Tatiana McNeil

Who is seeking to participate in the SPACE group? (Please specify each participant’s relationship to the child.)

Has your child ever been diagnosed with a mental health disorder? If so, please explain:

Is your child involved in any mental health treatment (i.e., parent coaching, individual therapy, medication management, family therapy, etc.?)  If yes, please list the name of the treatment provider and type of treatment.

Has your child ever been referred to or participated in an intensive outpatient treatment, partial hospital program, or inpatient hospitalization? If yes, please explain and include dates of treatment.

Is your child currently attending school (remote or in person?)  Has your child ever struggled to attend school consistently?

What are the ways that your child’s anxiety is interfering with family/parent functioning? 

Please let us know how you learned about this group - Ross Center newsletter, website, recommendation from therapist/psychiatrist/pediatrician (please include the name), etc.