Child and Adolescent Trauma Screen (CATS) - 7-17 Years
Clients Name
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First Name
Last Name
Date of Birth
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Month
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Day
Year
Date
Today's Date
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Month
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Day
Year
Date
Stage of Treatment
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New Client
During Treatment
End of Treatment
In what setting do you receive services? check all that apply:
Phoenix Office
Laveen Office
Telehealth/Remote
Stressful or scary events happen to many people. Below is a list of stressful and scary events that sometimes happen. Mark YES if it happened to you. Mark No if it didn’t happen to you.
1. Serious natural disaster like a flood, tornado, hurricane, earthquake, or fire.
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Yes
No
2. Serious accident or injury like a car/bike crash, dog bite, sports injury.
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Yes
No
3. Robbed by threat, force or weapon
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Yes
No
4. Slapped, punched, or beat up in your family
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Yes
No
5. Slapped, punched, or beat up by someone not in your family
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Yes
No
6. Seeing someone in your family get slapped, punched or beat up.
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Yes
No
7. Seeing someone in the community get slapped, punched
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Yes
No
8. Someone older touching your private parts when they shouldn’t.
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Yes
No
9. Someone forcing or pressuring sex, or when you couldn’t say no.
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Yes
No
10. Someone close to you dying suddenly or violently
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Yes
No
11. Attacked, stabbed, shot at or hurt badly
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Yes
No
12. Seeing someone attacked, stabbed, shot at, hurt badly or killed
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Yes
No
13. Stressful or scary medical procedure.
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Yes
No
14. Being around war
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Yes
No
15. Other stressful or scary event?
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Yes
No
Describe the event:
Which one is bothering you the most now?
Did you have any stressful or scary events? If you did, turn the page.
Yes
No
Back
Next
(CATS 7-17_1.2) Mark 0, 1, 2 or 3 for how often the following things have bothered you in the last two weeks: 0 Never / 1 Once in a while / 2 Half the time / 3 Almost always
1. Upsetting thoughts or pictures about what happened that pop into your head.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
2. Bad dreams reminding you of what happened.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
3. Feeling as if what happened is happening all over again.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
4. Feeling very upset when you are reminded of what happened.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
5. Strong feelings in your body when you are reminded of what happened (sweating, heart beating fast, upset stomach).
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
6. Trying not to think about what happened. Or to not have feelings about it.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
7. Staying away from anything that reminds you of what happened (people, places, things, situations, talks).
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
8. Not being able to remember part of what happened.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
9. Negative thoughts about yourself or others. Thoughts like I won’t have a good life, no one can be trusted, the whole world is unsafe.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
10. Blaming yourself for what happened. Or blaming someone else when it isn’t their fault.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
11. Bad feelings (afraid, angry, guilty, ashamed) a lot of the time.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
12. Not wanting to do things you used to do.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
13. Not feeling close to people.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
14. Not being able to have good or happy feelings.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
15. Feeling mad. Having fits of anger and taking it out on others.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
16. Doing unsafe things.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
17. Being overly careful (checking to see who is around you).
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
18. Being jumpy.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
19. Problems paying attention.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
20. Trouble falling or staying asleep.
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0 (Never)
1 (Once in a while)
2 (Half the time)
3 (Almost always)
Total Score
Score Meaning
Please mark YES or NO if the problems you marked interfered with:
1. Getting along with others
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Yes
No
2. Hobbies/fun
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Yes
No
3. School or work
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Yes
No
4. Family relationships
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Yes
No
5. General happiness
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Yes
No
Date
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Submit
Should be Empty: