BGCD Behavioral Health Needs Assessment
Thank you for taking the time to complete this assessment. The Director of Behavioral Health will follow up with families individually. 
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Email *
Child's Name *
Child's Age *
Does your child have a current/updated BGCD membership? *
Is your child currently receiving mental health supports outside of BGCD?
 *
My child has peer social skills and peer relationship skills
 *
My child has friends *
My child can manage their anger on their own *
My child has self-control skills *
My child has positive self-esteem *
My child has experienced grief and/or loss in the last 4 years *
If you answered yes above, please explain
My child is always worried *
My child could benefit from small group activities *
My child could benefit from small group activities on the following topics (check all that apply)  *
Required
Small group idea/ topic not listed above
I am aware of BGCD behavioral health supports currently in place- Doc Wayne Chalk Talk Group, MENTOR Individual Therapy, Sanctuary Space, Small groups with Virginia Mahoney Licensed Social Worker *
Best phone number for follow up communication  *
Please use the space below for any questions or comments you may have. 
Thank you for taking the time to complete this survey! 
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