Behavioral Survey
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"Brittany began sneaking out...seeking inappropriate relationships...experimenting with alcohol and drugs....running away...we turned to Project PATCH. We will be eternally grateful to Project PATCH for their devoted work and guidance bringing back home a new and delightful daughter!" |
Please use this tool to help determine whether your teenager can be helped by the Project PATCH Residential Treatment Program. Project PATCH Youth Ranch is only able to serve teens between the ages of 12 through 17.
Choose from the following: 0=Never, 1=Sometimes, 2=Frequently, 3=Always.
When you have rated all 40 statements, add up the numbers to determine a score for your teen. (There are no right or wrong answers.)
Academics
- My teen does not enjoy school
- My teen's academic performance has declined
- My teen fails classes
- My teen has excessive absences, suspensions, or expulsions
- My teen has authority problems with school staff
- My teen destroys school property
- My teen acts out physically at school
Home Life
- My teen doesn't respect parental authority
- My teen doesn't communicate or have a good relationship with parents
- My teen doesn't communicate or have a good relationship with siblings
- My teen doesn't willingly participate in family activities
- My teen doesn't accept and perform family obligations
- My teen steals from family members
- My teen destroys family property
- My teen acts out physically towards parents
- My teen acts out physically towards siblings
- My teen runs away
Spiritual Life
- My teen doesn't believe in God
- My teen believes in God but doesn't have a relationship with God
- My teen doesn't participate in spiritual activities such as youth group or church services
- My teen is angry with God
- My teen is involved with cult activities
Social
- My teen does not have friends
- My teen does not have positive friendships
- My teen cycles through friendships
- My teen does not act appropriately in social settings
- My teen steals from friends or peers
- My teen is involved with the juvenile justice system
Activities
- My teen gives up personal interests
- My teen does not have hobbies
- My teen does not use time constructively
- My teen seeks inappropriate social activities such as drug use
- My teen is sexually active
Behavior
- My teen is easily angered, or is argumentative
- My teen is impulsive
- My teen does not tell the truth, or is sneaky
- My teen makes excuses or rationalizes
- My teen blames everyone or everything else does not take responsibility for choices or behavior
- My teen acts as if the world or everyone else owes them, sense of entitlement
- My teen has either threatened or attempted suicide
Scoring:
| 0-30: | You are experiencing typical but not abnormal teenage years |
| 31-73: | Local community resources would be most appropriate for you and your child |
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74 +: |
Please call Project PATCH for a personalized interview to determine whether Project PATCH would be an appropriate match |
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We encourage your questions regarding the Project PATCH Youth Ranch To speak with the Youth Ranch Admissions Director |