II-10. Involvement with the Legal / Juvenile Justice System Peer Influences (PAST 30 DAYS) Child’s – social Youth has peers in his / her Youth predominantly has Youth is a member of a Youth’s primary peer group does not engage in peer group who do not peers who engage in gang whose membership delinquent / criminal behavior engage in criminal / delinquent behavior but youth encourages or requires or this information is delinquent behavior, but is not a member of a gang. illegal behavior as an unknown to me. some peers who do. aspect of gang membership. If the needs / functioning fall within a shaded box, explain why: child’s II-11. Sexual Development (PAST 30 DAYS) No evidence of any problems Mild to moderate problems Significant problems with Profound problems with with sexual development. with sexual development that sexual development that may sexual development that Any concerns are age may include concerns about include multiple and / or older may include prostitution, appropriate or this sexual identity or anxiety partners or high-risk sexual very frequent risky sexual information is unknown to about the reactions of others. behaviors. behavior, or sexual me. aggression. If the needs / functioning fall within a shaded box, explain why: child’s B. BEHAVIORAL CHARACTERISTICS (Ages 5 to 21) (Continued) II-12. School Attendance (PAST 30 DAYS) – Child attends school regularly Child has some problems Child is having problems with Child is generally truant or or this information is attending school, including a school attendance, including refusing to go to school unknown to me. history of truancy, frequent truancy, more than 3 days out of suspensions or expulsions suspensions or expulsions every week. but generally goes to school. and is missing at least 2 days / week on average. If the needs / functioning fall within a shaded box, explain why: child’s II-13. School Behavior (PAST 30 DAYS) – Child is behaving well in When child is in school, he / When child is in school, he / When child is in school, he school. Any concerns are she behaves well although she has moderate behavioral / she is having severe age appropriate or this some behavior problems problems and is disruptive. problems with behavior information is unknown to exist. Child may have received and is frequently or
II-10. Child’s Involvement with the Legal / Juvenile Justice System – Peer Influences (PAST 30 DAYS) Youth’s primary peer social group does not engage in delinquent / criminal behavior or this information is unknown to me. Youth has peers in his / her peer group who do not engage in criminal / delinquent behavior, but some peers who do. Youth predominantly has peers who engage in delinquent behavior but youth is not a member of a gang. Youth is a member of a gang whose membership encourages or requires illegal behavior as an aspect of gang membership. If the child’s needs / functioning fall within a shaded box, explain why: II-11. Sexual Development (PAST 30 DAYS) No evidence of any problems with sexual development. Any concerns are age appropriate or this information is unknown to me. Mild to moderate problems with sexual development that may include concerns about sexual identity or anxiety about the reactions of others. Significant problems with sexual development that may include multiple and / or older partners or high-risk sexual behaviors. Profound problems with sexual development that may include prostitution, very frequent risky sexual behavior, or sexual aggression. If the child’s needs / functioning fall within a shaded box, explain why: B. BEHAVIORAL CHARACTERISTICS (Ages 5 to 21) (Continued) II-12. School – Attendance (PAST 30 DAYS) Child attends school regularly or this information is unknown to me. Child has some problems attending school, including a history of truancy, suspensions or expulsions but generally goes to school. Child is having problems with school attendance, including frequent truancy, suspensions or expulsions and is missing at least 2 days / week on average. Child is generally truant or refusing to go to school more than 3 days out of every week. If the child’s needs / functioning fall within a shaded box, explain why: II-13. School – Behavior (PAST 30 DAYS) Child is behaving well in school. Any concerns are age appropriate or this information is unknown to When child is in school, he / she behaves well although some behavior problems exist. When child is in school, he / she has moderate behavioral problems and is disruptive. Child may have received When child is in school, he / she is having severe problems with behavior and is frequently or
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