Child and Adolescent Trauma Screen (CATS)-Youth Report(7-17 years) Welcome to your Child and Adolescent Trauma Screen (CATS)-Youth Report(7-17 years) Screening Name of the child Date Completed by Telephone Email Stressful or scary events happen to many people. Below is a list of stressful and scary events that sometimes happen. Mark YES if it happened to you. Mark No if it didn’t happen to you. 1. Serious natural disaster like a flood, tornado, hurricane, earthquake, or fire. Yes No None 2. Serious accident or injury like a car/bike crash, dog bite, or sports injury. Yes No None 3. Threatened, hit or hurt badly within the family. Yes No None 4. Threatened, hit or hurt badly in school or the community. Yes No None 5. Attacked, stabbed, shot at or robbed by threat. Yes No None 6. Seeing someone in the family threatened, hit or hurt badly. Yes No None 7. Seeing someone in school or the community threatened, hit or hurt badly. Yes No None 8. Someone doing sexual things to you or making you do sexual things to them when you couldn’t say no. Or when you were forced or pressured. Yes No None 9. On line or in social media, someone asking or pressuring you to do something sexual. Like take or send pictures. Yes No None 10. Someone bullying you in person. Saying very mean things that scare you. Yes No None 11. Someone bullying you online. Saying very mean things that scare you. Yes No None 12. Someone close to you dying suddenly or violently. Yes No None 13. Stressful or scary medical procedure. Yes No None 14. Being around war. Yes No None 15. Other stressful or scary event? Select and bescribe below: Yes No None Comment The following section has Questions about all the scary or stressful events that happened to you.Mark 0, 1, 2 or 3 for how often the following things have bothered you in the last two weeks:Never=0 / Once in a while=1 / Half the time=2 / Almost always=3 1. Upsetting thoughts or pictures about what happened that pop into your head. Never Once in a while Half the time Almost Always None 2. Bad dreams reminding you of what happened. Never Once in a while Half the time Almost Always None 3. Feeling as if what happened is happening all over again. Never Once in a while Half the time Almost Always None 4. Feeling very upset when you are reminded of what happened. Never Once in a while Half the time Almost Always None 5. Strong feelings in your body when you are reminded of what happened (sweating, heart beating fast, upset stomach). Never Once in a while Half the time Almost Always None 6. Trying not to think about or talk about what happened. Or to not have feelings about it. Never Once in a while Half the time Almost Always None 7. Staying away from people, places, things, or situations that remind you of what happened. Never Once in a while Half the time Almost Always None 8. Not being able to remember part of what happened. Never Once in a while Half the time Almost Always None 9. Negative thoughts about yourself or others. Thoughts like I won’t have a good life, no one can be trusted, the whole world is unsafe. Never Once in a while Half the time Almost Always None 10. Blaming yourself for what happened, or blaming someone else when it isn’t their fault. Never Once in a while Half the time Almost Always None 11. Bad feelings (afraid, angry, guilty, ashamed) a lot of the time. Never Once in a while Half the time Almost Always None 12. Not wanting to do things you used to do. Never Once in a while Half the time Almost Always None 13. Not feeling close to people. Never Once in a while Half the time Almost Always None 14. Not being able to have good or happy feelings. Never Once in a while Half the time Almost Always None 15. Feeling mad. Having fits of anger and taking it out on others. Never Once in a while Half the time Almost Always None 16. Doing unsafe things. Never Once in a while Half the time Almost Always None 17. Being overly careful or on guard (checking to see who is around you). Never Once in a while Half the time Almost Always None 18. Being jumpy. Never Once in a while Half the time Almost Always None 19. Problems paying attention. Never Once in a while Half the time Almost Always None 20. Trouble falling or staying asleep. Never Once in a while Half the time Almost Always None For the following set of questions, Please mark “YES” or “NO” if the problems you marked interfered with: 1. Getting along with others Yes No None 2. Hobbies/Fun Yes No None 3. School or work Yes No None 4. Family relationships Yes No None 5. General happiness Yes No None Time's up Leave a Reply Cancel replyCommentEnter your name or username to comment Enter your email address to comment Enter your website URL (optional) Save my name, email, and website in this browser for the next time I comment.
