1. Social data report Identifying information: name, DOB, age, gender, address and phone of parent or guardian Physical description: height, weight, handedness, eye and hair color, race

2. Social data  Presenting problem  Current offense or referral reason (date and type, events)  Arresting officer or petitioner  Prior record  Functional analysis: onset, any precipitating factors, frequency, severity  Maintenance factors

3. Social data  Methods used to deal with the problem  School data  Schools attended, current school, current grade in school, failed any grades  Grades, attendance, behavior in school (fights)  Involvement in school activities  Special ed: MR, LD, ADD, ADHD, ED

4. Family data  Father, stepfather, guardian (might have more than one of these)  Address, phone number, occupation, age  Educational level, health, court record  Nature of relationship of youth to this (these) person(s)  Physical or sexual abuse  Alcohol and drug use

5. Family  Mother, stepmother, guardian  Address, phone number occupation, age  Educational level, health, court record  Nature of relationship of youth to this (these) person(s)  Physical or sexual abuse  Alcohol and drug use

6. Family data  Family income, status of welfare and other  Current living arrangement, marital status  If parents are separated or divorced, when  If father abandoned family, when  Nature of relationship between parents, step-parents

7. Family data  Children in family and/or stepfamily, ages, whether they are living in the same home  Birth order  Discipline in home: by male, female, both, neither  Nature of discipline used  Level of supervision  Level of violence  Running away from home

8. Socioeconomic environment  Number of people in the home  Number of rooms (number of bedrooms)  Type of area: high crime, low crime, rural urban, isolated, slum, housing project  Modern conveniences  Housekeeping standards  Own home, rent, living with other relatives or non-relatives

9. Physical history of youth  Current state of health, any physical problems  Past problems (hospitalizations, diseases, injuries: lead poisoning, head injuries)  Diagnoses, medications  Other health problems in parents, family  Pregnancy/birth difficulties

10. Psychiatric history  DSM-IV diagnoses  Inpatient, outpatient, medication  Psychiatric history of family members  Suicide attempts (number, nature, when)  Self-mutilation  Alcohol and drug use (amount, frequency, duration, starting age)

11. History  History of residences  Vocational history: jobs, length, problems with employers and employees  Sexually active (age)  Hetero/homosexual, children  Contraceptive knowledge/use

12. History  Number of acquaintances, friends  Close friends, boy friends, girl friends  Enjoy peer interactions?  Nature of interactions  Delinquent friends  Dating

13. History  Leisure/recreational activities  Organized activities  Hobbies  Special skills, talents  Religious affiliation, church attendance, influence

14. Future plans  Further education  Jobs  Marriage and children  Description of self

15. Testing  Mental status exam  Appearance, attitude, behaviors  Speech (rate, production)  Appetite, sleep  Mood: anxiety, crying  Orientation: person, place time

16. Language  Name (use two common objects, such as pencil, and a watch)  Repeat a phrase (no ifs, ands or buts)  3 stage command (take this paper in your right hand, fold it in half and put in on the floor)  Memory: digit span (average 7 digits)

17. Mental status  Serial numbers  Fund of general information (50 x 5, capital of Missouri)  Abstract reasoning: how are a cat and a mouse alike, explain a proverb)  Unusual experiences: obsessions, hallucinations, compulsions, delusions, depersonalization  Insight

18. Psychological tests  Intelligence test (Peabody Picture Vocabulary Test (PPVT-R), Wais Intelligence Scale for Children (WISC), Stanford Binet—individualized. Also a variety of group tests that vary in quality  Bender Visual Motor Gestalt Test (can look at planning ability, impulsivity)

19. Psychological tests  Academic achievement test: some given by schools, Metropolitan, SAT, etc.), Wide Range Achievement Test (WRAT)  Personality test (MMPI, CPI)  Projective tests (Draw-a-person, the House Tree Person, the Thematic Apperception Test (TAT)