Adolescent Psychosocial Asessment Page 13
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14What else do you feel is important for us to know?
___________________________________________________________________________________________
___________________________________________________________________________________________
HISTORY OF VIOLENCE:
Has your child ever been accused of abusing or assaulting someone? Yes No If yes, please complete
chart below.
Type of Abuse
To Whom?
Age of your child?
Was it Reported?
Sexual
Yes No
Physical
Yes No
Emotional
Yes No
Verbal
Yes No
Abandoned/Neglected
Yes No
Has your child ever been known to bully other children? Yes No
What else do you feel/believe is important for us to know? __________________________________________
___________________________________________________________________________________________
STRENGTHS/RESOURCES/SUPPORTS:
What limitations does your child/ family have (if any)?______________________________________________
What strengths does your child/family have? ______________________________________________________
What resources does your child have to help with your current problem?
___________________________________________________________________________________________
What experiences (past & present) will help you in improving the current situation?
___________________________________________________________________________________________
___________________________________________________________________________________________
What are you (and your family) already doing to improve the current situation?
___________________________________________________________________________________________
Who does/can your child count on for support? Parents Boyfriend/Girlfriend Siblings
Extended Family Friends Neighbors School Staff Church Pastor Therapist
Group Community Services Doctor Other: _________________________________________
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