• WHO:         The relationship to your abuser, kin or non-kin, single person or multiple
• WHAT:       List all the types of things that happened to you that you didn't like
• WHEN:       Number of times your trauma took place
• WHEN:       Did this happen only at special holidays or events
• WHERE:     Location where abuse took place (may explain fear of certain places)
• WHY:          This question may never be answered
• HOW:          Did the bad person(s) have access to you?
• AGE:            What was your age (single trauma) or age range (mulitple traumas)
• SECRET:     Can you list the method used to force you to keep the secret?
• IMPACT:    Rate from 1 to 10, 10 being the worst, how your life was impacted by this trauma
• MENTAL INJURIES:   Did you suffer mental illness, temporary or permanent?
• PHYSICAL INJURIES:  Were your injuries temporary or permanent?
• KEEPING SECRETS: Name the method used to force you into silence 
• AGE:            At what age did you became a "Chi-ult" (emotionally frozen at the age of your trauma)
• CAPTIVE:   Minor children are captive to their families because they are unable to care for themelves.  Therefore, a child can not escape physical violence or sexual abuse, brutality or torture (incest) in their home, if predators are part of their family.  The stress on children being raised in these homes double the impact of whatever event happens to them. 

Use the Child History Form to document your experience and the age you were at the time of your trauma.