The following is a list of behaviors that are
associated with Youth at Risk. Circle the items that describe the youth you are concerned
about. Add the numbers up. A list of ranges are provided below.
You may also check the boxes next to each question and submit the form to us
by e-mail for feedback. These
ranges indicate a level of risk that your child's problem behavior will escalate without
Professional consultation is always appropriate if you have concerns
regarding mental, emotional or behavioral problems. This questionnaire should not be
used to screen for medical, psychiatric or mental health disorders. No
questionnaire can replace or substitute for professional consultation. This questionnaire is designed to help you clarify your concerns,
help you discuss issues with a counselor or mental health professional and to give you an
indicator of approximate risk.