COMPREHENSIVE Profile (ages 5-17)
Please Ö appropriate use: / Initial / Reassessment / Date: / M / M / D / D / Y / Y
Transition/Discharge
m / m / d / d / y / y / M / F
Child’s Name / DOB / Gender
November 2013 revised
Copyright 1999 Praed Foundation Page 1 of 2
**LIFE DOMAINE FUNCTIONING RATING0 = No evidence of problem - / 1 = History - Watchful
2 = Moderate need / 3 = Severe need -
**Life Domain Functioning 0 1 2 3
Family / / / /
Living Situation / / / /
Sleep / / / /
Social Development / / / /
Recreation / / / /
Developmental *1 / / / /
Communication / / / /
Judgment / / / /
Acculturation / / / /
Job Functioning / / / /
Legal / / / /
Medical *2 / / / /
Physical Health / / / /
Sexuality *3 / / / /
Daily Functioning / / / /
Independent Living(Age 14-21) / / / /
School Behavior / / / /
School Achievement / / / /
School Attendance / / / /
CHILD STRENGTHS RATING
0 = Strength / 1 = Useful
2 = Identified / 3 = Not yet identified
Child Strengths 0 1 2 3
Family / / / /
Interpersonal / / / /
Optimism / / / /
Educational / / / /
Vocational / / / /
Talents/interests / / / /
Spiritual/Religious / / / /
Community Life / / / /
Relationship Permanence / / / /
Child Involvement with Care / / / /
Natural Supports / / / /
ACCULTURATION RATING
0= No Evidence 1= Minimal Needs
2= Moderate Needs 3= Significant Needs
Acculturation 0 1 2 3
Language / / / /
Identity / / / /
Ritual / / / /
CAREGIVER STRENGTHS RATING
0= Strength 1= Some Need
2= Moderate Need 3= Severe Need
Caregiver Strengths 0 1 2 3
Supervision / / / /
Involvement / / / /
Knowledge / / / /
Organization / / / /
Social Resources / / / /
Residential Stability / / / /
CAREGIVER NEEDS RATING
0= No Evidence 1= Some Needs
2= Moderate Needs 3= Severe Needs
Caregiver Needs 0 1 2 3
Physical / / / /
Mental Health / / / /
Substance Use / / / /
Developmental / / / /
Safety / / / /
**CHILD BEHAVIORAL /EMOTIONAL NEEDS RATINGS
0= No Évidence 1= History, sub-threashold, watch- prevent
2= Causing Problem 3= Causing severe/dangerous problems
**Child Behavioral / Emotional Needs
Psychosis / / / /
Impulse/Hyperactivity / / / /
Depression / / / /
Anxiety / / / /
Oppositional / / / /
Conduct / / / /
Adjustment to Trauma *4 / / / /
Anger Control / / / /
Substance Use *5 / / / /
CHILD RISK RATING
0= No Evidence 1= History, watch-prevent
2= Recent Act 3= Acute, act immediately
Child Risk Behaviors 0 1 2 3
Suicide Risk / / / /
Self-Mutilation / / / /
Others Self Harm / / / /
Danger to Others *6 / / / /
Sexual Aggression *7 / / / /
Runaway *8 / / / /
Delinquency *9 / / / /
Judgment / / / /
Fire Setting *10 / / / /
Social Behavior / / / /
Modules (*)
1 - Developmental Module
2 - Medical
3 - Sexuality
4 - Trauma
5 - Substance Use Disorder
6 - Violence
7 - Sexual Abuse Behavior
8 - Runaway
9 - Juvenile Justice
10 - Fire Setting
**Must have at least one score of (2) or higher in each of the two highlighted sections above: “Life Domain Functioning” AND “Child Behavioral / Emotional Needs”.
Modules
DEVELOPMENTAL NEEDS MODULE(DD)0 / 1 / 2 / 3
Cognitive / / / /
Developmental / / / /
Communication / / / /
Self-Care / Daily Living / / / /
SEXUALITY MODULE
Sex-related Problems 0 1 2 3
Promiscuity / / / /
Masturbation / / / /
Reactive sexual behavior / / / /
Knowledge of sex / / / /
Choice of relationships / / / /
Sexual identity / / / /
Sexual deviance
Voyeurism / / / /
Frotteurism / / / /
Exhibitionism / / / /
Fetishism / / / /
Pedophilia / / / /
Sexual masochism / / / /
Sexual sadism / / / /
Transvestic fetishism / / / /
SUBSTANCE USE MODULE (SUD) 0 1 2 3
Severity of Use / / / /
Duration of Use / / / /
Stage of Recovery / / / /
Peer Influences / / / /
Parental Influences / / / /
Environmental Influences / / / /
TRAUMA MODULE
Characteristic of the trauma experiences
0 / 1 / 2 / 3
Sexual Abuse* / / / /
Physical Abuse / / / /
Emotional Abuse / / / /
Medical Trauma / / / /
Natural Disaster / / / /
Witness to Family Violence / / / /
Witness to Community Violence / / / /
Witness/Victim-Criminal Acts / / / /
If Sexual Abuse >0, complete the following
Emotional closeness to perpetrator / / / /
Frequency / / / /
Duration / / / /
Force / / / /
Reaction to disclosure / / / /
Adjustment 0 1 2 3
Affect Regulation / / / /
Intrusions / / / /
Attachment / / / /
Dissociation / / / /
Time Before Treatment / / / /
VIOLENCE MODULE
Historical Risk Factors / 0 / 1 / 2 / 3
History of physical abuse / / / /
History of violence / / / /
Witness to domestic violence / / / /
Witness Environmental violence / / / /
Emotional/Behavioral Risks / 0 / 1 / 2 / 3
Bullying / / / /
Frustration management / / / /
Hostility / / / /
Paranoid Thinking / / / /
Secondary gains from anger / / / /
Violent thinking / / / /
Resiliency Factors
Aware of violence potential / / / /
Response to consequences / / / /
Commitment to self-control / / / /
Treatment involvement / / / /
SAB- SEXUALLY AGGRESSIVE BEHAVIOR
0 / 1 / 2 / 3
Relationship / / / /
Physical force/threat / / / /
Planning / / / /
Age Differential / / / /
Type of sex act / / / /
Response to accusation / / / /
Temporal consistency / / / /
History of sexual behavior / / / /
Severity of sexual abuse / / / /
Prior treatment / / / /
RUNAWAY 0 1 2 3
Frequency of running / / / /
Consistency of destination / / / /
Safety of destination / / / /
Involvement in illegal acts / / / /
Likelihood of return on own / / / /
Involvement of others / / / /
Realistic expectations / / / /
Planning / / / /
JJ-JUVENILE JUSTICE 0 1 2 3
Seriousness / / / /
History / / / /
Planning / / / /
Community safety / / / /
Peer Influences / / / /
Parental Influences / / / /
Environmental Influences / / / /
FS- FIRE SETTING 0 1 2 3
Seriousness / / / /
History / / / /
Planning / / / /
Use of Accelerants / / / /
Intention to harm / / / /
Community safety / / / /
Response to accusation / / / /
Remorse / / / /
Likelihood to future fires / / / /
November 2013 revised
Copyright 1999 Praed Foundation Page 1 of 2