ADHD-5 Parent Form ages 11–17
Behavioral Health
Behavioral Health
A child's emotional health is just as important as their physical health, and at The Children's Clinic, we treat it that way. Our behavioral health program works in close collaboration with your child's primary care provider, so your family always receives coordinated, seamless support under one roof.
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In-house behavioral health support
Behavioral Health Consultants (BHCs) work directly alongside your child’s pediatrician to provide same-day consultations and short-term follow-up appointments, all grounded in evidence-based care.
If something feels off, call us. We’ll help you figure out the right next step.
When to seek help: If you’re wondering whether what you’re seeing is “normal” or something worth addressing, trust your instincts. You don’t need to wait for a crisis to reach out. We’re here to help with a wide range of emotional and behavioral concerns, including:
Early childhood parenting support
- Toileting
- Tantrums
- Bedtime or sleep concerns
- Separation anxiety
- Parent guidance on child adjustment to divorce
- Worries
- Not listening/following directions
Coaching Programs
- ADHD coaching
- FUEL coaching
Behavioral Regulation
Mild behavioral regulation difficulties: oppositionality, power struggles, arguing, refusals, withdrawal, isolating, shut-downs
Emotional & Mental Health
- Anxiety, adjustment stress, social stress
- Depression, non-suicidal self-injury
- Body image, eating disorder in remission, newly restricted eating patterns
- Substance use: e.g., occasional casual teen cannabis or alcohol use
- School refusal
Medical, Habits & Skills
- Tics and habit disorders
- Obsessions/compulsions
- Chronic pain
- Needle phobia, health anxiety
- Pill swallowing
- Health behaviors (e.g., diabetes management)
- Social skills
About ADHD Evaluation
Psychologists are available at TCC to do in-house evaluation of ADHD (by pediatrician screening and referral). In some cases, pediatricians are able to make a diagnosis based on their own screening and interview. However, when more information is needed, they often refer for in-house ADHD Evaluation.
Psychological evaluation of ADHD includes three steps:
- Intake interview (where ADHD diagnostic interview happens). This is scheduled by the front desk.
- Longer questionnaires — if the intake interview indicates that our clinic’s tests can do a sufficient job of evaluating the concerns raised, the psychologist will provide more in-depth questionnaires for parents and teachers (and self-report for adolescents).
- Cognitive testing appointment — a 2-3 hour appointment during which cognitive testing is completed. Results and recommendations are given either same day or the following week (depending on the provider). Reports generally come within 2 weeks. This appointment has to be more than 35 days after the intake (insurance companies require 30 days to respond to a testing authorization request we send after intake).
How Medical and Behavioral Health Work Together
One of the most effective ways that we communicate between disciplines is through our Electronic Medical Records (EMR). As such, you should be aware that general notes about you/your child's behavioral health visit are entered into the EMR and routinely reviewed by your pediatrician. Likewise, your child's medical notes are available for review by your behavioral health consultant. This allows the members of your Care Team to remain up to date on your treatment goals, medical status, and progress. In addition, mental and behavioral health diagnostic codes, and in some cases treatment summaries or notes, are requested by health insurance companies for billing purposes. For more information, please refer to our child's Notice of Privacy Practices.
Scheduling
You can call or schedule an appointment with the behavioral health consultant without a referral from the pediatrician. Most visits are for 45 minutes although some may be scheduled for a shorter period. The behavioral health consultant will provide short-term therapy and brief intervention with usually up to 3 or 4 visits, typically spaced about 2 weeks apart.
It is our goal to start and finish behavioral health appointments on time. If you have waited for longer than 15 minutes, please check in with our front desk staff as they can give you an estimate of when your child’s behavioral health consultant will be ready to meet with you.
Insurance Coverage
Verifying insurance benefits for mental health treatment is the parent’s responsibility and should be done prior to your child’s first appointment. Our office staff is happy to help with this process as needed, but it is always strongly recommended that you contact your health insurance company directly to ensure coverage and determine the limit of your plan.
Patients without insurance would receive a self-pay discount if paid within the first 30-day billing cycle. For an estimate of your charges, please contact the Business Office at 503-535-1458.
Helpful Forms
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ADHD-5 Parent Form ages 11–17
To be completed by a parent or guardian. A corresponding Teacher version should also be completed and returned to the clinic. -
ADHD-5 Parent Form ages 11–17
Behavioral Health
ADHD-5 Parent Form ages 11–17
To be completed by a parent or guardian. A corresponding Teacher version should also be completed and returned to the clinic. -
ADHD-5 Parent Form ages 5–10
Behavioral Health
ADHD-5 Parent Form ages 5–10
To be completed by a parent or guardian. A corresponding Teacher version should also be completed and returned to the clinic. -
ADHD-5 Parent Form ages 5–10
Behavioral Health
ADHD-5 Parent Form ages 5–10
To be completed by a parent or guardian. A corresponding Teacher version should also be completed and returned to the clinic. -
ADHD-5 Teacher Form ages 11–17
Behavioral Health
ADHD-5 Teacher Form ages 11–17
To be completed by your child's teacher and returned directly to the clinic. Please coordinate with the parent to ensure both the Parent and Teacher versions are submitted together. -
ADHD-5 Teacher Form ages 5–10
Behavioral Health
ADHD-5 Teacher Form ages 5–10
To be completed by your child's teacher and returned directly to the clinic. Please coordinate with the parent to ensure both the Parent and Teacher versions are submitted together. -
NICHQ Vanderbilt Assessment – Parent
Behavioral Health
NICHQ Vanderbilt Assessment – Parent
To be completed by a parent or guardian. A separate Teacher version must also be completed by your child's teacher and returned to the clinic before the assessment can be reviewed. -
NICHQ Vanderbilt Assessment – Parent
Behavioral Health
NICHQ Vanderbilt Assessment – Parent
To be completed by a parent or guardian. A separate Teacher version must also be completed by your child's teacher and returned to the clinic before the assessment can be reviewed. -
NICHQ Vanderbilt Assessment – Teacher
Behavioral Health
NICHQ Vanderbilt Assessment – Teacher
To be completed by your child's teacher and returned directly to the clinic. Please coordinate with the parent to ensure both the Parent and Teacher versions are submitted together. -
PHQ-9
Behavioral Health
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PSC-17
Behavioral Health
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PSC-17
Behavioral Health
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SCARED – Child Version
Behavioral Health
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SCARED – Parent Version
Behavioral Health
Instructions 
Download 
Helpful Resources
Finding Mental Health Providers – OHP
Guide to finding mental health providers for families on the Oregon Health Plan
Finding Mental Health Providers – OHP
Guide to finding mental health providers for OHP families (Spanish)
Finding Mental Health Providers – Private Insurance
Guide to finding mental health providers for families with private insurance
Finding Mental Health Providers – Private Insurance
Guide to finding mental health providers for families with private insurance (Spanish)
FUEL Program
FUEL (Families Undertaking Eating and Lifestyle Changes), a brief family-based program supporting sustainable nutrition and lifestyle changes without shame or blame. Available through TCC's Behavioral Health team.
List of Local Mental Health Clinics
List of local mental health clinics in the Portland metro area
List of Local Mental Health Clinics
List of local mental health clinics in the Portland metro area (Spanish)
List of Local Substance Use Clinics
List of local substance use treatment clinics in the Portland metro area
List of Local Substance Use Clinics
List of local substance use treatment clinics in the Portland metro area (Spanish)
