B. BEHAVIORAL CHARACTERISTICS (Ages 5 to 21) (Continued) II-2. Social Functioning Peer (PAST 30 DAYS) Child’s – Child has positive social Child is having some minor Child is having some Child is experiencing relationships with peers. Any problems in social moderate problems with his / severe disruptions in his / concerns are age relationships with peers. her social relationships with her social relationships appropriate or this same age peers. with same age peers. information is unknown to me. If the needs / functioning fall within a shaded box, explain why: child’s II-3. Social Functioning Adult (PAST 30 DAYS) Child’s – Child has positive social Child is having some minor Child is having some Child is experiencing relationships with adults. Any problems in social moderate problems with his / severe disruptions in his / concerns are age relationships with adults. her social relationships with her social relationships appropriate or this adults. with adults. information is unknown to me. If the needs / functioning fall within a shaded box, explain why: child’s II-4. Involvement with the Legal / Juvenile Justice System Seriousness (PAST 30 DAYS) Child’s – Youth has engaged in status Youth has engaged in Youth has engaged in Youth has engaged in offenses (curfew, tobacco delinquent behavior delinquent behavior delinquent behavior that possession, etc.) or this equivalent to a misdemeanor. equivalent to a felony. places other citizens at risk information is unknown to of significant physical me. harm. If the needs / functioning fall within a shaded box, explain why: child’s B. BEHAVIORAL CHARACTERISTICS (Ages 5 to 21) (Continued) II-5. Involvement with the Legal / Juvenile Justice System History (PAST 30 DAYS) Child’s – Current criminal / delinquent Youth has engaged in Youth has engaged in Youth has engaged in behavior is the first known multiple criminal / delinquent multiple criminal / delinquent multiple criminal / occurrence or this acts in the past year. acts for more than 1 year but delinquent acts for more information is unknown to me has had 3+ month periods than 1 year without any / not applicable. without. period without involvement.
B. BEHAVIORAL CHARACTERISTICS (Ages 5 to 21) (Continued) II-2. Child’s Social Functioning – Peer (PAST 30 DAYS) Child has positive social relationships with peers. Any concerns are age appropriate or this information is unknown to me. Child is having some minor problems in social relationships with peers. Child is having some moderate problems with his / her social relationships with same age peers. Child is experiencing severe disruptions in his / her social relationships with same age peers. If the child’s needs / functioning fall within a shaded box, explain why: II-3. Child’s Social Functioning – Adult (PAST 30 DAYS) Child has positive social relationships with adults. Any concerns are age appropriate or this information is unknown to me. Child is having some minor problems in social relationships with adults. Child is having some moderate problems with his / her social relationships with adults. Child is experiencing severe disruptions in his / her social relationships with adults. If the child’s needs / functioning fall within a shaded box, explain why: II-4. Child’s Involvement with the Legal / Juvenile Justice System – Seriousness (PAST 30 DAYS) Youth has engaged in status offenses (curfew, tobacco possession, etc.) or this information is unknown to me. Youth has engaged in delinquent behavior equivalent to a misdemeanor. Youth has engaged in delinquent behavior equivalent to a felony. Youth has engaged in delinquent behavior that places other citizens at risk of significant physical harm. If the child’s needs / functioning fall within a shaded box, explain why: B. BEHAVIORAL CHARACTERISTICS (Ages 5 to 21) (Continued) II-5. Child’s Involvement with the Legal / Juvenile Justice System – History (PAST 30 DAYS) Current criminal / delinquent behavior is the first known occurrence or this information is unknown to me / not applicable. Youth has engaged in multiple criminal / delinquent acts in the past year. Youth has engaged in multiple criminal / delinquent acts for more than 1 year but has had 3+ month periods without. Youth has engaged in multiple criminal / delinquent acts for more than 1 year without any period without involvement.
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