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Child and Adolescent Trauma Screen (CATS) - Caregiver Report (Ages 7-17 years)
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* Indica que la pregunta es obligatoria
Your First Initial, Last Name
*
Tu respuesta
Patient First Initial, Last Name
*
Tu respuesta
A serious natural disaster like a flood, tornado, hurricane, earthquake, or fire.
*
Yes
No
A serious accident or injury like a car/bike crash, dog bite, sports injury.
*
Yes
No
Robbed by threat, force or weapon.
*
Yes
No
Slapped, punched, or beat up in the family.
*
Yes
No
Slapped, punched, or beat up by someone not in the family.
*
Yes
No
Seeing someone in the family get slapped, punched or beat up.
*
Yes
No
Seeing someone in the community get slapped, punched or beat up.
*
Yes
No
Someone older touching his/her private parts when they shouldn’t.
*
Yes
No
Someone older touching his/her private parts when they shouldn’t.
*
Yes
No
Someone forcing or pressuring sex, or when s/he couldn’t say no.
*
Yes
No
Someone forcing or pressuring sex, or when s/he couldn’t say no.
*
Yes
No
Someone close to the child dying suddenly or violently.
*
Yes
No
Attacked, stabbed, shot at or hurt badly.
*
Yes
No
Seeing someone attacked, stabbed, shot at, hurt badly or killed.
*
Yes
No
Stressful or scary medical procedure.
*
Yes
No
Being around war.
*
Yes
No
Other stressful or scary event?
*
Tu respuesta
Which one is bothering the child most now?
*
Tu respuesta
If you marked “YES” to any stressful or scary events for the child, then continue to the next page and answer the next questions.
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