Discussion DB #2 - Risk Assessment Activity - Directions for this board are embedded in the audio clip for Powerpoint #8 (slide 11).
Child’s Name or ID#:_______________ Date: ____________
(First name SURNAME) (YYYY-MM-DD)
Assessor: _________________ Child’s DOB: ___________ Age: _____________
(YYYY-MM-DD)
| Family Items | Rating (0-1-2) | Critical Risk | |
| F1 | Household Circumstances (5 family members living in 2 bedroom apartment, finances very tight) | 2 | X |
| F2 | Caregiver Continuity (always lived with mom, parents separated, still maintains contact with dad) | 1 | |
| F3 | Supports (extended family, few close friends, child welfare worker, not connected to community ) | 1 | |
| F4 | Stressors (marital problems & family violence issues, school problems, seems to feel in control) | 1 | X |
| F5 | Parenting (ineffective limits, lack of patience, punitive discipline – cut hair) | 2 | X |
| F6 | Caregiver-Daughter Interaction (lots of maternal & daughter warmth & love, + contact with dad) | 0 |
|
| F7 | Antisocial Values and Conduct (family violence – dad spent night in jail) | 2 | X |
| Child Items | Rating (0-1-2) | Critical Risk | |
| C1 | Developmental Problems (none noted) | 0 |
|
| C2 | Onset of Behavioral Difficulties (aggressive behaviors identified at 4.5 yrs) | 2 | |
| C3 | Abuse/Neglect/Trauma (witnessed domestic violence) | 2 | X |
| C4 | HIA (Hyperactivity/Impulsivity/Attention Deficits) (“energetic” but able to concentrate and focus | 0 |
|
| C5 | Likeability (‘somewhat’ likeable according to teachers & mom’s friends, creative, stubborn) | 1 | |
| C6 | Peer Socialization (hard time making and keeping friends – hits kids) | 2 | X |
| C7 | Academic Performance (functioning at grade level – reading 1 year behind – special reading program) | 1 | |
| C8 | Neighborhood (unsafe, gang presence, lacking community connection) | 2 |
|
| C9 | Sexual Development (engaging in sexual exploration with her female cousin) | 1 | X |
| C10 | Antisocial Attitudes (difficulty apologizing, taking responsibility, or feeling badly) | 2 |
|
| C11 | Antisocial Behavior (school suspensions, violent, threatening, aggression, oppositional, bullies) | 2 | |
| C12 | Coping Ability (problems noted at school, issues with uncontrollable anger) | 1 | |
| Responsivity Items | Rating (0-1-2) | Critical Risk | |
| R1 | Family Responsivity (mom enthusiastic about participating in treatment, no noted concerns) | 0 | |
| R2 | Child Responsivity (positive – looking forward to the SNAP® Girls Connection) | 0 |
| Total Score: 25 |
| HIGH | MOD | LOW |
