Youth Risk Behaviors

Risk behaviors are behaviors that can get children and youth in trouble or put them in danger of harming themselves or others. Time frames in this section can change (particularly for ratings ‘1’ and ‘3’) away from the standard 30-day rating window.

Question to consider for this domain: Do the youth’s behaviors put them at risk for serious harm?

Basic Design for Rating Needs

Rating Level of Need Appropriate Action
0 No evidence of need No action needed
1 Significant history or possible need that is not interfering with functioning Watchful waiting/prevention/additional assessment
2 Need interferes with functioning Action/intervention required
3 Need is dangerous or disabling Immediate action/Intensive action required


This item is intended to describe the presence of thoughts or behaviors aimed at taking one’s life. This rating describes both suicidal and significant self-injurious behavior. This item rates overt and covert thoughts and efforts on the part of a child or youth to end one’s life.  A rating of ‘2’ or ‘3’ would indicate the need for a safety plan. Notice the specific time frames for each rating.

Questions to Consider

  • Has the youth ever talked about a wish or plan to die or to kill themselves?
  • Has the youth ever tried to commit suicide?


This rating includes repetitive, physically harmful behavior that generally serves as a self-soothing function to the youth (e.g., cutting, carving, burning self, face slapping, head banging, etc.).

Questions to Consider

  • Does the behavior serve a self-soothing purpose (e.g., numb emotional pain, move the focus of emotional pain to the physical)?
  • Does the youth use this behavior as a release?
  • Does the youth ever purposely hurt themselves (e.g., cutting)?

Supplemental Information:  Suicidal behavior is not self-mutilation. Carving and cutting on the body are common examples of self-injurious or self-mutilation behavior. Generally, body piercings and tattoos are not considered a form of self-injury. Repeatedly piercing or scratching one’s skin would be included. Self-mutilation in this fashion is thought to have addictive properties since generally the self-abusive behavior results in the release of endorphins that provide a calming feeling.


This rating includes reckless and dangerous behaviors that, while not intended to harm self or others, place the youth or others in some jeopardy.  Suicidal or self-injurious behaviors are not rated here.

Questions to Consider

  • Does the youth act without thinking?
  • Has the youth ever talked about or acted in a way that might be dangerous to themselves? (e.g., reckless behavior such as riding on top of cars, reckless driving, climbing bridges, etc.)?

Supplemental Information:  Any behavior that the youth engages in that has significant potential to place them in danger of physical harm would be rated here. This item provides an opportunity to identify other potentially self-destructive behaviors (e.g., reckless driving, subway surfing, unprotected sex, substance use, etc.). If the youth frequently exhibits significantly poor judgment that has the potential to place themselves in danger, but has yet to actually do so, a rating of ‘1’ might be used to indicate the need for prevention. A rating of ‘3’ is used for youth that have placed themselves in significant physical jeopardy during the rating period.


This item rates the child or youth’s violent or aggressive behavior. The intention of this behavior is to cause significant bodily harm to others.  A rating of ‘2’ or ‘3’ would indicate the need for a safety plan. Reckless behavior that may cause physical harm to others is not rated on this item.

Questions to Consider

  • Has the youth ever injured another person on purpose?
  • Does the youth get into physical fights?
  • Has the youth ever threatened to kill or seriously injure others?

Supplemental Information:  Imagined violence, when extreme, may be rated here. Physically harmful aggression or command hallucinations that involve the harm of others, or youth setting a fire that paced others at significant risk of harm would be rated a ‘3’.  Reckless behavior that may cause physical harm to others is not rated on this item.


This item describes the risk of running away or actual runaway behavior.

Questions to Consider

  • Has the youth ever run away from home, school, or any other place?
  • If so, where did the youth go? How long did the youth stay away? How was the youth found?
  • Does the youth ever threaten to run away?


This item describes whether the youth intentionally starts fires using matches or other incendiary devices. Malicious or reckless use of fire should be rated here; however, fires that are accidental should not be considered fire setting.

Questions to Consider

  • Has the youth ever played with matches, or set a fire? If so, what happened?
  • Did the fire setting behavior destroy property or endanger the lives of others?


Sexually reactive behavior includes age-inappropriate sexualized behaviors that may place the youth at risk for victimization, and risky sexual practices. These behaviors may be a response to sexual abuse and/or other traumatic experiences.

Questions to Consider

  • Does the youth exhibit sexually provocative behavior?
  • Could the youth’s sexualized behavior be a response to sexual abuse or other traumatic experiences?
  • Does the youth’s sexual behavior place them at risk?


This item is intended to describe both aggressive sexual behavior and sexual behavior in which the child/youth takes advantage of a younger or less powerful child.  Both the severity and recency of the behavior should inform the rating of this item.

Questions to Consider

  • Has the youth ever been accused of being sexually aggressive towards another youth?
  • Has the youth had sexual contact with a younger individual?


This rating includes both criminal behavior and status offenses that may result from youth failing to follow required behavioral standards (e.g., truancy, curfew violations, sexual offenses driving without a license).

Questions to Consider

  • Do you know of laws that the youth has broken (even if s/he has not been charged or caught)?
  • Has the youth ever been arrested?


This item describes the youth’s age-appropriate decision making process and understanding of choices and consequences.

Questions to Consider

  • How is the youth’s judgment and ability to make good decisions?
  • Does the youth typically make good choices for themselves?


This rating describes intentional behaviors that a youth engages in to force others to administer consequences.  This item should reflect problematic social behaviors (socially unacceptable behavior for the culture and community in which the youth lives) that put the youth at some risk of consequences.  It is not necessary that the youth be able to articulate that the purpose of their misbehavior is to provide reactions/consequences to rate this item.  There is always, however, a benefit to the youth resulting from this unacceptable behavior even if it does not appear this way on the face of it (e.g., youth feels more protected, more in control, less anxious because of the sanctions).  This item should not be rated for youth who engage in such behavior solely due to developmental delays.

Questions to Consider

  • Does the youth intentionally do or say things to upset others or get in trouble with people in positions of authority or (e.g., parents or teachers)?
  • Has the youth engaged in behavior that was insulting, rude or obnoxious and which resulted in sanctions for the youth such as suspension, job dismissal, etc.?


This item rates behavior that involves intimidation (verbal or physical) of others; threatening others with harm if they do not comply with the youth’s demands is rated here. A victim of bullying is not rated here.

Questions to Consider

  • Are there concerns that the youth might bully other children?
  • Have there been any reports that the youth has picked on, made fun or, harassed or intimidated another person?


This item describes a child or youth who has been victimized by others. This item is used to examine a history and pattern of being the object of abuse and/or whether the person is at current risk for re-victimization. This item includes children or youth who are currently being bullied at school or in their community. It would also include children or youth who are victimized in other ways (e.g., sexual abuse, prostitution, inappropriate expectations based on a child’s level of development, a child/youth who is forced to take on a parental level of responsibility, etc.).

Questions to Consider

  • Has the youth ever been bullied or the victim of a crime?
  • Has the youth traded sexual activity for goods, money, affection or protection?
  • Has the youth been a victim of human trafficking?
  • Is the youth parentified or has taken on parental responsibilities and has this impacted their functioning?

Supplemental Information:  Sexual exploitation includes any situation, context, or relationship where the youth receives something (e.g., food, accommodations, drugs and alcohol, cigarettes, affection, gifts, money, etc.) as a result of performing sexual activities, and/or others performing sexual activities on them. This includes commercial sexual exploitation in which a third party receives payment for the sexual exploitation of the youth.