CHAT Tool - Offender Health Research Network

Tick No or Yes as appropriate for each question and include additional notes No Yes
Does your worry stop you from doing things, or interfere with how well you get on
with your friends or family
If Yes, does the worry become so much that you start to panic e.g. heart racing, breathless,
shaky, thoughts that something bad is going to happen to them
Do you worry about going into particular situations e.g. a crowded room or
situations with a large number of your peers (agoraphobia/social phobia)
Do these symptoms get in the way of normal life e.g. at home, education, work
settings or with friends
ACTION FOR CARE PLAN
Surname:
DOB:
Forenames:
NHS Number:
CHAT Tool Secure Estate (Version 3 - June 2013)
71 | P age