequent and/or severe aggressive behavior that
places others at risk of injury requiring attention.
CHILD STRENGTHS
1. FAMILY
Family refers to all biological or adoptive relatives with whom the child remains in
contact and with other individuals who have relationships with these relatives.
Ratings Anchor Definitions
0
Significant family strengths. This level indicates a family with much love and
mutual respect for each other. Family members are central in each other's
lives. Child is fully included in family activities.
1
Moderate level of family strengths. This level indicates a loving family with
generally good communication and ability to enjoy each other's company.
There may be mild problems between family members. Child is generally
included in family activities.
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2
3
Mild level of family strengths. Family is able to communicate and participate in
each other's lives; however, family members may not be able to provide
significant emotional or concrete support for each other. Child is often not
included in family activities.
This level indicates a child with no known family strengths. Child is not included
in normal family activities.
2. PEER SUPPORTS
This rating refers to the interpersonal skills of the child with same age peers including
boyfriends and girlfriends.
Ratings Anchor Definitions
0
Significant peer supports. Child is seen as well liked by others and has
significant ability to form and maintain positive relationships with peers.
Individual has multiple close friends and is friendly with others.
1
Moderate level of peer supports. Child has formed positive interpersonal
relationships with peers. Child may have one friend, and that friendship is a
healthy ‘best friend model.’
2
Mild level of peer supports. Child has some social skills that facilitate positive
relationships with peers (but may not have any current relationships) and has a
history of making and maintaining healthy friendships with others.
3
This level indicates a child with no known peer supports. Child currently does
not have any friends nor has he/she had any friends in the past. Child does not
have positive relationships with peers.
3. ADULT RELATIONSHIPS
This item is used to identify a child’s adult non-family relationship skills. A child can have
skills but be struggling in their adult relationships at a particular point in time. Thus
rating this as a strength indicates long-standing skills in making and maintaining adult
non-family relationships
Anchor Definitions
0
Child has significant adult relationships outside of family that directly facilitate
healthy development.
1
Child has positive adult relationships outside of family that support healthy
development.
2
Child demonstrates the ability to form relationships with adults that may
become positive.
3
Child has no known adult relationships outside of family members.
4. EDUCATIONAL/SCHOOL CONNECTEDNESS
This rating refers to the strengths of the school system and may or may not reflect any
specific educational skills possessed by the child.
Ratings Anchor Definitions
25
0
1
2
3
This level indicates a child who is in school and is involved with an educational
plan that exceeds expectations. School works well with family and caregivers
to create a special learning environment. A child in a mainstream educational
system who does not require an individual plan would be rated here.
This level indicates a child who is in school and has a plan that is effective.
School works with family and caregivers to ensure appropriate educational
development.
This level indicates a child who is in school, but has a plan that is not effective.
This level indicates a child who is either not in school or is in a school setting
that does not further his/her education.
5. VOCATIONAL
Generally, this rating is reserved for adolescents and is not applicable for children 12
years and under. Computer skills would be rated here.
Ratings Anchor Definitions
0
This level indicates an adolescent with vocational skills who is currently
working in a natural environment.
1
This level indicates an adolescent with pre-vocational and some vocational
skills, but limited work experience.
2
This level indicates an adolescent with some pre-vocational skills. This also
may indicate a child with a clear vocational preference.
3
This level indicates an adolescent with no known or identifiable vocational or
pre-vocational skills and no expression of any future vocational preferences.
6. TALENTS & INTERESTS
This rating should be based broadly on any talent, athletic ability, creative interests or
artistic skill a child may have including art, theatre, music, athletics, etc.
Ratings Anchor Definitions
0
This level indicates a child with significant and multiple creative/artistic/athletic
strengths. A child who receives a significant amount of personal benefit from
activities surrounding a talent/athletic ability would be rated here. This may be
a child who has learned to use his/her talent or interests to cope with
difficulties.
1
This level indicates a child with notable talent/athletic ability. For example, a
child who is involved in sports or plays a musical instrument, etc. would be
rated here.
2
This level indicates a child who has expressed interest in developing a specific
talent(s)/ability(ies) even if they have not developed that talent/ability to date.
3
This level indicates a child who has not identified any current interests or
hobbies.
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7. SPIRITUAL/RELIGIOUS
This rating should be based on the child or adolescent's involvement in spiritual or
religious beliefs and activities.
Ratings Anchor Definitions
0
This level indicates a child with strong moral and spiritual strengths. Child may
be actively involved in a religious community or may have strongly held
spiritual or religious beliefs that sustain or comfort him/her in difficult times.
1
This level indicates a child with some moral and spiritual strengths. Child finds
comfort in his/her spiritual beliefs and/or involvement in a religious
community.
2
This level indicates a child with few spiritual or religious strengths. Child may be
questioning current beliefs or wanting to explore his/her spirituality. Child may
have some contact with a religious community, but does not consider it a
support.
3
This level indicates a child with no known spiritual or religious involvement or
interest.
8. COMMUNITY LIFE/RECREATIONAL
This rating should be based on the child’s level of involvement in his/her community. This
should include involvement in recreational activities. Community can include local family,
friends, and neighbors with whom families have supportive relationships.
Ratings Anchor Definitions
0
This level indicates a child with extensive and substantial, long-term (e.g., more
than one year) ties with the community. For example, individual may be an
active member of one or more organized community groups (e.g., sports team,
volunteer service, child group, student councils), or involved in other
community activities, informal networks, etc.
1
This level indicates a child with significant community ties although they may
be relatively short term (e.g., past year). This would include joining one
community group/sports team or being involved in one community
organization.
2
This level indicates a child with limited ties and/or involvement in the
community. This would include a child who has expressed interest in joining a
community organization, but is not yet involved.
3
This level indicates a child with no known involvement or interest in his/her
community.
9. RELATIONSHIP PERMANENCE
This rating refers to the stability of significant relationships in the child's life. This likely
includes family members, but may also include other individuals.
Ratings Anchor Definitions
27
0
1
2
3
This level indicates a child who has very stable relationships. Family members,
friends, and community have been stable for most of his/her life and are likely
to remain so in the foreseeable future. Child is involved with both parents.
This level indicates a child who has had stable relationships, but there is some
concern about instability in the near future (one year) due to transitions,
illness, or age. A child who has a stable relationship with only one parent may
be rated here.
This level indicates a child who has had at least one stable relationship over
his/her lifetime, but has experienced other instability through factors such as
divorce, moving, removal from home, and/or death.
This level indicates a child who has not had any stability in relationships.
10. OPTIMISM
This rating should be based on the child or adolescent's sense of him/herself in his/her
own future. This is intended to rate the child’s positive future orientation.
Ratings Anchor Definitions
0
Child has a strong and stable optimistic outlook on his/her life. Child is future
oriented.
1
Child is generally optimistic. Child is likely able to articulate some positive
future vision.
2
Child has difficulties maintaining a positive view of his/her life with regard to
the future. Child may vary from overly optimistic to overly pessimistic. Child
may be ambivalent regarding the future.
3
Child has difficulties seeing any positives about his/her life in the future.
11. COPING & SAVORING
This rating should be based on the psychological strengths the child or adolescent might
have developed including both the ability to enjoy positive life experiences and/or
manage negative life experiences. This should be rated independent of the child's current
level of distress.
Ratings Anchor Definitions
0
This level indicates a child with exceptional psychological strengths. Ability to
both cope with negative experiences and appreciate positive experiences is
well developed.
1
This level indicates a child with good psychological strengths. This child
generally has solid coping skills for managing distress and solid skills for
appreciating and enjoying pleasurable events.
2
This level indicates a child with limited psychological strengths. This child often
struggles to cope with negative life experiences and has difficulty appreciating
pleasurable events.
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3
This level indicates a child with no known or identifiable psychological
strengths who cannot cope with negative life events or appreciate positive
events. This may be due to intellectual impairment or serious psychiatric
disorders.
12. RESILIENCY
This rating should be based on the child’s ability to identify and use internal strengths in
managing his/her life and supporting his/her healthy development.
Ratings Anchor Definitions
0
This level indicates a child who is able to both identify and use strengths to
better him/herself and successfully manage difficult challenges.
1
This level indicates a child who able to identify most of his/her strengths and is
able to partially utilize them.
2
This level indicates a child who is able to identify strengths, but is not able to
utilize them effectively.
3
This level indicates a child who is not able to identify personal strengths.
13. RESOURCEFULNESS
This rating should be based on the child’s ability to identify and use external strengths in
managing his/her life and supporting his/her healthy development.
Ratings Anchor Definitions
0
This level indicates a child who is able to both identify and use external
strengths to better him/herself and successfully manage difficult challenges.
1
This level indicates a child who able to identify most of his/her external
strengths and is able to partially utilize them.
2
This level indicates a child who is able to identify external strengths, but is not
able to utilize them effectively.
3
This level indicates a child who is not able to identify external strengths.
14. YOUTH KNOWLEDGE
This rating is intended to capture an individual’s awareness and understanding for
his/her psychiatric symptoms and diagnosis.
Ratings Anchor Definitions
0
This level indicates a child who is aware of his/her needs and strengths and can
articulate them clearly and consistently and understand the implications.
1
This level indicates a child who is aware of his/her needs and strengths, but is
not clear about the implications.
2
This level indicates a child who is unaware that he/she has some significant
needs and/or strengths, but recognizes that there are needs.
3
This level indicates a child who is unaware of his/her needs and strengths.
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CAREGIVER’S STRENGTHS & NEEDS
NOTE: Caregiver refers to parent(s) or other adult with primary care-taking responsibilities for the child.
1. SUPERVISION
This rating is used to determine the caregiver's capacity to provide the level of monitoring
and discipline needed by the child.
Ratings Anchor Definitions
0
This rating is used to indicate a caregiver circumstance in which supervision
and monitoring is appropriate and well functioning.
1
This level indicates a caregiver circumstance in which supervision is generally
adequate, but inconsistent. This may include a placement in which one
member is capable of appropriate monitoring and supervision, but others are
not capable or not consistently available.
2
This level indicates a caregiver circumstance in which supervision and
monitoring are very inconsistent and frequently absent.
3
This level indicates a caregiver circumstance in which appropriate supervision
and monitoring are nearly always absent or inappropriate.
2. INVOLVEMENT
This rating should be based on the level of involvement the caregiver has in planning and
provision of mental health and related services.
Ratings Anchor Definitions
0
This level indicates a caregiver who is actively involved in the planning and/or
implementation of services and is able to be an effective advocate on behalf of
the child.
1
This level indicates a caregiver who is consistently involved in the planning
and/or implementation of services for the child.
2
This level indicates a caregiver who is only somewhat or inconsistently involved
in the implementation and planning of the care of the child.
3
This level indicates a caregiver who is uninvolved with the care of the child or
adolescent. Caregiver likely wants individual out-of-home or fails to visit
individual in out-of-home placement or acute care setting.
3. KNOWLEDGE
This rating should be based on caregiver's knowledge of the specific strengths of the child
and any problems experienced by the child and the ability to understand the rationale for
the treatment or management of these problems.
Ratings Anchor Definitions
0
This level indicates that the present caregiver is fully knowledgeable about the
child's psychological strengths, weaknesses, talents, and limitations.
Parent/Caregiver have realistic expectations of the child and support his/her
best efforts.
30
1
2
3
This level indicates that the present caregiver, while being generally
knowledgeable about the child, has some mild deficits in knowledge or
understanding of either the child's psychological condition or his/her talents,
skills, and assets. Child may be supported in efforts, however expectations
may be higher than a level the child can perform.
This level indicates that the caregiver does not know or understand the child
well and notable deficits exist in the caregiver's ability to relate to the child's
problems or strengths. There are unrealistic expectations of the child and/or a
high level of parental pressure.
This level indicates that the present caregiver has a significant problem in
understanding the child's current condition. The caregiver is unable to cope
with the child, given his/her status at the time, not because of the needs of the
child, but because the caregiver does not understand or accept the child.
4. ORGANIZATION
This rating should be based on the ability of the caregiver to participate in or direct the
organization of the household, services, and related activities.
Ratings Anchor Definitions
0
Caregiver is well organized and efficient.
1
Caregiver has some difficulties with organizing or maintaining household to
support needed services. For example, may be forgetful about appointments
or occasionally fails to call back case manager.
2
Caregiver has significant difficulty organizing or maintaining household to
support needed services.
3
Caregiver is unable to organize household to support needed services.
5. SOCIAL RESOURCES
This rating refers to the financial and social assets (extended family) and resources that
the caregiver can bring to bear in addressing the multiple needs of the child and family. If
child is living independently then the rating applies to the financial and social assets
available to the child.
Ratings Anchor Definitions
0
Caregiver (or independent child) has sufficient resources/natural supports such
that there are few limitations on what can be provided for the child.
1
Caregiver (or independent child) has the necessary resources/natural supports
to help address the child's basic needs. Caregiver is helpful in the care and
treatment of the child.
2
Caregiver (or independent child) has limited financial and other resources (e.g.,
grandmother living in same town who is sometimes available to watch child).
3
Caregiver (or independent child) has severely limited resources/natural
supports available to assist in the care and treatment of the child.
31
6. RESIDENTIAL STABILITY
This dimension rates the child’s current and likely future housing circumstances. If child
lives outside the family home, the rating applies to the child’s current residence.
Ratings Anchor Definitions
0
Caregiver and child have stable housing for the foreseeable future.
1
Caregiver and child are currently in stable housing, but have either moved in
the past three months or there are significant risks of housing disruption (e.g.,
loss of job, change in foster/group homes).
2
Caregiver and child have moved multiple times in the past year or current
housing is unstable.
3
Caregiver and child are currently homeless or have experienced periods of
homelessness in the past six months and current housing remains unstable.
7. PHYSICAL/BEHAVIORAL HEALTH
Physical and behavioral health includes medical, physical, and mental health, and
substance abuse challenges currently faced by the caregiver.
Ratings Anchor Definitions
0
Caregiver has no health limitations that impact assistance or care of child.
1
Caregiver has some health limitations that interfere with provision of
assistance or care to the child.
2
Caregiver has significant health limitations that prevent them from providing
the needed assistance or make care of the child difficult.
3
Caregiver is physically or mentally unable to provide any needed assistance or
care for child.
Ratings Anchor Definitions
0
Caregiver has access to sufficient child care services.
1
Caregiver has limited access to childcare services. Needs are minimally met by
existing, available services.
2
Caregiver has limited access or access childcare services. Current services do
not meet the caregiver’s needs.
3
Caregiver has no access to child care services.
9. MILITARY TRANSITIONS
Ratings Anchor Definitions
0
Caregiver not experiencing any transitions related to military service. Caregiver
not involved in military service would be rated here.
1
Caregiver anticipating a transition related to military service in the near future
or a caregiver experienced a transition in the past, which was challenging.
2
Caregiver experiencing a transition related to military service.
3
Caregiver experiencing a transition related to military service that has a major
impact on their care giving roles.
32
10. CHILD SAFETY
This rating refers to the safety of the assessed child. It does not refer to the safety of
other family or household members based on any danger presented by the assessed child.
Ratings Anchor Definitions
0
This level indicates that the present placement is as safe or safer for the child
(in his or her present condition) as could be reasonably expected.
1
This level indicates that the present placement environment presents some
mild risk of emotional abuse, neglect, exposure to undesirable environments or
occasional presence of questionable role models, but no immediate risk is
present.
2
This level indicates that the present placement environment presents a
moderate level of risk to the child including such things as the risk of neglect or
abuse, few appropriate role models or exposure to individuals who potentially
pose a risk to the safety of the child.
3
This level indicates that the present placement environment presents a
significant risk to the well-being of the child. Neglect or abuse is occurring or is
at imminent risk to occur. Individuals in the environment are, or have the
potential to, significantly harm the child.
11. FAMILY STRESS
This item reflects the degree of stress or burden experienced by the family as a result of
the child’s needs as described elsewhere in the assessment.
Ratings Anchor Definitions
0
Family is able to manage the stress of child’s needs.
1
Family has some problems managing the stress of child’s needs.
2
Family has notable problems managing the stress of child’s needs. This stress
interferes with the functioning of the family.
3
Family is unable to manage the stress associated with child’s needs. This stress
creates severe problems with family functioning.
33
TRANSITION AGE MODULE (COMPLETE FOR ANY CHILD AGE 16+)
1. CAREGIVING ROLE
This item is intended to rate the youth in any caregiver role. For example, a youth with a son or daughter
or a youth responsible for an elderly parent or grandparent would be rated here.
Ratings
Anchor Definitions
0
The youth has no role as a caregiver.
1
2
3
The youth has responsibilities as a caregiver, but is currently able to manage
these responsibilities.
The youth has responsibilities as a caregiver and is struggling with these
responsibilities or they are currently interfering with the youth’s functioning in
other life domains.
The youth has responsibilities as a caregiver and is currently unable to meet
these responsibilities or these responsibilities are making it impossible for the
youth to function in other life domains.
2. LIVING SKILLS
This rating focuses on the presence or absence of short or long-term risks associated with impairments in
independent living abilities.
Ratings
Anchor Definitions
0
This level indicates a youth who has developmentally appropriate living skills.
1
2
3
No evidence of any deficits that impede maintaining own living space that are
not considered developmentally appropriate.
This level indicates a youth with mild impairment of independent living skills
that are not considered developmentally appropriate. Some problems exist
with maintaining reasonable cleanliness. Problems with money management
may occur at this level. These problems are generally addressable with training
or supervision.
This level indicates a youth with moderate impairment of independent living
skills that are not considered developmentally appropriate. Notable problems
with completing tasks necessary for independent living are apparent. Difficulty
with cooking, cleaning, and self-management when unsupervised would be
common at this level. Problems are generally addressable with community
support.
This level indicates a youth with profound impairment of independent living
skills that are not considered developmentally appropriate. This youth would
be expected to be unable to live independently given their current status.
Problems require a structured living environment.
3. MEDICATION ADHERENCE
This rating focuses on the level of the individual’s willingness and participation in taking prescribed
medications.
Ratings
Anchor Definitions
0
This level indicates a youth who takes medications as prescribed and without
reminders, or a person who is not currently prescribed any medication.
34
1
2
3
This level indicates a youth who will take medications routinely, but who
sometimes needs reminders to maintain compliance. Also, a history of
medication noncompliance, but no current problems would be rated here.
This level indicates a youth who is somewhat non-compliant. This youth may
be resistant to taking medications or this youth may tend to overuse his or her
medications. He/she might comply with prescription plans for periods of time
(1-2 weeks), but generally does not sustain taking medication in prescribed
dose or protocol.
This level indicates a youth who has refused to take prescribed medications
during the past 30 day period or a youth who has abused his or her
medications to a significant degree (e.g., overdosing or over using medications
to a dangerous degree).
4. EDUCATIONAL ATTAINMENT
This rates the degree to which the youth has completed his/her planned education.
Ratings
Anchor Definitions
0
Youth has achieved all educational goals or has none, but educational
1
2
3
attainment has no impact on lifetime vocational functioning.
Youth has set educational goals and is currently making progress towards
achieving them.
Youth has set educational goals, but is currently not making progress towards
achieving them.
Youth has no educational goals and lack of educational attainment is
interfering with individual’s lifetime vocational functioning.
5. PERSONALITY DISORDER/TRAITS
This rating identifies the presence of any DSM-IV Axis II personality disorder or evidence of a sufficient
number of symptoms to warrant a rule out for personality disorder for individuals 18 years or older. This
rating identifies the presence of personality traits that may be associated with future personality disorders
for individuals under 18.
Ratings
Anchor Definitions
0
No evidence of symptoms of a personality disorder.
1
2
3
Evidence of mild degree, probably sub-threshold for the diagnosis of a
personality disorder. For example, mild but consistent dependency in
relationships might be rated here. Or, some evidence of mild antisocial or
narcissistic behavior. Also, an unconfirmed suspicion of the presence of a
diagnosable personality disorder would be rated here.
Evidence of sufficient degree of personality disorder to warrant a DSM-IV Axis II
diagnosis.
Evidence of a severe personality disorder that has significant implications for
the individual long-term functioning. Personality disorder dramatically
interferes with the individual’s ability to function independently.
35
6. JOB FUNCTIONING
This item is intended to describe functioning in vocational settings.
Ratings
Anchor Definitions
0
Youth is employed in a job and experiencing no problems in attendance,
1
2
3
N/A
performance or relationships at work.
Youth is employed, but may have some difficulties at work with attendance,
performance or relationships.
Youth has significant job-related problems with attendance, performance, or
relationships.
Youth is experiencing severe problems in employment situation with
attendance, performance or relationships. Child may have recently been fired.
Not applicable as the youth is not employed.
36
MODULE 1: TRAUMA
Characteristics of the Traumatic Experience:
1. SEXUAL ABUSE
Please rate within the lifetime
Ratings Anchor Definitions
0
There is no evidence that child has experienced sexual abuse.
1
Child has experienced one episode of sexual abuse or there is a suspicion that
child has experienced sexual abuse, but no confirming evidence.
2
Child has experienced repeated sexual abuse.
3
Child has experienced severe and repeated sexual abuse. Sexual abuse may
have caused physical harm.
2. PHYSICAL ABUSE
Please rate within the lifetime
Ratings Anchor Definitions
0
There is no evidence that child has experienced physical abuse.
1
Child has experienced one episode of physical abuse or there is a suspicion that
child has experienced physical abuse, but no confirming evidence.
2
Child has experienced repeated physical abuse.
3
Child has experienced severe and repeated physical abuse that caused
sufficient physical harm to necessitate hospital treatment.
3. EMOTIONAL ABUSE
Please rate within the lifetime
Ratings Anchor Definitions
0
There is no evidence that child has experienced emotional abuse.
1
Child has experienced mild emotional abuse.
2
Child has experienced emotional abuse over an extended period of time (at
least one year).
3
Child has experienced severe and repeated emotional abuse over an extended
period of time (at least one year).
4. MEDICAL TRAUMA
Please rate within the lifetime
Ratings Anchor Definitions
0
There is no evidence that child has experienced any medical trauma.
1
Child has experienced mild medical trauma including minor surgery (e.g.,
stitches, bone setting).
2
Child has experienced moderate medical trauma including major surgery or
injuries requiring hospitalization.
37
3
Child has experienced life threatening medical trauma.
5. NATURAL DISASTER
Please rate within the lifetime
Ratings Anchor Definitions
0
There is no evidence that child has experienced any natural disaster.
1
Child has been indirectly affected by a natural disaster.
2
Child has experienced a natural disaster, which has had a notable impact on
his/her wellbeing.
3
Child has experienced life threatening natural disaster.
6. WITNESS TO FAMILY VIOLENCE
Please rate within the lifetime
Ratings Anchor Definitions
0
There is no evidence that child has witnessed family violence.
1
Child has witnessed one episode of family violence.
2
Child has witnessed repeated episodes of family violence, but no significant
injuries (e.g., requiring emergency medical attention) have been witnessed.
3
Child has witnessed repeated and severe episodes of family violence.
Significant injuries have occurred as a direct result of the violence.
7. WITNESS TO COMMUNITY VIOLENCE
Please rate within the lifetime.
Ratings Anchor Definitions
0
There is no evidence that child has witnessed violence in the community.
1
Child has witnessed fighting or other forms of violence in the community
2
Child has witnessed the significant injury of others in his/her community.
3
Child has witnessed the death of another person in his/her community.
8. WITNESS TO CRIMINAL ACTS
Please rate within the lifetime.
Ratings Anchor Definitions
0
There is no evidence that child has been victimized or witness significant
criminal activity.
1
Child is a witness of significant criminal activity.
2
Child is a direct victim of criminal activity or witnessed the victimization of a
family or friend.
3
Child is a victim of criminal activity that was life threatening or caused
significant physical harm, or child witnessed the death of a loved one.
38
9. WAR AFFECTED
This rating describes the degree of severity of exposure to war, political violence, or
torture. Violence or trauma related to terrorism is not included here.
Ratings Anchor Definitions
0
There is no evidence that the child has been exposed to war, political violence,
or torture.
1
Child did not live in war-affected region or refugee camp, but family was
affected by war. Family members directly related to the child may have been
exposed to war, political violence, or torture; family may have been forcibly
displaced due to war, or both. This does not include children who have lost one
or both parents during the war.
2
Child has been affected by war or political violence. He or she may have
witnessed others being injured in war, may have family members who were
hurt or killed in war, and may have lived in an area where bombing or fighting
took place. Child may have lost one or both parents during war or both parents
may be so physically or psychologically disabled from war such that they are
not able to provide adequate caretaking for the child. The child may have spent
an extended amount of time in a refugee camp.
3
Child has experienced the direct affects of war. Child may have feared for
his/her own life during war due to bombing and shelling very near to them.
They may have been directly injured, tortured or kidnapped. Some may have
served as soldiers, guerrillas or other combatants in their home countries.
10. TERRORISM AFFECTED
This rating describes the degree to which a child has been affected by terrorism.
Terrorism is defined as “the calculated use of violence or the threat of violence to
inculcate fear, intended to coerce or to intimidate governments or societies in the pursuit
of goals that are generally political, religious, or ideological.” Terrorism includes attacks
by individuals acting in isolation (e.g., sniper attacks).
Ratings Anchor Definitions
0
There is no evidence that the child has been affected by terrorism or terrorist
activities.
1
Child’s community has experienced an act of terrorism, but the child was not
directly impacted by the violence (e.g., child lives close enough to site of
terrorism that may have visited before, or child recognizes the location when
seen on TV, but child’s family and neighborhood infrastructure was not directly
affected).
2
Child has been affected by terrorism within his/her community, but did not
directly witness the attack. Child may live near the area where the attack
occurred and be accustomed to visiting regularly in the past. Infrastructure of
the child’s daily life may be disrupted due to the attack (e.g., utilities or school),
and the child may see signs of the attack in the neighborhood (e.g., destroyed
building). Child may know people who were injured in the attack.
39
3
Child has witnessed the death of another person in a terrorist attack, or has
had friends or family members seriously injured as a result of terrorism, or has
directly been injured by terrorism, leading to significant injury or lasting
impact.
If Child has been sexually abused:
11. EMOTIONAL CLOSENESS TO PERPETRATOR
Ratings Anchor Definitions
0
Perpetrator was a stranger at the time of the abuse.
1
Perpetrator was known to the child at the time of event, but only as an
acquaintance.
2
Perpetrator had a close relationship with the child at the time of the event, but
was not an immediate family member.
3
Perpetrator was an immediate family member (e.g., parent, sibling).
12. FREQUENCY OF ABUSE
Ratings Anchor Definitions
0
Abuse occurred one time.
1
Abuse occurred two times.
2
Abuse occurred two to ten times.
3
Abuse occurred more than ten times.
13. DURATION
Ratings Anchor Definitions
0
Abuse occurred one time.
1
Abuse occurred within a six month time period.
2
Abuse occurred within a six-month to one year time period.
3
Abuse occurred over a period of longer than one year.
14. FORCE
Ratings Anchor Definitions
0
No physical force or threat of force occurred during the abuse episode(s).
1
Sexual abuse was associated with threat of violence, but no physical force.
2
Physical force was used during the sexual abuse.
3
Significant physical force/violence was used during the sexual abuse. Physical
injuries occurred as a result of the force.
15. REACTION TO DISCLOSURE
Ratings Anchor Definitions
0
All significant family members are aware of the abuse and supportive of the
child coming forward with the description of his/her abuse experience.
40
1
2
3
Most significant family members are aware of the abuse and supportive of the
child for coming forward. One or two family members may be less supportive.
Parent may be experiencing anxiety/depression/guilt regarding abuse.
Significant split among family members in terms of their support of the child
for coming forward with the description of his/her experience.
Significant lack of support from close family members of the child for coming
forward with the description of his/her abuse experience. Significant
relationship (e.g., parent, care-giving grandparent) is threatened.
Adjustment:
16. AFFECT REGULATION
Ratings Anchor Definitions
0
Child has no problems with affect regulation.
1
Child has mild to moderate problems with affect regulation.
2
Child has severe problems with affect regulation, but is able to control affect at
times. Problems with affect regulation interfere with child’s functioning in
some life domains.
3
Child unable to regulate affect.
17. INTRUSIONS
Ratings Anchor Definitions
0
There is no evidence that child experiences intrusive thoughts about trauma.
1
Child experiences some intrusive thoughts of trauma, but they do not effect
his/her functioning.
2
Child experiences intrusive thoughts that interfere with his/her ability to
function in some life domains.
3
Child experiences repeated and severe intrusive thoughts of trauma.
18. ATTACHMENT
This item should be rated within the context of the child’s significant parental or
parent/caregiver relationships. Separation anxiety should be rated under the item
‘Anxiety.’
Ratings Anchor Definitions
0
No evidence of attachment problems. Caregiver-child relationship is
characterized by mutual satisfaction of needs and child’s development of a
sense of security and trust. Caregiver appears able to respond to child’s cues in
a consistent, appropriate manner, and child seeks age-appropriate contact with
caregiver for both nurturing and safety needs.
41
1
2
3
Mild problems with attachment. There is some evidence of insecurity in the
caregiver-child relationship. Caregiver may at times have difficulty accurately
reading child’s bids for attention and nurturance; may be inconsistent in
response; or may be occasionally intrusive. Child may have mild problems with
separation (e.g., anxious/clingy behaviors in the absence of obvious cues of
danger) or may avoid contact with parent/caregiver, and may have ongoing
difficulties with physical or emotional boundaries with others.
Moderate problems with attachment. Attachment relationship is marked by
sufficient difficulty as to require intervention. Caregiver may consistently
misinterpret child cues, act in an overly intrusive way, or ignore/avoid child’s
bids for attention/nurturance. Child may have ongoing difficulties with
separation, may consistently avoid contact with caregiver.
Severe problems with attachment. Child is unable to form attachment
relationships with others (e.g., chronic dismissive/avoidant/detached behavior
in caregiving relationships) or child presents with diffuse emotional/physical
boundaries leading to indiscriminate attachment with others. Child is
considered at ongoing risk due to the nature of his/her attachment behaviors.
Child may have experienced significant early separation from or loss of
caregiver, or child may have individual vulnerabilities (e.g., mental health,
developmental disabilities) that interfere with the formation of positive
attachment relationships.
19. DISSOCIATION
Symptoms included in this dimension are daydreaming, spacing or blanking out,
forgetfulness, fragmentation, detachment, and rapid changes in personality often
associated with traumatic experiences. This dimension may be used to rate dissociative
disorders (e.g., Dissociative Disorder NOS, Dissociative Identity Disorder, but can also
exist when other diagnoses are present (e.g., PTSD, depression).
Ratings Anchor Definitions
0
Child has no evidence of dissociation.
1
Child has minor dissociative problems, including some emotional numbing,
avoidance or detachment, and some difficulty with forgetfulness, daydreaming,
spacing or blanking out.
2
Child has a moderate level of dissociation. This can include amnesia for
traumatic experiences or inconsistent memory for trauma (e.g., remembers in
one context but not in another), more persistent or perplexing difficulties with
forgetfulness (e.g., loses things easily, forgets basic information), frequent
daydreaming or trance-like behavior, depersonalization and/or derealization.
This rating would be used for someone who meets criteria for Dissociative
Disorder NOS or another diagnosis that is specified with “dissociative features.”
42
3
Child has severe dissociative disturbance. This can include significant memory
difficulties associated with trauma that also impede day to day functioning.
Child is frequently forgetful or confused regarding things he/she should know
(e.g., no memory of activities or whereabouts of previous day or hours). Child
shows rapid change in personality or evidence of distinct personalities. Child
who meets criteria for Dissociative Identity Disorder or more severe level of
Dissociative Disorder NOS would be rated here.
20. HYPERAROUSAL
These symptoms include difficulty falling or staying asleep, irritability or outbursts of
anger, difficulty concentrating, hypervigiliance and/or exaggerated startle response.
Children may also commonly manifest physical symptoms such as stomachaches and
headaches. These symptoms are part of the DSM-IV criteria for PTSD.
Ratings Anchor Definitions
0
Child has no evidence of hyperarousal symptoms.
1
Child exhibits mild symptoms of hyperarousal that do not significantly interfere
with his/her day-to-day functioning. Children may also occasionally manifest
physical symptoms such as stomachaches and headaches.
2
Child exhibits moderate symptoms of hyperarousal. The child may exhibit one
significant symptom or combination of two or more of the following
symptoms: difficulty falling or staying asleep, irritability or outbursts of anger,
difficulty concentrating, hypervigiliance and/or exaggerated startle response.
Children may also commonly manifest physical symptoms such as stomachaches and headaches
3
Child exhibits significant or multiple hyperarousal symptoms including, but not
limited to, difficulty falling or staying asleep, irritability or outbursts of anger,
difficulty concentrating, hypervigiliance and/or exaggerated startle response.
The intensity or frequency of these symptoms are distressing for the child and
lead to frequent problems with day-to-day functioning.
MODULE 2: SUBSTANCE USE
1. SEVERITY OF USE
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
Child is currently abstinent and has maintained abstinence for at least six
months.
1
Child is currently abstinent, but only in the past 30 days or child has been
abstinent for more than 30 days, but is living in an environment where access
to substances or use of substances is difficult.
2
Child actively uses alcohol or drugs, but not daily.
3
Child uses alcohol and/or drugs on a daily basis.
43
2. DURATION OF USE
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
Child has begun use of alcohol and/or drugs in the past year.
1
Child has been using alcohol and/or drugs for at least one year, but has had
periods of at least 30 days where he/she did not use.
2
Child has been using alcohol or drugs for at least one year (but less than five
years), but not daily.
3
Child has been using alcohol or drugs daily for more than the past year or
intermittently for at least five years.
3. STAGE OF RECOVERY
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
Child is in maintenance stage of recovery. Child is abstinent and able to
recognize and avoid risk factors for future alcohol or drug use.
1
Child is actively trying to use treatment to remain abstinent.
2
Child is in contemplation phase, recognizing a problem, but not willing to take
steps for recovery.
3
Child is in denial regarding the existence of any substance use problem.
4. PEER INFLUENCES
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
Child's primary peer social network does not engage in alcohol or drug use.
1
Child has some peers in his/her primary peer social network who engage in
alcohol and/or drug use.
2
Child predominantly has peers who engage in alcohol or drug use, but child is
not a member of a gang.
3
Child is a member of a peer group that consistently engages in alcohol or drug
use.
5. PARENTAL INFLUENCES
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
There is no evidence that child's parents have ever engaged in substance
abuse.
1
One of child's parents has history of substance abuse, but not in the past year.
2
One or both of child’s parents have been intoxicated with alcohol or drugs in
the presence of the child.
3
One or both of child's parents use alcohol or drugs with the child.
44
6. ENVIRONMENTAL INFLUENCES
Please rate the environment around the child’s living situation.
Ratings Anchor Definitions
0
No evidence that the child's environment stimulates or exposes the child to
any alcohol or drug use.
1
Mild problems in the child's environment that might expose the child to alcohol
or drug use.
2
Moderate problems in the child's environment that clearly expose the child to
alcohol or drug use.
3
Severe problems in the child's environment that stimulate the child to engage
in alcohol or drug.
MODULE 3: LEGAL
1. SERIOUSNESS
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
Child has engaged only in status violations (e.g., curfew).
1
Child has engaged in delinquent behavior.
2
Child has engaged in criminal behavior.
3
Child has engaged in criminal behavior that places other citizens at risk of
significant physical harm.
2. HISTORY
Please rate using time frames provided in the anchors
Ratings Anchor Definitions
0
Current criminal/delinquent behavior is the first known occurrence.
1
Child has engaged in multiple criminal/delinquent acts in the past one year.
2
Child has engaged in multiple criminal/delinquent acts for more than one year,
but has had periods of at least 3 months where he/she did not engage in
delinquent behavior.
3
Child has engaged in multiple criminal/delinquent acts for more than one year
without a period of at least 3 months where he/she did not engage in criminal
or delinquent behavior.
3. ARRESTS
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
Child has no known arrests.
1
Child has history of delinquency, but no arrests past 30 days.
2
Child has 1 to 2 arrests in last 30 days.
3
Child has more than 2 arrests in last 30 days.
45
4. PLANNING
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
No evidence of any planning. Criminal/delinquent behavior appears
opportunistic or impulsive.
1
Evidence suggests that child places him/herself into situations where the
likelihood of criminal/delinquent behavior is enhanced.
2
Evidence of some planning of criminal/delinquent behavior.
3
Considerable evidence of significant planning of criminal/delinquent behavior.
Behavior is clearly premeditated.
5. COMMUNITY SAFETY
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
Child presents no risk to the community. He/she could be unsupervised in the
community.
1
Child engages in behavior that represents a risk to community property.
2
Child engages in behavior that places community residents in some danger of
physical harm. This danger may be an indirect effect of the child’s behavior.
3
Child engages in behavior that directly places community members in danger
of significant physical harm.
6. LEGAL COMPLIANCE
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
Child is fully compliant with all responsibilities imposed by the court (e.g.,
school attendance, treatment, restraining orders) or no court orders are
currently in place.
1
Child is in compliance with responsibilities imposed by the court. (e.g.,
occasionally missed appointments)
2
Child is in partial noncompliance with standing court orders (e.g., child is going
to school, but not attending court-order treatment).
3
Child is in noncompliance with standing court orders (e.g., parole violations).
7. PEER INFLUENCES
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
Child's primary peer social network does not engage in criminal/delinquent
behavior.
1
Child has some peers in his/her primary peer social network who engage in
criminal/delinquent behavior.
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2
3
Child predominantly has peers who engage in delinquent behavior, but child is
not a member of a gang.
Child is a member of a gang whose membership encourages or requires illegal
behavior as an aspect of gang membership.
8. PARENTAL INFLUENCES
Please rate the highest level from the past 30 days
Ratings Anchor Definitions
0
There is no evidence that child's parents have engaged in criminal/delinquent
behavior.
1
One of child's parents has history of criminal/delinquent behavior, but child has
not been in contact with this parent for at least one year.
2
One of child's parents has history of criminal/delinquent behavior and child has
been in contact with this parent in the past year.
3
Both of child's parents have history of criminal/delinquent behavior.
9. ENVIRONMENTAL INFLUENCES
Please rate the environment around the child’s living situation.
Ratings Anchor Definitions
0
No evidence that the child's environment stimulates or exposes the child to any
criminal/delinquent behavior.
1
Mild problems in the child's environment that might expose the child to
criminal/delinquent behavior.
2
Moderate problems in the child's environment that clearly expose the child to
criminal/delinquent behavior.
3
Severe problems in the child's environment that stimulate the child to engage
in criminal/delinquent behavior.
MODULE 4: ACCULTURATION
1. LANGUAGE
This item includes both spoken and sign language.
Ratings Anchor Definitions
0
There are no language barriers as the child/family speak English well.
1
Child and family speak some English, but potential communication problems
exist due to limits on vocabulary or understanding of the nuances of the
language.
2
Child and/or significant family members do not speak English. Translator or
native language speaker is needed for successful intervention, but qualified
individual can be identified within natural supports.
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3
Child and/or significant family members do not speak English. Translator or
native language speaker is needed for successful intervention and no such
individual is available from among natural supports.
2. IDENTITY
Cultural identity refers to the child’s view of him/herself as belonging to a specific cultural
group. This cultural group may be defined by a number of factors including race, religion,
ethnicity, geography or lifestyle.
Ratings Anchor Definitions
0
Child has clear and consistent cultural identity and is connected to others who
share his/her cultural identity.
1
Child is experiencing some confusion or concern regarding cultural identity.
2
Child has significant struggles with his/her own cultural identity. Child may
have cultural identity, but is not connected with others who share this culture.
3
Child has no cultural identity or is experiencing significant problems due to
conflict regarding his/her cultural identity.
3. RITUAL
Cultural rituals are activities and traditions that include the celebration of culturally
specific holidays such as kwanza, cinco de mayo, etc. Rituals also may include daily
activities that are culturally specific (e.g., praying toward Mecca at specific times, eating
a specific diet, or access to media).
Ratings Anchor Definitions
0
Child and family are consistently able to practice rituals pertaining to their
cultural identity.
1
Child and family are generally able to practice rituals consistent with their
cultural identity; however, they sometimes experience obstacles to the
performance of these rituals.
2
Child and family experience significant barriers and are sometimes prevented
from practicing rituals consistent with their cultural identity.
3
Child and family are unable to practice rituals consistent with their cultural
identity.
4. CULTURAL STRESS
Culture stress refers to experiences and feelings of discomfort and/or distress arising from
friction (real or perceived) between an individual’s own cultural identity and the
predominant culture in which he/she lives.
Ratings Anchor Definitions
0
No evidence of stress between caregiver’s cultural identify and current living
situation.
1
Some mild or occasional stress resulting from friction between the caregiver’s
cultural identify and his/her current living situation.
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2
3
Caregiver is experiencing cultural stress that is causing problems of functioning
in at least one life domain. Caregiver needs to learn how to manage culture
stress.
Caregiver is experiencing a high level of cultural stress making functioning in
any life domain difficult under the present circumstances. Caregiver needs
immediate plan to reduce culture stress.
MODULE 5: DANGER TO SELF
1. SUICIDE RISK
Please rate the highest level from the past 30 days.
Ratings Anchor Definitions
0
No evidence of suicidal risk.
1
History, but no recent ideation or gesture.
2
Recent ideation or gesture, but not in past 24 hours.
3
Current ideation and intent or command hallucinations that involve self-harm.
If Suicide Risk is rated greater than ‘0’:
2. IDEATION
Please rate the highest level from the past 30 days.
Ratings Anchor Definitions
0
No evidence of suicidal ideation.
1
History, but no recent ideation.
2
Recent ideation, but not in past 24 hours.
3
Current ideation or command hallucinations that involve self-harm.
3. INTENT
Please rate the highest level from the past 30 days.
Ratings Anchor Definitions
0
No evidence.
1
History, but no recent intent to commit suicide.
2
Recent intention to commit suicide.
3
Current intention.
4. PLANNING
Please rate the highest level from the past 30 days.
Ratings Anchor Definitions
0
No evidence of a concrete plan.
1
Vague notions of a plan, but plan is not realistic.
2
Individual has a plan to commit suicide that is feasible.
3
Individual has a plan that is immediately accessible and feasible.
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5. HISTORY
Please rate the highest level from the past 30 days.
Ratings Anchor Definitions
0
No history of suicidal ideation or attempt.
1
History of significant suicidal ideation, but no potentially lethal attempts.
2
History of a potentially lethal suicide attempt.
3
History of multiple, potentially lethal suicide attempts.
MODULE 6: DANGER TO OTHERS
1. FRUSTRATION MANAGEMENT
Please rate from the past 30 days.
Ratings Anchor Definitions
0
Individual appears to be able to manage frustration well. No evidence of
problems of frustration management.
1
Individual has some mild problems with frustration. He/she may anger easily
when frustrated; however, he/she is able to calm down following an angry
outburst.
2
Individual has problems managing frustration. His/her anger when frustrated
is causing functioning problems in school, at home, or with peers.
3
Individual becomes explosive and dangerous to others when frustrated.
He/she demonstrates little self-control in these situations and others must
intervene to restore control.
2. HOSTILITY
Please rate from the past 30 days.
Ratings Anchor Definitions
0
Individual appears to not experience or express hostility except in situations
where most people would become hostile.
1
Individual appears hostile, but does not express it. Others experience
individual as being angry.
2
Individual expresses hostility regularly.
3
Individual is almost always hostile either in expression or appearance. Others
may experience individual as ‘full of rage’ or ‘seething.’
3. PARANOID THINKING
Please rate from the past 30 days.
Ratings Anchor Definitions
0
Individual does not appear to engage in any paranoid thinking.
1
Individual is suspicious of others, but is able to test out these suspicions and
adjust his/her thinking appropriately.
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2
3
Individual believes that others are ‘out to get’ him/her. Individual has trouble
accepting that these beliefs may not be accurate. Individual at times is
suspicious and guarded, but at other times can be open and friendly.
Suspicions can be allayed with reassurance.
Individual believes that others plan to cause him/her harm. Individual is nearly
always suspicious and guarded.
4. SECONDARY GAINS FROM ANGER
Please rate from the past 30 days.
Ratings Anchor Definitions
0
No evidence that the child benefits from his/her expression of anger.
1
History or suspicion of the child using his/her anger to generate secondary
benefits and/or to manipulate others.
2
Child uses anger to gain benefits that would otherwise be unavailable. Anger is
used to be manipulative.
3
Secondary benefits from anger make this behavior either dangerous or
disabling. Child may disable others through the manipulative use of anger.
5. VIOLENT THINKING
Please rate from the past 30 days.
Ratings Anchor Definitions
0
There is no evidence that individual engages in violent thinking.
1
Individual has some occasional or minor thoughts about violence.
2
Individual has violent ideation. Language is often characterized as having
violent themes and problem solving often refers to violent outcomes.
3
Individual has specific homicidal ideation or appears obsessed with thoughts
about violence. For example, an individual who spontaneously and frequently
draws only violent images may be rated here.
6. AWARENESS OF VIOLENCE POTENTIAL
Please rate from the past 30 days.
Ratings Anchor Definitions
0
Individual is completely aware of his/her level of risk of violence. Individual
knows and understands risk factors. Individual accepts responsibility for past
and future behaviors. Individual is able to anticipate future challenging
circumstances. An individual with no violence potential would be rated here.
1
Individual is generally aware of his/her potential for violence. Individual is
knowledgeable about his/her risk factors and is generally able to take
responsibility. Individual may be unable to anticipate future circumstances
that may challenge him/her.
2
Individual has some awareness of his/her potential for violence. Individual may
have tendency to blame others, but is able to accept some responsibility for
his/her actions.
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3
Individual has no awareness of his/her potential for violence. Individual may
deny past violent acts or explain them in terms of justice or as deserved by the
victim.
7. RESPONSE TO CONSEQUENCES
Please rate from the past 30 days.
Ratings Anchor Definitions
0
Individual is clearly and predictably responsive to identified consequences for
violent behavior. Individual is regularly able to anticipate consequences and
adjust behavior.
1
Individual is generally responsive to identified consequences; however, not all
appropriate consequences have been identified or he/she may sometimes fail
to anticipate consequences.
2
Individual responds to consequences on some occasions, but sometimes does
not appear to care about consequences for his/her violent behavior.
3
Individual is unresponsive to consequences for his/her violent behavior.
8. COMMITMENT TO SELF-CONTROL
Please rate from the past 30 days.
Ratings Anchor Definitions
0
Individual fully committed to controlling his/her violent behavior.
1
Individual is generally committed to control his/her violent behavior; however,
individual may continue to struggle with control in some challenging
circumstances.
2
Individual ambivalent about controlling his/her violent behavior.
3
Individual not at all interested in controlling his/her violent behavior at this
time.
9. TREATMENT INVOLVEMENT
Please rate from the past 30 days.
Ratings Anchor Definitions
0
Individual fully involved in his/her own treatment. Family supports treatment
as well.
1
Individual or family involved in treatment, but not both. Individual may be
somewhat involved in treatment, while family members are active or individual
may be very involved in treatment while family members are unsupportive.
2
Individual and family are ambivalent about treatment involvement. Individual
and/or family may be skeptical about treatment effectiveness or suspicious
about clinician intentions.
3
Individual and family are uninterested in treatment involvement. An individual
with treatment needs who is not currently in treatment would be rated here.
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MODULE 7: SEXUALLY AGGRESSIVE BEHAVIOR
1. RELATIONSHIP
Please rate the most recent episode of sexual behavior.
Ratings Anchor Definitions
0
No evidence of victimizing others. All parties in sexual activity appear to be
consenting. No power differential.
1
Although parties appear to be consenting, there is a significant power
differential between parties in the sexual activity, with this child or adolescent
being in the position of authority.
2
Child is clearly victimizing at least one other individual with sexually abusive
behavior.
3
Child is severely victimizing at least one other individual with sexually abusive
behavior. This may include physical harm that results from either the sexual
behavior or physical force associated with sexual behavior.
2. PHYSICAL FORCE/THREAT
Please rate the most recent episode of sexual behavior.
Ratings Anchor Definitions
0
No evidence of the use of any physical force or threat of force in either the
commission of the sex act or in attempting to hide it.
1
Evidence of the use of the threat of force in an attempt to discourage the
victim from reporting the sex act.
2
Evidence of the use of mild to moderate force in the sex act. There is some
physical harm or risk of physical harm.
3
Evidence of severe physical force in the commission of the sex act. Victim
harmed or at risk for physical harm from the use of force.
3. PLANNING
Please rate the most recent episode of sexual behavior.
Ratings Anchor Definitions
0
No evidence of any planning. Sexual activity appears entirely opportunistic.
1
Some evidence of efforts to seek situations where likelihood of opportunities
for sexual activity is enhanced.
2
Evidence of some planning of sex act.
3
Considerable evidence of predatory sexual behavior in which victim is
identified prior to the act, and the act is premeditated.
4. AGE DIFFERENTIAL
Please rate the most recent episode of sexual behavior.
Ratings Anchor Definitions
0
Ages of the perpetrator and victim and/or participants essentially equivalent
(less than 3 years apart).
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1
2
3
Age differential between perpetrator and victim and/or participants is 3 to 4
years.
Age differential between perpetrator and victim at least 5 years, but
perpetrator less than 13 years old.
Age differential between perpetrator and victim at least 5 years and
perpetrator 13 years old or older.
5. TYPE OF SEX ACT
Please rate the most recent episode of sexual behavior.
Ratings Anchor Definitions
0
Sex act(s) involve touching or fondling only.
1
Sex act(s) involve fondling plus possible penetration with fingers, or oral sex.
2
Sex act(s) involve penetration into genitalia or anus with body part.
3
Sex act involves physically dangerous penetration due to differential size or use
of an object.
6. RESPONSE TO ACCUSATION
Please rate the most recent episode of sexual behavior.
Ratings Anchor Definitions
0
Child admits to behavior and expresses remorse and desire to not repeat.
1
Child partially admits to behavior and expresses some remorse.
2
Child admits to behavior, but does not express remorse.
3
Child neither admits to behavior nor expresses remorse. Child is in complete
denial.
7. TEMPORAL CONSISTENCY
Ratings Anchor Definitions
0
This level indicates a child who has never exhibited sexually abusive behavior
or who has developed this behavior only in the past three months following a
clear stressor.
1
This level indicates a child who has been sexually abusive during the past two
years or a child who has become sexually abusive in the past three months
despite the absence of any clear stressors.
2
This level indicates a child who has been sexually abusive for an extended
period of time (e.g., more than two years), but who has had significant
symptom-free periods.
3
This level indicates a child who has been sexually abusive for an extended
period of time (e.g., more than two years) without significant symptom-free
periods.
8. HISTORY OF SEXUAL BEHAVIOR (TOWARD OTHERS)
Ratings Anchor Definitions
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0
1
2
3
Child or adolescent has one incident of sexually abusive behavior that has been
identified and/or investigated.
Child or adolescent has two or three incidents of sexually abusive behavior that
have been identified and/or investigated.
Child or adolescent has four to ten incidents of sexually abusive behavior with
more than one victim that have been identified and/or investigated.
Child or adolescent has more than ten incidents of sexually abusive behavior
with more than one victim that have been identified and/or investigated.
9. SEVERITY OF SEXUAL ABUSE
Ratings Anchor Definitions
0
No history of any form of sexual abuse.
1
History of occasional fondling or being touched inappropriately, however, not
occurring on a regular basis, or by someone in a caregiver capacity or who has
a suspicion of history of sexual abuse, without confirming evidence.
2
This level is to indicate a moderate level of sexual abuse. This may involve a
child who has been fondled on an ongoing basis or sexually penetrated (anal or
genital) once by someone not in a caregiver capacity.
3
This level is to indicate a severe level of sexual abuse involving penetration on
an ongoing basis by someone either in a caregiver capacity or in close
emotional relation to the child.
END OF MANUAL
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