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Name::
PEER SUPPORT SERVICE NOTE
Name:
Date of Session:
Session Duration 4hrs
Place:
Home Office Residential Group Home
Community Other ______________
Type of Service: Intake/Assessment
Peer Support Non-billable Service
Present: Consumer Mother Father
Brother Sister Guardian
Other (indicate relationship) psychiatrist__________
Type of Contact: Face-to-Face Phone Collateral
Goal(s) addressed during session (include goal s from plan):
1. Glenda will learn to develop and improve independent living skills while living at assisted living facility to assist her also if
she chooses to live again in her own place. She will learn to budget her spending money, perform activities of daily living plus
keep her room organized and neat so these skills will assist her with caring for her own household at least 3 times a week
during the next 12 months. This will be reported by Glenda and peer support staff.
2. Glenda will decrease her symptoms of anxiety by learning coping skills that she can utilize independently, getting linked
with and attending OPT, and taking her medications as prescribed over the next 12 months.
3Glenda will work to stabilize mental health/substance abuse use symptoms and recovery as evidenced by working with
mental health support staff attending na groups and psychiatric evaluation over the next 12 months. This will be reported by
Glenda and Community Care Service Providers.
Description of the Intervention/Activity:
The following Interventions/Activities were provided to the member and participation was encouraged, monitored and/or
modeled by the provider:
Instill Hope Self-Determination System Navigation Individual Advocacy Pre-Crisis/Post-Crisis Support
Housing Education/Employment Whole Health/Wellness Activities WRAP Plan
Recovery Assessment Scale (RAS) Other ___________________
Please provide a description of the intervention(s)/activities provided: next visit.
CPSS arrived at the consumer’s house in time for the meeting consumer was happy to see CPSS and welcomed
her into the house. Consumer was well groomed and the house well organized. Consumer verbalized that she had
been cleaning and tidying the room daily and felt more relaxed in the room now. CPSS congratulated her for the
effort to maintain a sanitary environment and showed her how to arrange her clothes in the closet better. CPSS
reviewed the consumer’s ability to follow her budget as taught in the previous meeting. Consumer revealed that
although she had not fully followed it, she was within her spending limit. CPSS encouraged her to restrict her
pending as per her budgets and avoid diversions. CPSS reviewed consumers adherence to medication and
realized she has been adhering well and documenting it in her daily journal. Consumer was well prepared for her
scheduled visit for psychiatric review. CPSS drove the consumer to the psychiatrist’s office and explained to
consumer what to expect in the review, CPSS advised the consumer to remain relaxed and answer all questions
asked by the psychiatrist honestly. Consumer verbalized that she was comfortable and understood what she was
to expect during the evaluation she completed her evaluation and invited CPSS to discuss her results with the
psychiatrist. Consumer was happy to hear that she was progressing well and shared that the medication was not
giving her any bad side effects. CPSS, emphasized on the need of ensuring she adheres to medication to prevent
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Name::
PEER SUPPORT SERVICE NOTE
relapse, this was echoed by the psychiatrist. CPSS also advised the consumer to maintain her attendance for
therapy without fail and to share her experiences with the therapist openly. CPSS drove consumer home and
discussed plan for next meeting.
Effectiveness of the Intervention/Activity per individual receiving services
The review of interventions done last visit revealed that the consumer was able to make and follow her budged.
CPSS corrected her on a few diversions on her budget and encouraged her to stick to the budget. Consumer was
well groomed and maintained a tidy room, CPSS assisted her to arrange her closet, and consumer was able to
maintain tidiness as taught in the last meeting. The consumer maintains good records of her scheduled therapy
and psychiatric evaluation visits as well as her medication schedule. She strictly follows her medication schedule
and maintains that she does not have any adverse side effects from the medication. Consumer is keen to
document her progress in her journal, and willing to attend substance abuse group meetings, to help with his
healing.
(Print Provider Name, Provider Signature, Credentials & Date):

Unformatted Attachment Preview

Name:: Name: Date of Session: Session Duration 4hrs Place: Home Office Community Residential Group Home Other ______________ Type of Service: Intake/Assessment Peer Support Present: Non-billable Service Consumer Mother Father Brother Sister Guardian Other (indicate relationship) psychiatrist__________ Type of Contact: Face-to-Face Phone Collateral Goal(s) addressed during session (include goal s from plan): 1. Glenda will learn to develop and improve independent living skills while living at assisted living facility to assist her also if she chooses to live again in her own place. She will learn to budget her spending money, perform activities of daily living plus keep her room organized and neat so these skills will assist her with caring for her own household at least 3 times a week during the next 12 months. This will be reported by Glenda and peer support staff. 2. Glenda will decrease her symptoms of anxiety by learning coping skills that she can utilize independently, getting linked with and attending OPT, and taking her medications as prescribed over the next 12 months. 3Glenda will work to stabilize mental health/substance abuse use symptoms and recovery as evidenced by working with mental health support staff attending na groups and psychiatric evaluation over the next 12 months. This will be reported by Glenda and Community Care Service Providers. Description of the Intervention/Activity: The following Interventions/Activities were provided to the member and participation was encouraged, monitored and/or modeled by the provider: Instill Hope Self-Determination System Navigation Individual Advocacy Pre-Crisis/Post-Crisis Support Housing Education/Employment Whole Health/Wellness Activities WRAP Plan Recovery Assessment Scale (RAS) Other ___________________ Please provide a description of the intervention(s)/activities provided: next visit. CPSS arrived at the consumer’s house in time for the meeting consumer was happy to see CPSS and welcomed her into the house. Consumer was well groomed and the house well organized. Consumer verbalized that she had been cleaning and tidying the room daily and felt more relaxed in the room now. CPSS congratulated her for the effort to maintain a sanitary environment and showed her how to arrange her clothes in the closet better. CPSS reviewed the consumer’s ability to follow her budget as taught in the previous meeting. Consumer revealed that although she had not fully followed it, she was within her spending limit. CPSS encouraged her to restrict her pending as per her budgets and avoid diversions. CPSS reviewed consumer’s adherence to medication and realized she has been adhering well and documenting it in her daily journal. Consumer was well prepared for her scheduled visit for psychiatric review. CPSS drove the consumer to the psychiatrist’s office and explained to consumer what to expect in the review, CPSS advised the consumer to remain relaxed and answer all questions asked by the psychiatrist honestly. Consumer verbalized that she was comfortable and understood what she was to expect during the evaluation she completed her evaluation and invited CPSS to discuss her results with the psychiatrist. Consumer was happy to hear that she was progressing well and shared that the medication was not giving her any bad side effects. CPSS, emphasized on the need of ensuring she adheres to medication to prevent PEER SUPPORT SERVICE NOTE Name:: relapse, this was echoed by the psychiatrist. CPSS also advised the consumer to maintain her attendance for therapy without fail and to share her experiences with the therapist openly. CPSS drove consumer home and discussed plan for next meeting. Effectiveness of the Intervention/Activity per individual receiving services The review of interventions done last visit revealed that the consumer was able to make and follow her budged. CPSS corrected her on a few diversions on her budget and encouraged her to stick to the budget. Consumer was well groomed and maintained a tidy room, CPSS assisted her to arrange her closet, and consumer was able to maintain tidiness as taught in the last meeting. The consumer maintains good records of her scheduled therapy and psychiatric evaluation visits as well as her medication schedule. She strictly follows her medication schedule and maintains that she does not have any adverse side effects from the medication. Consumer is keen to document her progress in her journal, and willing to attend substance abuse group meetings, to help with his healing. (Print Provider Name, Provider Signature, Credentials & Date): PEER SUPPORT SERVICE NOTE Name: Description: ...
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