Parent COPE Referral Form

Some introductory copy (this can be edited in the cms)



Narrative Description of Child – Parent (IRS)

Centre for Children & Families, University of Buffalo

In the spaces below, please describe what you see as your child's primary problems in each area, both at home and at school, and describe the effects of your child's problems in that area. Then drag the slider towards the points that describe how much the child's problems affect each area and whether he or she needs treatment or special services for the problems (see sample below)

No Problem
Extreme Problem
No Problem
Extreme Problem
No Problem
Extreme Problem
No Problem
Extreme Problem
No Problem
Extreme Problem
No Problem
Extreme Problem
No Problem
Extreme Problem

The MTA SNAP-IV Rating Scaler

(c) James M. Swanson, PhD., University of California, Irvine, CA 92715