Assessment Area - drug questions Correct Answers Use by
peers? (include tobacco and alcohol)
Use by a young person? (include tobacco and alcohol)
Use by family members? (include tobacco and alcohol)
Amounts, frequency, patterns of use/abuse while intoxicated?
Drive while under the influence?
Source?
How paid for?
Assessment Area - Education and Employment Correct
Answers How is your grade or performance in school? Any
recent changes in your grades in school?
Favorite and least favorite subjects (include grades)?
Any years repeated classes failed?
Suspension/dropping out?
Future education/employment plans?
Any current or past employment?
Relations with teachers, employers-school, work attendance?
Assessment Area - Home Questions Correct Answers Who
lives with the young person/where?
Do they have their own room?
What are relationships like at home?
What do parents and relatives do for a living?
Have you ever been institutionalized?
Have you ever been incarcerated?
Have you had any recent moves?
Have you ever run away?
Are there any new people in the home environment?
, Assessment Area - sexuality Correct Answers Orientation?
Degree and types of experiences?
Number of partners?
Masturbation (normalize)
History of pregnancy/abortion?
Sexually transmitted infections? Knowledge and prevention?
Contraception? Frequency of use?
Comfort with sexual activity, enjoyment/pleasure obtained?
History of sexual/physical abuse?
Assessment Area -activities Correct Answers What do you do
for fun? Where do you go? (individually or with peers)
Sports/ exercise?
Church attendance, clubs, projects?
Hobbies or other activities?
Reading for fun? What do you like to read?
TV-how much weekly? Favorite shows?
Favorite music?
Have a car? Use seat belts?
History of arrest, acting out, crimes?
Assessment Area -Suicide/Depression Questions Correct
Answers Sleep disorders?
Appetite/eating behavior changes?
Emotional outbursts and impulsive behavior?
History or withdrawal/social isolation?
Boredom, depression, psychological counseling?
Hopeless/helpless feelings?
History of suicide attempts by family members or peers?
History of recurrent serious accidents?
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