<p> FFT INSPIRE DATA Enrollment</p><p>______Worksheet Complete ______Data entered in INSPIRE</p><p>CSS Case ID: ______First and Last Name:______</p><p>Additional information about how to answer the questions can be found in the INSPIRE Screen Guide for Clinical Users.</p><p>Complete this information for all youth who consent to treatment Would this youth have been placed out of home if they were not accepted to participate in the FFT program? (Answer “Yes” if the youth is being enrolled in the FFT program in lieu of out-of-home placement, as a last chance at avoiding placement, as a step-down from placement, or is expected to be placed out-of-home if he/she does not make progress in FFT . Out of home placement refers to placement in a dependency system, foster care system, juvenile justice system, drug and alcohol system, or mental health system.)  Yes  No</p><p>Was this youth referred due to concerns about his/her school (academic) performance?  Yes  No</p><p>Was this youth referred due to concerns about his/her drug and alcohol abuse? (Do not include tobacco use.)  Yes  No</p><p>Was this youth referred due to concerns about his/her school attendance?  Yes  No</p><p>Number of caregivers that participated in first session: ______</p><p>Page 1 of 1 Rev. 3/9/2012</p>