Information about Each of the Adults in the Home Name Don’t Relationship Yes No know Was s/he a victim of as a child? o □ ∆ Was the over a long period? o □ ∆ Did s/he witness abuse as a child? o □ ∆ Did s/he witness family violence as a child? o □ ∆ Did s/he have a difficult childhood? o □ ∆ Was/he in care? o □ ∆ Did s/he have multiple carers as a child? o □ ∆ Did s/he present difficult behaviour as a o □ ∆ Did s/he present difficult behaviour as an adolescent? o □ ∆ Has previous professional involvement resolved any of o □ ∆ these issues? Is s/he 18 years of age? o □ ∆ Does s/he present difficult behaviour? o □ ∆ Has s/he had employment difficulties? o □ ∆ Is s/he unemployed o □ ∆ Has s/he a history of alcohol or drug o □ ∆ Is the alcohol or drug of long standing? o □ ∆ Has s/he had failed attempts to detoxify? o □ ∆
Information about Each of the Adults in the Home Name Relationship Yes No Don’t know Was s/he a victim of as a child? □ o ∆ Was the over a long period? □ o ∆ Did s/he witness abuse as a child? □ o ∆ Did s/he witness family violence as a child? □ o ∆ Did s/he have a difficult childhood? □ o ∆ Was/he in care? □ o ∆ Did s/he have multiple carers as a child? □ o ∆ Did s/he present difficult behaviour as a □ o ∆ Did s/he present difficult behaviour as an adolescent? □ o ∆ Has previous professional involvement resolved any of these issues? o □ ∆ Is s/he 18 years of age? □ o ∆ Does s/he present difficult behaviour? □ o ∆ Has s/he had employment difficulties? □ o ∆ Is s/he unemployed □ o ∆ Has s/he a history of alcohol or drug □ o ∆ Is the alcohol or drug of long standing? □ o ∆ Has s/he had failed attempts to detoxify? □ o ∆
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