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Candidate Data:
First Name: 
Last Name: 

Date of Birth:












Guardian Info:

First Name:


Last Name:



737 Green Mountain Rd




Guardian/Family Phone:

Guardian/Family Email Address:


Living Situation:


Financial Situation:



Free/Reduced Lunch:



How many live in the household?


How many work and/or provide income to support the household?


Household Situation:

I am/was working with the boy's older brothers (22 and 24yrs old) who have intense substance misuse and mental health disorders. The 22yr old brother just passed from an OD and the older brother is staying at the house, while still actively abusing substances and, in stepdad's words, "manipulating their mother's love". While I work(ed) with the older brothers, I have met most of the family. Mom also has mental health struggles and stepdad reports both parents not being able to work due to the current family situation/atmosphere. He also reports that Henry is beginning to pick up on the brother's behaviors. In the house there is also a young daughter (6yrs old I think), and they frequently have stepdad's older son (20-ish yrs old) and mom's older daughter (15yrs old) stay with them, though they do not live there full-time. Henry and younger sister are homeschooled due to family's beliefs, so do not have an escape from the chaos. Henry has minimal contact with biological father due to alcohol and substance misuse.

Organizations / Mentor Programs:

Unsure of exact programs, but the family is heavily involved in religion, though I am not sure if they attend a church or practice at home.

Special Assistance:

Henry is homeschooled so is not receiving any services.

Health Concerns:

Not that I am aware of.

Victim of Sexual Abuse:

Not that I am aware of at this time.

Perpetrator of Sexual Abuse:

Not that I am aware of.

Victim of Physical Abuse:

Not that I am aware of, though he has witnessed physical altercations from his older brothers.

Threatening or Aggressive Behavior:

Not that I am aware of.

Required Physical Restraint:

Not that I am aware of.

Personality / Social Standing:

I have only met him a couple of times, so take this narrative as you will. From what I observed, he was very friendly and outgoing. Even though I was with most of the family, he stayed right with me the entire time, wanting to socialize with me and show how good he was at performing household tasks. He presented as very outgoing and charismatic, and responded positively when parents asked him to do things and help out.

Behavioral Patterns:

I do not know the child well enough to answer this question appropriately.


As for strengths, the boy was very engaging and seemed to very much want to interact and spend time with people outside of his family unit. He also seemed eager to please, and easily frustrated when his younger sister was not the same.
Conversely, stepdad reports that some "concerning" behaviors have begun to increase, including refusing tasks and lying/manipulation. Stepdad really wants to help him by getting him out of the house for at least a little while to shield him from the current issues with older brother living in the household, as brother is actively using substances, stealing from the family, and attempting to bring others around to bring/use substances as well. Stepdad also reports that the mother is struggling to be present and available for the other children, as she is wrapped up in one son's recent death and the other son's 24-hr care.
Family frequently struggles with money, lacking finances for food/gas. This is especially present currently, because neither parent is able to work due to watching the children all day every day.
To be blunt, from what I observed, the family is very kind and very chaotic.
Also, I am unsure of the boy's grade since he is homeschooled.