CARE Network Evaluation Consent Form (Behavioral Health)

Consent form must be completed by parent/guardian/legal custodian in order to be eligible for reimbursement and qualify as a CARE Network assessment.

The Child PTSD Symptom Scale for    DSM-V

Screening measure to evaluate presence of  trauma symptomology and/or a diagnosis of PTSD

PHQ-9

(modified for  adolescents- PHQ-A)

Screening measure to evaluate presence of depressive symptomology and/or a diagnosis of Depression

Decision Tree for Adjunctive Measures

Recommendations for additional screening measures based on positive screens in the PTSD, PHQ-A or SCARED measures

EXAMPLE- Child Intake Form

Here is an example of an intake form that CU’s trauma team uses

A Flyer for Families: A CARE Network Behavioral Health Intake

Flyer that provides information on a CARE Network Behavioral Health Intake, what families can expect, how to talk to children, etc. Download here.

Screen for Child Anxiety Related Disorders (SCARED)

Screening measure to evaluate presence of anxiety symptomology and/or diagnosis of Anxiety