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Children & Young People Therapy Assessment Form
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The Presenting Problem - Please describe the reasons for seeking therapy for your child.
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When did it start and when does it occur? How often and for how long? What are the triggers? What makes it better/worse?
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Who and what does it affect? What is the impact on the child, family members, child's school attendance or grades, their friendships?
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Relevant health or mental health problems (diagnoses or medication the child is on) and any previous therapy or hospitalization.
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Any significant or stressful life events that the child has been experiencing (tick those that apply):
A recent move or change in school?
Abuse or neglect?
Bullied or ignored by peers?
Academic difficulties?
Weight control issues?
Sexual orientation concerns?
Self-harm?
Death or illness of a loved one or pet?
Family conflict?
Separation or Divorce?
Other?
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Please provide details for the answers you ticked in the previous question.
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What was the child’s early development like? What are your child’s strengths and interests?
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Current health and functioning (sleeping, eating, smoking, drinking, hobbies, habits etc.)
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How do you work together as a family? What do you enjoy together? How does the child relate to family members? Is the family dealing with any ongoing stressors?
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What are your expectations of therapy? What would you like to change?
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What are the child's expectations of therapy? What would they like to change?
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Additional information.
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