Your Family Story

Your Family's Story
Please share your story with us and we will be in touch with recommendations. All your information is confidential and won't be shared outside of our organization without your consent.
Brief overview of your struggles with your challenging child(ren)
Age(s) of your challenging child(ren)
Diagnoses (if you have them)
What you've tried so far
Issues you've had or are currently having with your child(ren) - (click all that apply)

LyingStealingRunning awayArgues with authorityAggression or violence with siblingsSubstance abuse (drugs or alcohol)Hospitalized in the last yearFeels like you've lost control of your home
Any brief additional comments about the above
Please answer each below on a scale from 1-10 by clicking on the number in the circle.
Level of chaos and behavior problems

1

2

3

4

5

6

7

8

9

10

1 is Seems normal, 10 is Daily problems
Level of violence/aggression/defiance

1

2

3

4

5

6

7

8

9

10

1 is Not a problem, 10 is Needing police/safety plan
Controlling behaviors

1

2

3

4

5

6

7

8

9

10

1 is Minor, 10 is Refusals, argues, won't do as told
School

1

2

3

4

5

6

7

8

9

10

1 is Manageable, 10 is Daily problems/ suspensions
Anything else you are struggling with that isn't mentioned above
Does your child have Idaho Medicaid?*

YesNo
How would you like to be contacted?*

PhoneEmailTextOther
Name

First NameLast Name
Phone Number
Please enter a valid phone number.
Email*
example@example.com
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