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 the young person need significant coaching in order to complete tasks e.g. making beans on toast or washing laundry If Yes please provide details below: Can the young person only maintain their daily routine (e.g. washing/getting to school or work) with imposed structure or prompting If Yes please provide details below: Does the young person have problems attending to personal hygiene independently If Yes please provide details below: Is the young person excessively vulnerable within their peer group If Yes please provide details below: Are there any accompanying records that indicate that the young person has an IQ
INFORMATION FROM THE YOUNG PERSON Tick No or Yes as appropriate for each question and include additional notes Have you struggled with schoolwork If Yes please provide details below: (clarify whether in primary, secondary school or both) No Yes Did you have any additional support in lessons If Yes please provide details below: Has anyone told you that you have a learning disability or learning needs If Yes please provide details below: Do you struggle with reading or writing (show them a story in a magazine and discuss it with them) If Yes please provide details below: Do you struggle telling the time (check using non digital clock) If Yes please provide details below: Surname: DOB: Forenames: NHS Number: <strong>CHAT</strong> <strong>Tool</strong> Secure Estate (Version 3 - June 2013) 92 | 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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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
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Page 41 and 42: 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 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: Learning Disability and Educational
Page 95 and 96: Autistic Spectrum Disorder Start by
Page 97 and 98: Section 3: In social interactions d
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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