Choosing the Right Program  |  Assess Your Child

Please answer the following assessment as honestly and accurately as you can. Your results will be processed and will give you an indication of what is recommended for your child. All information submitted is confidential. The results will be displayed upon pressing the submit button.
 

This assessment is for my:

Son     Daughter

Has your child had recurring problems due to:

  1. Any traumatic events/changes such as abuse, divorce, or death, in his life?
            Yes             No
     
  2. Inability to manage anger?
            Yes             No

Within the last six months, has your child:

  1. Disregarded family rules and parental guidance?
            Yes             No
     
  2. Had any changes in behavior and/or mood?
            Yes             No
     
  3. Exhibited depressive symptoms, such as weight loss/gain or excessive sleep?
            Yes             No
     
  4. Had problems getting along with others?
            Yes             No
     
  5. Do you suspect that your child has used drugs or alcohol?
            Yes             No
     
  6. Had problems in school such as poor grades or challenging authority?
            Yes             No
     
  7. Has your child been able to manipulate people and situations in order to escape consequences?
            Yes             No
     
  8. Been destructive to property?
            Yes             No
     
  9. Intentionally frightened others?
            Yes             No
     
  10. Made threatening statements in writing?
            Yes             No
     
  11. Implied that they may have a plan for violent or suicidal behavior?
            Yes             No
     
  12. Implied that they have identified a target for violence?
            Yes             No

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