case senario

User Generated

furvyrl12

Humanities

Description

Submit an intake and assessment form based on the hypothetical case that was provided from your faculty member (that was created by another student).

Include a 1-2 page assessment of the strengths and challenges that you personally may have in working with this client and/or family.


Hypothetical Case Senario:

Julie Marie Johnson is a single mother of Sara Marie Johnson.She lives with her daughter Sara, in an apartment at 124 Forest Road, Apt 1 Menomonie WI 54751.Julie was born on 4-24-1998 and grew up with only her mother (Joan Johnson).Julie has never met her father and did not grow up with a father figure.Julie is an only child and doesn’t have any relatives close.She recalls spending a lot of time alone as Julie’s mother worked long hours and at times Julie was in charge of meals and taking care of herself.Julie attended East High School and graduated in May of 2016.Julie was a good student overall buy struggled to make friends.Julie found herself among a group of kids who were unethical and repeatedly made poor choices.

Shortly after graduation in May of 2016 Julie found out she was pregnant with Sara.Julie continued to live with her mother and began working at Perkins Family Restaurant as a waitress until she gave birth to Sara on January 26, 2017.Sara’s father (Johnny Smith) has refused to be a part of Julie and Sara’s life.Julie has full custody and full placement of Sara and doesn’t receive any child support from Johnny Smith. Julie went back to work after Sara was born and relied on her mother and her good friend Tammy Stone to help with the care of Sara. Julie’s mother has become very ill and Julie made the decision to move into her own apartment. Julie has struggled with depression and anxiety over raising a daughter at the young age of 19, and her finances.She feels like she needs some additional resources for parenting skills and financial help.Julie does not socialize outside of her friend Tammy Stone as she has had a hard time meeting other young mothers.She has looked to her church for support but hasn’t felt very successful. She does receive Food Share through Dunn County Human Services, but is also looking for other assistance to help her and take some of the stress off of her.

Julie’s primary physician is Jennifer Star. Dr Star has prescribed Sertraline for Julie’s Anxiety. Julie takes 20 mg of Sertraline daily. Julie has never used illegal drugs and takes Tylenol or ibuprofen when needed.Her alcohol use is Infrequent, once or twice a month socially and drinks appropriate amounts. Last consumed alcohol approximately January 25, 2018.


Unformatted Attachment Preview

Case Management Intake and Assessment Form Client Information Client Name: Service Point #: Date: Last Address: Age: How long here? DOB: Race: /_ /_ SSN: Cell Phone #: Ethnicity:  Hispanic or Latino Emergency Contact(s):  Non-Hispanic or Non-Latino or Relationship: Phone #: DL or ID? Y  N Birth Certificate? Y NSS Card? Y N How long have you been homeless? Anyone here with you?  Yes: What is your current marital status? :  No Do you have children with you:  Yes If yes, List Below  No Name: Age: DOB: Gender: SSN: Name: Age: DOB: Gender: SSN: Name: Age: DOB: Gender: SSN: Name: Age: DOB: Gender: SSN: Veteran Information Are you a veteran?  Yes  No Copy of your DD214: Yes NoDischarge Status: Honorable Dishonorable Military benefits in past? Yes  No  Education Special education, behavioral problems or disabilities? Yes  No  Highest level of education completed? Employment Are you working?  Yes  No Where?: Wage: What was your last job? When?  Temp  Permanent Reason for leaving? What type of work experience do you have? Have you ever been fired?  Yes  No When: Have you applied for any jobs recently?  Yes Physical limitations?  Yes  No What: Reason:  No Where: Mental health /substance abuse affected work?  Yes  No Legal Have you ever been convicted of a crime?  Yes What?  No Are you on probation?  Yes When was this? Do you have any legal actions pending currently?  Yes  No What? When was this?  No Jail/Prison?  Yes  No Income and Resources Debts/Financial Responsibilities Are you receiving any of the following? Do you have to pay on the following in the next 90 days? • • • • • • • • • • • • • • • • • • • • • • • SSI(Child) SSI/SSDI/Retirement FIP (TANF) Child Support Alimony/spousal support Employment Unemployment Disability/Work Comp Pension Medicaid or Medicare Food Stamps or WIC Section 8, public housing or ongoing rental assistance TANF Child Care, Transportation, Other VA Medical, Iowa Care, MH/DS Credit card(s) Loans(s) Past due rent Cell phone Vehicle Utility bills Child support Court fees or fines Storage units Other Physical Health Do you have access to health care?  Yes Do you take any medications?  Yes Pregnant?  Yes Due date: _  No  No Any current health concerns/diagnosis? Do you need any refills on medications?  Yes  No Physical limitations?  Yes Do you need referrals for HIV/AIDS/Hepatitis testing or services?  Yes Do you need glasses?  Yes  No  Yes  No  No  No  No Hearing loss or difficulty?  Yes  No Allergies:  Yes  No Mental Health Have you ever been seen by someone for mental health?  Yes Have you had any inpatient treatments?  Yes  No  No If yes, your diagnosis: Have you had outpatient treatments?  Yes Any current treatment?  Yes  No If no, would you like to be seen?  Yes  No  No Case Manager: Complete additional Mental Health and Wellness Form Substance Abuse Have you ever used drugs or alcohol?  Yes Inpatient Treatment? Current  Yes  No  Yes If yes, list type and date last used:  No  No Outpatient?  Yes Clean UA today?  Yes Case Management Is there anything else I should know about you and/or your family?  Yes  No Client Signature: Date:  No  No Case Manager Signature: Date:
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Explanation & Answer

Attached.

Case Management Intake and Assessment Form
Client Information
Client Name: Julie Marie Johnson

Last Address:

Age: 19

Service Point #:

124 Forest Road, Apt 1 Menomonie WI 54751

DOB: 4/_24/ 1998

Race: N/A

How long here? Entire life

SSN: N/A

Cell Phone #: N/A

Ethnicity: 
Hispanic or Latino

Emergency Contact(s): N/A

or


Non-Hispanic or Non-Latino

Relationship: single

DL or ID? Y 
N Birth Certificate? Y
NSS Card? Y
N
What is your current marital status? :

Single

Date: March 9, 2018

Phone #: N/A

How long have you been homeless?

Anyone here with you? 
Yes:

Never
 No

Do you have children with you: 
Yes If yes, List Below 
No
Name: Sara Marie Johnson

Age: 13
months

DOB: 26?
January /2017

Gender:
Female

SSN: N/A

Name:

Age:

DOB:

Gender:

SSN:

Name:

Age:

DOB:

Gend...


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