Child & Adolescent Therapy Initial Assessment Template
Description:
This template provides a structured framework for therapists conducting an initial assessment session with a child or adolescent client, capturing critical developmental, behavioral, and contextual information to establish a baseline for treatment. It is designed to gather comprehensive data from the young client and their caregivers, with detailed guidance within brackets to ensure a thorough, age-appropriate evaluation that informs therapeutic planning.
Note:
This template is intended for the first session with a child or adolescent. Adapt sections based on the client’s age, developmental stage, or caregiver involvement, ensuring sensitivity to the young client’s comfort and engagement.
Date: [Record the date of the initial assessment session to establish the starting point of the client’s therapeutic record]
Client Name: [Enter the child or adolescent’s full legal name for accurate identification and documentation]
Therapist Name: [Enter the therapist’s full name to establish accountability and authorship of the assessment]
Age: [Note the client’s current age to provide context for developmental expectations and assessment interpretation
Consent and Confidentiality
[Document the caregiver’s and, if applicable, the child/adolescent’s understanding and agreement to the therapy process, including confidentiality limits (e.g., mandatory reporting for harm), noting signatures or verbal consent as required by practice standards and legal guidelines for minors.]
Client Information
Client Name: [Enter the child or adolescent’s full legal name as provided, ensuring clarity for record-keeping]
Date of Birth: [Record the client’s date of birth in MM/DD/YYYY format to confirm their exact age and developmental stage]
Caregiver(s): [List the names, relationships (e.g., mother, guardian), and contact information of primary caregivers, to identify key adults involved in the client’s care and support system]
School Information: [Note the client’s current school, grade level, and any relevant educational details (e.g., special education status), to contextualize their academic environment and performance]
Presenting Problem & History
Reason for Referral: [Describe the primary concerns or issues prompting therapy, as reported by the caregiver, child/adolescent, or referrer (e.g., teacher), capturing their perspective on why help is sought.]
Onset and Duration: [Record when the presenting problems began, how long they have persisted, and any patterns or changes over time, to establish a timeline of the issues and their impact.]
Developmental History: [Detail the client’s developmental milestones (e.g., walking, talking), any delays, or significant events (e.g., trauma, medical issues), to assess how their growth trajectory may influence current functioning.]
Behavioral/Mental Health History: [List any past or current behavioral concerns (e.g., tantrums, withdrawal) or mental health diagnoses (e.g., ADHD, anxiety), including prior interventions, to build a comprehensive psychological background.]
Medical History: [Note any past or current medical conditions, medications, or hospitalizations, including dates and relevance to mental health, to understand physical factors that might affect therapy.]
Current Functioning
Behavioral Observations: [Describe the client’s observable behaviors during the session, such as activity level, attention span, or social interaction, to provide a snapshot of their current presentation in a therapeutic setting.]
Emotional State: [Record the client’s reported or observed emotions (e.g., sad, anxious), including how they express feelings, to assess their emotional regulation and awareness.]
Social Functioning: [Note the client’s interactions with peers, family, or others, as reported or observed, to evaluate their social skills and relational patterns.]
Academic Functioning: [Detail the client’s current school performance, engagement, or challenges (e.g., grades, truancy), to understand how their issues manifest in an educational context.]
Family and Environmental Context
Family Structure: [Describe the client’s household composition, key relationships, and dynamics (e.g., divorce, siblings), to contextualize their family environment and support system.]
Caregiver Observations: [Record the caregiver’s perspective on the client’s behavior, strengths, and needs, to incorporate the adult lens into the assessment.]
Environmental Factors: [Note external influences like housing stability, socioeconomic status, or community stressors (e.g., bullying), to identify contextual contributors to the client’s well-being.]
Risk Assessment
[Document any reported or observed risks, such as self-harm, aggression toward others, or suicidal ideation, including frequency, intensity, and protective factors (e.g., supportive caregiver), to prioritize safety and guide immediate interventions.]
Strengths and Interests
Client Strengths: [Highlight the child/adolescent’s positive attributes, skills, or resilience factors (e.g., creativity, kindness), to identify resources for therapy and build on their capabilities.]
Interests and Hobbies: [List activities or passions the client enjoys (e.g., sports, art), to leverage these as engagement tools or coping mechanisms in treatment.]
Goals for Therapy
Caregiver Goals: [Describe what the caregiver hopes the client will achieve through therapy, capturing their priorities or expectations for change.]
Client Goals: [Note the child/adolescent’s own goals or desires for therapy, if expressed (e.g., “feel less scared”), to honor their voice and motivation.]
Therapist’s Initial Goals: [Outline preliminary therapeutic objectives based on the assessment, such as improving emotional regulation or social skills, to set a direction for treatment planning.]
Next Steps
[Detail the proposed frequency and format of future sessions (e.g., weekly with child, monthly caregiver check-ins), what to expect initially, and how caregivers can contact the therapist, to establish a clear plan and communication pathway.]
Summary and Initial Impressions
[Summarize the therapist’s initial understanding of the client’s situation, integrating presenting problems, strengths, and contextual factors, to provide a cohesive overview for guiding therapy.]
Plan for Treatment
[Outline the preliminary treatment approach, including potential modalities (e.g., play therapy, CBT), focus areas, or immediate actions (e.g., school consultation), to initiate a tailored therapeutic process.]
Therapy Child/Adolescent Initial Assessment Template
Date: February 25, 2025
Client Name: Liam Smith
Therapist Name: Dr. Sarah Nguyen, LMFT
Age: 10
Consent and Confidentiality
Liam’s mother, Emily Smith, signed the consent form, agreeing to therapy and understanding confidentiality limits (e.g., reporting harm). Liam verbally assented, nodding when I explained I’d help him feel better.
Client Information
Client Name: Liam Smith
Date of Birth: 09/12/2014
Caregiver(s): Emily Smith, Mother, 555-789-1234; David Smith, Father, 555-456-7890
School Information: Westview Elementary, 5th grade, enrolled in general education with reported struggles in math
Presenting Problem & History
Reason for Referral: Liam’s mother reports “frequent meltdowns” at home and school, saying, “He gets so angry over small things.” The teacher noted similar outbursts.
Onset and Duration: Meltdowns began 2 years ago after parents’ separation, escalating in the past 6 months with 3-4 weekly incidents.
Developmental History: Met milestones on time (walking at 12 months, talking by 2 years). No major delays, but mother notes he’s “always been sensitive.”
Behavioral/Mental Health History: No formal diagnoses. Saw a school counselor briefly last year for “anger issues” (4 sessions, minimal change).
Medical History: No chronic conditions. Takes children’s multivitamins daily. Had ear infections as a toddler, but no recent issues.
Current Functioning
Behavioral Observations: Liam fidgeted with a toy during the session, avoiding eye contact initially but warming up after 10 minutes. He threw the toy once when frustrated.
Emotional State: Reported feeling “mad a lot” and “sad sometimes,” clenching fists when discussing school. Smiled briefly talking about his dog.
Social Functioning: The mother says Liam has one close friend but often fights with peers. He said, “Kids think I’m weird.”
Academic Functioning: Struggling with math (C- average), avoids homework, and has had two detentions this year for disrupting class.
Family and Environmental Context
Family Structure: Lives with mother and younger sister (age 7); father visits weekends. Parents separated 2 years ago, contentious co-parenting.
Caregiver Observations: Mother reports Liam’s meltdowns worsen after dad’s visits, saying, “He bottles it up then explodes.” She notes he’s kind to his sister.
Environmental Factors: Stable housing, middle-income suburb. His mother works full-time, leaving Liam with a sitter after school.
Risk Assessment
No suicidal ideation or self-harm was reported. Mother denies aggression toward others beyond tantrums. Protective factors include the mother’s support and pet dog.
Strengths and Interests
Client Strengths: Liam is articulate for his age, shows empathy toward his sister, and calmed himself by petting a stuffed animal in session.
Interests and Hobbies: Loves playing soccer, video games (Minecraft), and his dog, Max—“He’s my best friend.”
Goals for Therapy
Caregiver Goals: His mother wants Liam to “handle frustration better” and reduce meltdowns at home and school.
Client Goals: Liam said, “I don’t want to get so mad all the time.”
Therapist’s Initial Goals: Improve emotional regulation, develop coping skills for anger, and enhance communication about family changes.
Next Steps
Weekly 45-minute sessions with Liam, monthly 30-minute check-ins with mother. Initial focus on building rapport and introducing play-based coping tools. Mother can email sarah.nguyen@therapy.org or call 555-321-9876.
Summary and Initial Impressions
Liam is a 10-year-old boy with anger outbursts likely tied to parental separation and sensitivity to transitions. Strengths include verbal skills and family bonds, but emotional regulation is a key challenge.
Plan for Treatment
Begin with play therapy to build trust, introduce CBT-based anger management (e.g., stop-and-think technique), and consult with the school counselor if behaviors persist.