CHAT Tool - Offender Health Research Network

Tick No or Yes as appropriate for each question and include additional notes No Yes
3. Have you previously experienced withdrawal symptoms
If Yes please give details:
4. Is the young person currently intoxicated with alcohol/drugs
If Yes, consider whether screening should stop and be completed a few hours later.
5. Is the young person withdrawing from ALCOHOL e.g. nausea & vomiting; sweating;
tachycardia; insomnia; agitated and restless; anxious; can’t sleep; hallucinations; grand
mal seizures (use your observational skills)
If showing active signs of withdrawal, arrange for immediate examination by a clinical
team member, and monitor with Clinical Institute Withdrawal Assessment (CIWA-Ar2).
Surname:
DOB:
Forenames:
NHS Number:
CHAT Tool Secure Estate (Version 3 - June 2013)
11 | P age