CATS - Child and Adolescent Trauma Screen

Name

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

Yes

2. Serious accident or injury like a car/bike crash, dog bite, sports injury

Yes

3. Robbed by threat, force or weapon

Yes

4. Slapped, punched, or beat up in your family

Yes

5. Slapped, punched, or beat up by someone not in your family

Yes

6. Seeing someone in your family get slapped, punched or beat up

Yes

7. Seeing someone in the community get slapped, punched

Yes

8. Someone older touching your private parts when they shouldn’t

Yes

9. Someone forcing or pressuring sex, or when you couldn’t say no

Yes

10. Someone close to you dying suddenly or violently

Yes

11. Attacked, stabbed, shot at or hurt badly

Yes

12. Seeing someone attacked, stabbed, shot at, hurt badly or killed

Yes

13. Stressful or scary medical procedure

Yes

14. Being around war

Yes

15. Other stressful or scary event?

Yes

If so, describe:

Which one (from above) is bothering you the most now?

Check 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

Please mark YES or NO if the problems you marked interfered with:

1. Getting along with others

Yes

2. Hobbies/Fun

Yes

3. School or work

Yes

4. Family relationships

Yes

5. General happiness

Yes

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