11-21. Danger to Others (PAST 30 DAYS) No evidence that the child History of homicidal ideation, Recent homicidal ideation, Homicidal ideation with a presents a danger to others. physically harmful aggression physically harmful aggression plan or physically harmful Any concerns are age or fire setting that has put self or dangerous fire setting but aggression within the past appropriate or this or others in danger of harm. not in the past 24 hours. 24 hours. information is unknown to me. If the needs / functioning fall within a shaded box, explain why: child’s II-22. Sexual Aggression (PAST 30 DAYS) No evidence of any history of History of sexually Child is engaged in sexually Child has engaged in sexually aggressive behavior. aggressive behavior (but not aggressive behavior in the sexually aggressive Any sexual contact has been in the past year) OR sexually past year but not in the past behavior in the past 30 age appropriate and inappropriate behavior in the 30 days (use of force, days (use of force, consenting. No sexual past year (e.g. harassing talk coercion, unconsenting coercion, unconsenting contact with younger or excessive masturbation). contact). contact). children, or this information is unknown to me. If the needs / functioning fall within a shaded box, explain why: child’s II-23. Delinquent Behavior No evidence of any History of criminal / Recent acts of criminal / Severe acts of criminal / delinquent behavior or this delinquent behavior but no delinquent behavior but no delinquent behaviors that information is unknown to acts in the past 30 days. acts in the past 30 days. placed others at risk of me. significant loss or injury or place the child at risk of adult sanctions. If the needs / functioning fall within a shaded box, explain why: child’s B. BEHAVIORAL CHARACTERISTICS (Ages 5 to 21) (Continued) II-24. Runaway (PAST 30 DAYS) No evidence that the child History of runaway from Recent runaway behavior or Serious threat to runaway runs away. Any concerns are home or other settings ideation but not in the past 7 as shown by either recent age appropriate or this involving at least 1 overnight days. attempts OR child is information is unknown to absence, at least 30 days currently a runaway. me. ago. If the needs / functioning fall within a shaded box, explain why: child’s
11-21. Danger to Others (PAST 30 DAYS) No evidence that the child presents a danger to others. Any concerns are age appropriate or this information is unknown to me. History of homicidal ideation, physically harmful aggression or fire setting that has put self or others in danger of harm. Recent homicidal ideation, physically harmful aggression or dangerous fire setting but not in the past 24 hours. Homicidal ideation with a plan or physically harmful aggression within the past 24 hours. If the child’s needs / functioning fall within a shaded box, explain why: II-22. Sexual Aggression (PAST 30 DAYS) No evidence of any history of sexually aggressive behavior. Any sexual contact has been age appropriate and consenting. No sexual contact with younger children, or this information is unknown to me. History of sexually aggressive behavior (but not in the past year) OR sexually inappropriate behavior in the past year (e.g. harassing talk or excessive masturbation). Child is engaged in sexually aggressive behavior in the past year but not in the past 30 days (use of force, coercion, unconsenting contact). Child has engaged in sexually aggressive behavior in the past 30 days (use of force, coercion, unconsenting contact). If the child’s needs / functioning fall within a shaded box, explain why: II-23. Delinquent Behavior No evidence of any delinquent behavior or this information is unknown to me. History of criminal / delinquent behavior but no acts in the past 30 days. Recent acts of criminal / delinquent behavior but no acts in the past 30 days. Severe acts of criminal / delinquent behaviors that placed others at risk of significant loss or injury or place the child at risk of adult sanctions. If the child’s needs / functioning fall within a shaded box, explain why: B. BEHAVIORAL CHARACTERISTICS (Ages 5 to 21) (Continued) II-24. Runaway (PAST 30 DAYS) No evidence that the child runs away. Any concerns are age appropriate or this information is unknown to me. History of runaway from home or other settings involving at least 1 overnight absence, at least 30 days ago. Recent runaway behavior or ideation but not in the past 7 days. Serious threat to runaway as shown by either recent attempts OR child is currently a runaway. If the child’s needs / functioning fall within a shaded box, explain why:
2868.docx