Yes No Situation Does the child need help/supervision in the following areas due to a long-term health condition or disability? Always / Have Don't have Have no Don't sometimes difficulty, difficulty, difficulty know need help but don't but use and/or need help aids / supervision / equipment supervision Self-care mobility communication The following questions relate to the child's mental health history: Prior mental health diagnosis How long have services been Other mental health indicators Yes received Agency worker No Currently receiving services Health Professional Don't know Received services in the last 12 Non-Government agency Not applicable months Family, friends, carers Received services more than 12 Self-identified months ago Other Received services no No information indicating timeframe reported mental illness No services ever received Not applicable Don't know Not applicable Living arrangements One parent with Children Group Couple with child (ren) Don’t know Other family type (please state):
Yes No Situation Does the child need help/supervision in the following areas due to a long-term health condition or disability? Always / sometimes need help and/or supervision Have difficulty, but don't need help / supervision Don't have difficulty, but use aids / equipment Have no difficulty Don't know Self-care mobility communication The following questions relate to the child's mental health history: Prior mental health diagnosis Yes No Don't know Not applicable How long have services been received Currently receiving services Received services in the last 12 months Received services more than 12 months ago Received services no timeframe reported No services ever received Don't know Not applicable Other mental health indicators Agency worker Health Professional Non-Government agency Family, friends, carers Self-identified Other No information indicating mental illness Not applicable Living arrangements One parent with Children Couple with child (ren) Other family type (please state): Group Don’t know