Mental Health Assessment

Question 1

Behavior/Affect

Answer 1

Appropriate Agitated
Anxious Depressed
Crying Fearful
Hostile Inappropriate
Help-rejecting/complaining
Embarrassed Evasive
Resentful Angry
Negativistic Impulsive
Disturbed Sleep Nightmares
Night terrors Regression
Other

Question 2

Stressors

Answer 2

Condition Hospitalization
Diagnosis Procedure
Family Death Family Illness
Family Problems Finances
Surgery Unknown Causes
Abuse neglect Exposure to violence
Familial Substance abuse
Developmental disabilities in caregivers
Impulsive acting out
History of DSS involvement
History of juvenile services involvement
Other

Question 3

Coping

Answer 3

Well
Fair
Poor
Ineffective
Other

Question 4

Consult

Answer 4

Chaplain
Social Work
Psychiatry
Child Life

Question 5

Coping Style

Answer 5

Acting out Intellectualization
Affiliation Isolation of affect
Altruism Omnipotence
Anticipation Passive aggression
Autistic fantasy Projection
Denial Protective ID
Devaluation Rationalization
Displacement Reaction formation
Dissociation Repression
Humor Idealization Self Assertion
Self-observation Splitting
Sumblimation Suppression
Undoing

Question 6

Thoughts Exhibited

Answer 6

Delusional
Hallucinatory
Depersonalization