Professional Documents
Culture Documents
Mod3 10 Psychosocial and Environmental Stressor Checklist
Mod3 10 Psychosocial and Environmental Stressor Checklist
Mod3 10 Psychosocial and Environmental Stressor Checklist
Comments
(including duration and severity)
continued
Copyright 2005 ZERO TO THREE
Page 2 of 3
Age of Onset
(in months)
Comments
(including duration and severity)
Educational/ChildCare Challenges
More than 9 hours/day in out-of-home care
Multiple changes in child care provider
Parent without high school diploma
Parental illiteracy or low literacy
Poor-quality early learning environment (e.g., health
and safety concerns; high child:staff ratios and large
groups; inadequately trained staff; lack of attention to
social and emotional development)
Housing Challenges
Dislocation from home
Homelessness
Multiple moves
Problems maintaining heat, electricity, water, and
telephone
Unsafe neighborhood
Unsafe or overcrowded housing
Economic Challenges
Food insecurity
Heavy indebtedness
Poverty or near poverty
Occupational Challenges
Dangerous or stressful parental work conditions
(civilian)
Military deployment
Parental unemployment
Threat of parental job loss
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Copyright 2005 ZERO TO THREE
Page 3 of 3
Age of Onset
(in months)
Health of Child
Hospitalization of child
Medical illness in child (acute or chronic); child
accident/injury (e.g. animal bite, passenger in
vehicular accident)
Medical procedure(s) performed on child (e.g., spinal
tap)
Other
Abduction (specify by family member or non-family
member)
Child witness to violence (in the home)
Child witness to violence (out of the home)
Epidemic (e.g., AIDS)
Natural disaster (e.g., fire, hurricane)
War/terrorism
Other
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Diagnostic Classification of Mental Health and Developmental Disorders
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Comments
(including duration and severity)