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Behaviors of Concern Checklist

This caregiver checklist supports the CCD process by helping identify observable behaviors that caregivers can track over time. These behaviors become measurable symptom objectives, allowing play therapy to stay focused on internal growth.
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Clarify the behaviors. Make space for the growth.

The Behaviors of Concern Checklist is a 4-page, editable form completed by caregivers or teachers before intake. It helps clarify concerns in clear, measurable terms—such as frequency, intensity, and duration.


Using this checklist allows the CCPT therapist to create a more focused and effective treatment plan by translating caregiver concerns into observable, trackable behaviors.

This tool helps you:

  • Identify observable behaviors that caregivers can monitor over time
  • Translate concerns into measurable symptom objectives (frequency, intensity, duration)
  • Support the CCD “Golden Thread” from behaviors → diagnosis → objectives
  • Strengthen medical necessity using a checklist informed by diagnostic categories
  • Build a clear foundation so play therapy can focus on internal growth
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How to Use the Behaviors of Concern Checklist:

Give Before Intake

Send to caregivers or teachers before the intake session to gather observable concerns

Create Symptom Objectives

Use responses to build measurable symptom objectives based on frequency, intensity, and duration

Track Progress

Monitor changes over time with caregivers, teachers, and other support systems

Explore Courses to Learn More About CCD

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