Case Example Intake Assessment, psychology homework help

User Generated

Wzvnu83

Humanities

Description

 Develop a problem and a complete history of the client. Use the attached assessment form to complete your report.



Unformatted Attachment Preview

Intake Assessment Form Client Name _______________________________________ D.O.B. __________________ Unit # __________ Date of Assessment__________________________________________ 1. PRESENTING PROBLEM (Functional impairment, symptoms, background) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 2. CURRENT CLIENT INVOLVEMENT WITH OTHER AGENCIES AGENCY/PERSON PHONE SERVICE DATE ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 3. ASSESSMENT OF LIFE CIRCUMSTANCES OR CHANGES IN THE FOLLOWING AREAS FAMILY ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SOCIAL ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SUPPORT ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ LEGAL ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ EDUCATION ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ OCCUPATION ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ FINANCES ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ PSYCHOSOCIAL & ENVIRONMENTAL PROBLEMS ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 4. CURRENT MEDICAL CONDITIONS CONDITION PHYSICIAN TREATMENT ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 5. PREGNANT ( ) YES ( RECEIVING PRENATAL CARE? ( ) NO ) YES ( ) NO 6. PRIMARY CARE PHYSICIAN ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 7. CURRENT MEDICATIONS NAME /DOSAGE PRESCRIBED BY CONDITION ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ SIDE EFFECTS ____________________________________________________________________________________ MEDICATION ALLERGIES ____________________________________________________________________________________ 7. RELATIONSHIP RISK FACTORS; IS CLIENT SAFE AT HOME? ( ) YES ( ) NO DOES CLIENT FEEL THREATENED IN ANYWAY? ( ) YES ( ) NO IF YES DESCRIBE ____________________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ HAS CLIENT BEEN ABUSED IN ANY WAY ( ) YES ( ) NO IF YES CHECK ALL THAT APPLY ( ) PHYSICAL ( ) EMOTIONAL ( ) SEXUAL RELATIONSHIP OF PERPETRATOR TO CLIENT ___________________________________________________________________________________ ANY LEGAL ACTION TAKEN? ___________________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ DOES CLIENT HAVE A SAFETY PLAN? ( NEEDS SHELTER ( ) YES ( ) YES ( ) NO ) NO NEEDS PROTECTION FROM ABUSE ORDER ( ) YES ( ) NO 8. SUICIDE/HOMICIDE EVALUATION CLIENT'S SELF RATING OF SUICIDE RISK ____________ CLIENT'S SELF RATING OF BECOMING VIOLENT __________ CLIENT'S SELF-RATING OF HOMICIDE RISK __________ (1-NONE 2 – SLIGHT 3 – MODERATE 4 – EXTREME/IMMEDIATE) 9. MENTAL STATUS EXAM _________________________________________________________________________________________________________ ________ APPEARANCE ( ) Age appropriate ( ) Well groomed ( ) disheveled/unkempt ( ) bizarre ( ) other ORIENTATION ( ) Person ( ) Place BEHAVIOR/ EYE ( ) Good ( ) Limited ( ) Rigid ( ) Agitated ( ) Time ( ) Situation ( ) Avoidant ( ) None ( ) Relaxed/calm ( ) Restless CONTACT ( ) slumped posture ( ) Tense ( ) Tics ( ) Tremors MOTOR ACTIVITY ( ) Mannerisms ( ) Motor retardation MANNER ( ) Appropriate ( ) Trusting Withdrawn ( ) Catatonic behavior ( ) Cooperative ( ) Inappropriate ( ) ( ) Seductive ( ) Playful ( ) Evasive ( ) Defensive ( ) Hostile ( ) Manic ( ) Guarded ( ) Sullen ( ) Passive ( ) Demanding ( ) Inappropriate boundaries SPEECH ( ) Normal ( ) Incoherent ( ) Pressured ( ) Too detailed ( ) Slurred ( ) slowed ( ) Impoverished ( ) Halting ( ) Neologisms ( ) Depressed ( ) Irritable ( ) Neurological language disturbances MOOD ( ) Appropriate ( ) Anxious ( ) Euphoric ( ) Fatigued AFFECT ( ) Angry ( ) Expansive ( ) Broad ( ) Tearful ( ) Blunted ( ) Constricted ( ) Flat ( ) Labile ( ) Excited ( ) SLEEP Anhedonic ( ) Good ( ) Fair ( ) Poor ( ) Increased ( ) Decreased ( ) Initial ( ) Decreased ( ) Weight gain insomnia APPETITE ( ) Middle insomnia ( ) Terminal Insomnia ( ) Good ( ) Poor ( ) Fair ( ) Increased ( ) Weight loss THOUGHT PROCESS ( ) Logical and well organized ( ) Illogical ( ) Flight of ideas ( ) Circumstantial ( ) Loose Associations ( ) Rambling ( ) Obsessive ( ) Blocking ( ) Tangential ( ) Spontaneous THOUGHT CONTENT ( ) Delusions ( ) Perseverative ( ) Distractible ( ) Paranoid delusions ( ) Distortions ( ) Thought insertion ( ) Thought broadcast ( ) Somatic delusions ( ) Ideas of reference ( ) Grandiose delusions PERCEPTION/HALLUCINATIONS ( ) Illusions SUICIDE RISK ( ) None ( ) Slight ( ) No Plan ( ) Delusional guilt ( ) Nihilistic delusions ( ) Hallucinations ( ) Ideas of inference ( ) Depersonalization ( ) Moderate ( ) Thought withdrawal ( ) Magical thinking ( ) Significant ( ) Derealization ( ) Extreme ( ) Plan (describe _________________________________________________________________________________________________________ ________________________________________________________________________________ VIOLENCE RISK ( ) None ( ) Slight ( ) No Plan ( ) Moderate ( ) Significant ( ) Extreme ( ) Plan (describe _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ 9. MENTAL STATUS EXAM cont. ____________________________________________________________________________ JUDGEMENT ( ) Intact ( ) Age appropriate ( ) Impaired INSIGHT ( ) Intact ( ) Mile ( ) Limited ( ) Impulsive ( ) Moderate ( ) Immature ( ) ( ) Severe ( ) very limited ( ) Fair ( ) None ( ) Aware if current disorder ( ) Understands personal role in problems SENSORIUM MEMORY ( ) Alert ( ) Intact ( ) Drowsy ( ) Stupor ( ) Impaired ( ) Obtundation ( ) Immediate recall ( ) Remote ( ) Coma ( ) Amnesia Type of amnesia _________________________________________________________________________________________________________ INTELLIGENCE ( ) Average ( ) Above average ( ) Below average ( ) Unable to establish _------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ INTERVIEWER SUMMARY OF FINDINGS ( add details where appropriate 10. SUBSTANCE USE/ABUSE TYPE OF LAST AMOUNT HOW TAKEN DURATION FREQUENCY DATE USED USE _____________________________________________________________________________________________ TOBACCO _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ ALCOHOL________________________________________________________________________________________________ _________________________________________________________________________________________________________ ILLICIT DRUGS _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ PRESCRIPTION DRUGS _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ OTC DRUGS _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ OTHER _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ _________________________________________________________________________________________________________ EXPERIENCING: WITHDRAWAL ( ) YES ( ) NO BLACKOUTS ( ) YES ( ) NO HALLUCINATIONS ( ) YES ( ) NO VOMITING ( ) YES ( ) NO SEVERE DEPRESSION ( ) YES ( ) NO DTS AND SHAKING ( ) YES ( ) NO SEIZURES ( ) YES ( ) NO OTHER ( ) YES ( ) NO DESCRIBE _____________________________________________________________________________________________ _____________________________________________________________________________________________ _____________________________________________________________________________________________ PATTERNS OF USE USES MORE UNDER STRESS ( ) YES ( ) NO CONTINUES USE WHEN OTHERS HAVE STOPPED ( ) YES ( ) NO HAS LIED ABOUT CONSUMPTION ( ) YES ( ) NO HAS TRIED TO AVOID OTHERS WHILE USING ( ) YES ( ) NO HAS BEEN DRUNK/HIGH FOR SEVERAL DAYS AT A TIME ( ) YES ( ) NO NEGLECTS OBLIGATIONS WHEN USING ( ) YES ( ) NO USUALLY USES MORE THAN INTENDED ( ) YES ( ) NO NEEDS TO INCREASE USE TO BECOME INTOXICATED ( ) YES ( ) NO HAS TRIED TO IDE CONSUMPTION ( ) YES ( ) NO SOMETIMES USES BEFORE NOON ( ) YES ( ) NO CANNOT LIMIT USE ONCE BEGUN ( ) YES ( ) NO FAILED TO KEEP PROMISES TO REDUCE USE ( ) YES ( ) NO DESCRIBE ATTEMPTS TO STOP ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ DESCRIBE CIRCUMSTANCES THAT USUALLY LEAD TO RELAPSE ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ IS CLIENT INVOLVED IN AA/NA? ( ) YES ( ) NO _____________________________________________________________________________________________ 11. CLIENT REQUESTS, GOALS, EXPECTATIONS ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 12. CLINICAL SUMMARY (PULL TOGETHER INFORMATION YOU HAVE COLLECTED AND SUMMARIZE, IDENTIFYING POSSIBLE RELATIONSHIPS, CONDITIONS AND CAUSES THAT MAY HAVE LED TO CURRENT SITUATION) ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 13. IMPRESSIONS ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ 14. RECOMMENDATIONS ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________
Purchase answer to see full attachment
User generated content is uploaded by users for the purposes of learning and should be used following Studypool's honor code & terms of service.

Explanation & Answer

Here it is! I hope you love it.

Intake Assessment Form
Client Name Bob Smith______________________________________ D.O.B.
04/22/1947__________________
Unit # __Psych________ Date of
Assessment__9/15/2016________________________________________

1. PRESENTING PROBLEM (Functional impairment, symptoms, background)
__Bob does not seem to know where he is and was wandering around confused in the
street._______________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
___
2. CURRENT CLIENT INVOLVEMENT WITH OTHER AGENCIES
AGENCY/PERSON

PHONE

SERVICE

DATE

n/a Just starting intake
process______________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
______
3. ASSESSMENT OF LIFE CIRCUMSTANCES OR CHANGES IN THE FOLLOWING AREAS

FAMILY

__Bob has no
family._______________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
___
SOCIAL

_Bob has no local friends and seems very antisocial. He just moved here from
California.____________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
_______
SUPPORT

___Bob seems to have no
support.______________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
___
LEGAL

_Bob does not have a prison
record.______________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
_____
EDUCATION

___Bob says he is a retired
doctor._______________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________

____________________________________________________________________________
__
OCCUPATION

___Bob says he is a retired doctor buy I am not sure if he is a doctor of college or a medical
doctor of some
kind.________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
_
FINANCES

Seems to have no
resources.____________________________________________________________________
____________________________________________________________________________
____________________________________________________________________________
_________________________________________...


Anonymous
Great! 10/10 would recommend using Studypool to help you study.

Studypool
4.7
Trustpilot
4.5
Sitejabber
4.4

Related Tags