CHAT Tool - Offender Health Research Network

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Tick No or Yes as appropriate for each question and include additional notes No Yes Does food dominate your thinking and life Have you lost a lot of weight in the last 3 months If Yes then how much Do these symptoms get in the way of everyday life e.g. at home, education, and work settings or with friends Any concerns from the physical health assessment (part 2) of the CHAT or centile chart for weight/BMI ACTION FOR CARE PLAN Surname: DOB: Forenames: NHS Number: CHAT Tool Secure Estate (Version 3 - June 2013) 79 | P age
Risk Review Tick No or Yes as appropriate and include additional notes No Yes Is the young person at risk to themselves e.g. risk of self-harm, vulnerable to bullying or poor self-care If yes please explain and incorporate into the care plan Have any child sexual exploitation concerns been raised e.g. homelessness, frequent sexually transmitted infections, risky sexual behaviour, substance misuse, frequently missing from home etc. If yes explain below and incorporate into the care plan Have any other safeguarding concerns been raised If yes explain below and incorporate into the care plan If YES to any of the above make a referral to children’s social care services Have any health problems been identified that may increase vulnerability during a restraint If yes explain below, incorporate into the care plan and communicate with relevant staff Surname: DOB: Forenames: NHS Number: CHAT Tool Secure Estate (Version 3 - June 2013) 80 | P age
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Comprehensive Health Assessment Too
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Mental Health Assessment No Yes Is
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CHAT RECEPTION SCREEN • Every you
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Medical and Psychiatric History Doc
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5. Do you have DIABETES MELLITUS If
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Reception Screen Section Two: Subst
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6. Is the young person withdrawing
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Tick No or Yes as appropriate for e
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Tick No or Yes as appropriate for e
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Documents you have access to at the
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CHAT Immediate Care Plan Name: DOB:
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Substance Misuse Service No Yes No
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Is the young person subject to a CH
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MMR BCG HPV Hep A Hep B Typhoid Flu
Page 29 and 30: Tick No or Yes as appropriate for e
Page 43 and 44: Disability and Impairment Invitatio
Page 45 and 46: Physical Health Summary/Review Summ
Page 47 and 48: Do the accompanying documents or in
Page 49 and 50: Drug/Alcohol History and Misuse (Co
Page 51 and 52: Drug/Alcohol History and Misuse (Co
Page 53 and 54: Withdrawal - These symptoms are der
Page 55 and 56: DRUG/ALCOHOL USE Where do you usual
Page 57 and 58: Employment E.g. lack of qualificati
Page 59 and 60: Risk Review Tick No or Yes as appro
Page 61 and 62: CHAT MENTAL HEALTH ASSESSMENT • E
Page 79: Tick No or Yes as appropriate for e
Page 83 and 84: CHAT NEURODISABILITY ASSESSMENT •
Page 87 and 88: After a head injury or accident som
Page 89 and 90: NARRATIVE TASK Ask the young person
Page 91 and 92: Learning Disability and Educational
Page 93 and 94: INFORMATION FROM THE YOUNG PERSON T
Page 95 and 96: Autistic Spectrum Disorder Start by
Page 97 and 98: Section 3: In social interactions d
Page 99 and 100: Risk Review Tick No or Yes as appro
Page 101 and 102: Name: CHAT CARE PLAN DOB: Date: NHS
Page 103 and 104: Problem/Issue Intervention/Action R
Page 105 and 106: Initial Weight: Date: Discharge Wei
Page 107 and 108: Summary of any current or previous
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CHAT Tool - Offender Health Research Network

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