Home Life/Living Situation

Notes (include risks and protective factors):

  • How are things at home?
  • Who lives there?
  • How do you get along?
Risk rating:


Education/Employment

Notes (include risks and protective factors):

  • Are you at school/working/unemployed?
  • How is it going – Good/ not so good?
Risk rating:


Sleeping, Eating and Exercise

Notes (include risks and protective factors):

  • Are you sleeping well?
  • Has there been a change to your sleep patterns?
  • Are you eating OK?
  • Do you do much physical activity?
Risk rating:


Activities and Peer Relationships

Notes (include risks and protective factors):

  • What do you do for fun?
  • Are you involved in any activities outside home/education/work?
  • Friends?Are they supportive?
Risk rating:


Drug Use Including Alcohol

Notes (include risks and protective factors):

  • Have you ever used alcohol or other drugs?
  • What?
  • How often?
  • With who?
  • Does this create any risk for you or others?
Risk rating:


Sexuality

Notes (include risks and protective factors):

  • Do you have sex?
  • If so, how are you managing that?
  • Do you know how to keep safe sexually?
  • Are you attracted to boys or girls?
Risk rating:


Mood

Notes (include risks and protective factors):

  • Have your moods changed over the last few days/ weeks/ months?
  • If so, how have they changed?
  • How would you measure your mood today?
Risk rating:


Self Harm

Notes (include risks and protective factors):

  • Have you ever done self-harming things?
  • When did this start happening?
  • What was the most recent?
Risk rating:


Depression

Notes (include risks and protective factors):

  Risk rating:


Suicide

Notes (include risks and protective factors):

  Risk rating:


Safety

Notes (include risks and protective factors):

  Risk rating:


Action Plan

Action Plan: