top answer: SOC-449 Topic 2: Intake Form & Questions Worksheet Scoring Guide REQUIREMENTS: Fi

  

Don't use plagiarized sources. Get Your Custom Essay on
top answer: SOC-449 Topic 2: Intake Form & Questions Worksheet Scoring Guide REQUIREMENTS: Fi
Just from $10/Page
Order Essay


SOC-449 Topic 2: Intake Form & Questions Worksheet Scoring Guide

REQUIREMENTS:

Find a person to role play with. Have them choose a character to play. Answer the prompts to assist with the intake process and questions for your interview.

POSSIBLE

ACTUAL

In this section, briefly explain the person in the selected intake form you will use to conduct your mock interview (50 words):

10

Describe possible culture/subculture influences on the client (50-75 words):

10

Describe the presenting problem (30-40 words):

5

Explain the possible identified problems. (30-40 words):

5

Next, after reviewing the selected intake form, write 10 questions, based off the information presented in the selected intake form, for your client to answer.

20

TOTAL

50

Instructor Comments:

© 2015. Grand Canyon University. All Rights Reserved.


SOC-449

Intake Interview Form 1

Name of Client: Debbie Dogooder

Age:
55 DOB:

7-4-1962
Date: ___________________

Marital Status: (circle) Single Married Separated Divorced

Email: [email protected]

Address: 3334 N. 56th Street Scottsdale, AZ 85000

Phone: (602)555-4444

Work Status: (Circle all that apply)

1. Currently employed as a
clerk of the court________________________

2. Looking for employment as
__________________________________________

3. Involved with local government agency to find employment_________

4. Going to college at ___________________________________________

5. Obtaining vocational training at_________________________________

Any formal diagnoses:
Mild depression. High Cholesterol

Any medications (dose and frequency):
Lipitor 50 mg; Paxil 30 mg
_________

Specific concerns: (Provide reasons for today’s visit. Please be specific about work life, school, and family influences):

I’ve been having trouble sleeping and focusing at work lately. My boss suspects I might be addicted to pain meds, so she said I had to meet with you or be fired. I think she’s threatened by me and wants me out of her department, but I can’t prove that. I was in a car accident a year ago and had surgery on my shoulder. I was put on Percocet for the pain. I went through physical therapy but my shoulder never healed right. My doctor stopped prescribing painkillers even though I’ve had pain every day since the accident. I turned to heroin because I could no longer get painkillers. Heroin is cheap and it works. That’s so unlike me. I never used drugs before when I was younger. I’ve never even smoked a cigarette. I was able to continue working until I failed a random drug test at work. I was suspended until I could pass the test again. I did and now I am back at work. My coworkers talk about me behind my back. I tend to work and eat alone more than I used to. My family says they are worried about me because I am losing a lot of weight. My mom and older sister taught me how to take care of myself. They instilled in me a strong work ethic. We’re Italian, so family is important to me. They’re all I have. They keep me centered. I’ve always been independent, so it’s been hard for them to see me so thin and weak. I want to get better so they won’t worry about me. I’m here for suggestions on what to do. I no longer use heroin, but I am still in constant pain. I can’t lose my job even though it’s very stressful. I have to sit and listen to court proceedings all day. I have 10 years left before I can retire and I can’t lose my pension. I need help.

Any Family History of Mental Illness:
Not that I know of
__________

Possible Services Desired: (Circle all that apply)

Diagnostic Evaluation

Development of personal goals

Individual or Family Therapy

Sensitivity Training

Development of a Problem Assessment Plan

Anger Management Classes

Social services

Social skills (group or individual)

Medication review/Prescriptions

Other:

Legal assistance

**This client may be passive at first and may become combative if pressed about addiction issues. She may appear lethargic and depressed due to possible drug abuse or withdrawal. The interviewer will need to use effective engagement strategies to obtain more information. The interviewer will need to be ready to suggest social services to the client.

© 2017. Grand Canyon University. All Rights Reserved.


SOC-449

Intake Interview Form 1

Name of Client: Sheldon Snodgrass

Age:
45

DOB:
7-4-1972

Date: _________________

Marital Status: (circle) Single Married Separated Divorced

Email: [email protected]

Address: 1234 W. Idunno Drive Denver, CO 56789

Phone: (602)555-5678

Work Status: (Circle all that apply)

1. Currently employed as a
IT Tech for Faculty Services at West Community College

2. Looking for employment as
__________________________________________

3. Involved with local government agency to find employment

4. Going to college at ___________________________________________

5. Obtaining vocational training at_________________________________

Any formal diagnoses: High blood pressure/hypertension.

Any medications (dose and frequency): ___
Lisinopril for high blood pressure

Specific concerns: (Provide reasons for today’s visit. Please be specific about work life, school, and family influences):

I’m here because my boss says my work is suffering lately. He said I’m coming in late and leaving early and that “something must be wrong” with me. I put in my hours, so I am only here to satisfy the requirement by Human Resources. Everything is fine. I haven’t been sleeping well, lately, so I’ve been staying up later than usual. They’re moving me to a new department next month, so I won’t be working with my group. I have a feeling it’s racial. I’m the only minority in our small department. I’m not happy about that but I have no say in it. My father taught me and my brother how to handle racism. We lived in a poor neighborhood as kids and had to defend ourselves against the upper-class kids. I know how to handle racism, but this is different. I don’t feel comfortable speaking out at work. I value my job and am committed to working hard. I want to earn a manger promotion someday. I’ve been here long enough to be a manager. My ex-wife has been complaining a lot lately about my anger issues. She said our kids (boy age 13 and a girl age 15) have expressed some concerns, but I think she’s making it all up. So, I’m here to fulfill the HR commitment and not get fired from my job. I guess I wouldn’t mind talking to someone about things now and then as long as it’s confidential.

Any Family History of Mental Illness:
My mother suffered from depression, but she’s on meds now and everything is fine.

Possible Services Desired: (Circle all that apply)

Diagnostic Evaluation

Development of personal goals

Individual or Family Therapy

Sensitivity Training

Development of a Problem Assessment Plan

Anger Management Classes

Social services

Social skills (group or individual)

Medications review/prescriptions

Legal assistance

Other:

**This client may be passive at first and the interviewer will need to use engagement strategies to make him feel safe enough to share. If pressed too hard about anger issues, he could become combative during the interview. Because he is cautious, he may not be able to hide his discomfort and may wring his hands, tap his foot, glance at his watch, or shift in his chair frequently. The interviewer will need to know how to handle this behavior and use engagement strategies to stimulate discussion in order to uncover the identified problem.

© 2017. Grand Canyon University. All Rights Reserved.

SOC-449 Intake Form & Questions Worksheet

First, you will find a person to partner with for this mock interview. It can be a friend or family member or classmate.

Important Consideration: Make sure you make it very clear to your partner that they are simply playing a role. They should not add to the information in the intake form or use any experiences from their personal lives when acting out this role. They should also not choose a character situation that might remind them of any traumatic or difficult experiences they have had. This interview has nothing to do with them, it is just about acting out a role they have been provided in the case study.

Next, provide the selected person with all four of the “Intake Interview Forms.” This person is to select only
one
intake form “character” to play in your mock intake interview scenario. In other words, it’s a chance for them to perform a scene like in one of the videos you watched for this course. This person is
NOT
to discuss or disclose with you how they are planning to act in the mock interview. They are to simply tell you which client they are going to portray prior to the mock interview so you can prepare the corresponding Intake Interview Questions with the little info you do have on that character before you conduct the interview. They may refer to the intake form information at any time during the mock interview.

Keep in mind the engagement strategies and the culture/subculture issues of the client when drafting your questions. Try to utilize these questioning techniques:


© 2021. Grand Canyon University. All Rights Reserved.

· Empathy and compassion

· Suggestions/solutions

· Guiding the discussion

· Affective words & phrases

· Furthering responses

· Reflective listening

· Client expectations

· Eliciting essential information

· Emphatic communication techniques

· Ending the interview

© 2021. Grand Canyon University. All Rights Reserved.

Part 1: Intake Form Client Due Topic 2

In this section, briefly explain the person in the selected intake form you will use to conduct your mock interview (50 words):

Describe possible culture/subculture influences on the client (50-75 words):

Describe the presenting problem (30-40 words):

Explain the possible identified problems. (30-40 words):

Intake Interview Questions: Next, after reviewing the selected intake form, write 10 questions, based off the information presented in the selected intake form, for your client to answer. [Keep in mind Phase I in the Helping Process (in Chapter 3 in Direct Social Work Practice) and obvious adherence to the NASW Code of Ethics when analyzing and revising your questions.]

You will use these 10 questions to conduct your mock intake interview in the upcoming weeks. Write 10 questions that will lead you to the identified problem. Use the instructor feedback to revise your questions before you complete your mock interview later in the course.

1.

2.

3.

4.

5.

6.

7.

8.

9.

10.

Assessment Description

Access and complete the “Intake Form & Questions Worksheet.”

While APA style is not required for the body of this assessment, solid academic writing is expected and in-text citations and references should be presented using APA documentation guidelines, which can be found in the APA Style Guide, located in the Student Success Center.

This assignment uses a scoring guide. Please review the scoring guide prior to beginning the assignment to become familiar with the expectations for successful completion.

You are required to submit this assignment to LopesWrite. A link to the LopesWrite technical support articles is located in Class Resources if you need assistance.

SOC-449

Intake Interview Form 1

Name of Client: Susie Sensible

Age:
34
DOB:

7-4-1983

Date: _____________

Marital Status: (circle) Single Married Separated Divorced

Email: [email protected]

Address: 1776 W. Patriots Lane, Phoenix, AZ 12345


Phone: (602)555-1234

Work Status: (Circle all that apply)

1. Currently employed as a_______________________________________

2. Looking for employment as
a high school English teacher_________________________

3. Involved with local government agency to find employment

4. Going to college at
NAU online
__________________________________

5. Obtaining vocational training at_________________________________

Any formal diagnoses:

None. I am perfectly healthy.

Any medications (dose and frequency): ___
Imitrex for chronic migraines- 10 mg
__________________________________________________________________________________________________________________________________________________________________________________________________

Specific concerns: (Provide reasons for today’s visit. Please be specific about work life, school, and family influences):

I was fired from my teaching job for arguing with my principal in front of others. It was suggested that I need some counseling. I don’t really think that I do, but if it helps me get another teaching job, then I will. I only pointed out to my principal how my way of leading meetings was superior to hers because I had measurable results and she didn’t. I’m the one with the two master’s degrees, one in education and one in leadership. I graduated with honors and have had many of my articles published. She only has one master’s degree in education. I’m working toward my doctorate. I feel I was wrongly fired, but I am here at this agency to obtain counseling. I suffer from chronic migraines and have had trouble sleeping lately, but I think it’s because I am worried about getting another teaching job. I’m pretty concerned that I won’t find another job. I’m not particularly used to failing at a job or anything in my life. I’m fairly accomplished for someone my age. I’m an only child whose parents taught me how to work hard and succeed. They both were medical engineers with advanced degrees. They worked hard to provide a nice life for us in an affluent neighborhood. I value hard work and education. I’ve had to put up with this “competitive” issue from other bosses and even with professors before. I know how to handle these people. It’s probably a feminist thing. My former principal is obviously threatened by my success as a single woman in society today. She’s from another era where women who weren’t married were frowned upon. So, I’m here at this agency for suggestions on how to get along with people so I can get another teaching job.

Any Family History of Mental Illness:
My mother suffered from migraines and depression. She was treated in the 1980s for mental illness. She was on strong anti-depressants all her life. She passed away two years ago. She accidently overdosed on pills. It wasn’t considered a suicide.

Possible Services Desired: (Circle all that apply)

Diagnostic Evaluation

Development of personal goals

Individual or Family Therapy

Sensitivity Training

Development of a Problem Assessment Plan

Anger Management Classes

Social services

Social skills (group or individual)

Medication review/Prescriptions

Legal assistance

Other:

**This client may show a sense of self-importance during the interview. She may boast about her accomplishments and show a lack of empathy toward others. She may become combative if pressed about lack of empathy or possible depression issues, especially about her mother’s death. Because she is aggravated, she may shift in her chair, check her watch, and appear cautious about questions. As the interviewer, you will need to use engagement strategies to help you stay on track toward the identified problem.

© 2017. Grand Canyon University. All Rights Reserved.


SOC-449

Intake Interview Form 1

Name of Client: Derick Dawson

Age:
22

DOB:
7-4-1995
Date: ____________

Marital Status: (circle) Single Married Separated Divorced

Email: [email protected]

Address: 25 N. 19th Street, apt. 2122 Los Angeles, CA 90210

Phone: (212)555-5556

Work Status: (Circle all that apply)

1. Currently employed as a
Teacher’s assistant at school_______________

2. Looking for employment as
_________________________________________

3. Involved with local government agency to find employment

4. Going to college at
University of Los Angeles online
________________

5. Obtaining vocational training at_________________________________

Any formal diagnoses: None. I am perfectly healthy.

Any medications (dose and frequency):
None
__________________________________________________________________________________________________________________________________________________________________________________________________

Specific concerns: (Provide reasons for today’s visit. Please be specific about work life, school, and family influences):

I’ve been having trouble sleeping lately. My stomach has been bothering me. I think I may have an ulcer. I make myself throw up and my stomach feels better. I recently broke up with my girlfriend and think I may be depressed but I’m not sure. I don’t socialize much anymore. I work out a lot at CrossFit. My girlfriend complained that I work out too much and obsess about food, but physical fitness is my passion. I’m working on an Exercise Science degree because I want to be a personal trainer. She always said my body was fine but I want to be bigger and stronger. I was extremely thin when I was a kid and people made fun of me. My own father teased me a lot when I was in high school because I couldn’t play sports. He would hate it if he knew I was here asking for help. That goes against the family way. I have a strong work ethic and am very disciplined when it comes to exercise and school. My mom taught me to be disciplined. She raised us as a single mom and showed us how to work hard. She inspires me. I have goals that are important to me. I guess I’m here to figure out what those goals are.

Any Family History of Mental Illness:
Not that I know of. I think my grandmother suffered from depression and was on medication.

Possible Services Desired: (Circle all that apply)

Diagnostic Evaluation

Development of personal goals

Individual or Family Therapy

Sensitivity Training

Development of a Problem Assessment Plan

Anger Management Classes

Social services

Social skills (group or individual)

Medication review/prescriptions

Legal assistance

Other:

**This client may be passive at first. He may show signs of discomfort or irritability like shifting in his seat, tapping fingers or feet. He may avoid talking about the breakup with his girlfriend. He may become combative if pressed about a possible eating disorder, so the interviewer will need to use engagement strategies that stimulate discussion in order to find the identified problem. The interviewer must be prepared to suggest social services to the client.

© 2017. Grand Canyon University. All Rights Reserved.

Place your order
(550 words)

Approximate price: $22

Calculate the price of your order

550 words
We'll send you the first draft for approval by September 11, 2018 at 10:52 AM
Total price:
$26
The price is based on these factors:
Academic level
Number of pages
Urgency
Basic features
  • Free title page and bibliography
  • Unlimited revisions
  • Plagiarism-free guarantee
  • Money-back guarantee
  • 24/7 support
On-demand options
  • Writer’s samples
  • Part-by-part delivery
  • Overnight delivery
  • Copies of used sources
  • Expert Proofreading
Paper format
  • 275 words per page
  • 12 pt Arial/Times New Roman
  • Double line spacing
  • Any citation style (APA, MLA, Chicago/Turabian, Harvard)

Our guarantees

Delivering a high-quality product at a reasonable price is not enough anymore.
That’s why we have developed 5 beneficial guarantees that will make your experience with our service enjoyable, easy, and safe.

Money-back guarantee

You have to be 100% sure of the quality of your product to give a money-back guarantee. This describes us perfectly. Make sure that this guarantee is totally transparent.

Read more

Zero-plagiarism guarantee

Each paper is composed from scratch, according to your instructions. It is then checked by our plagiarism-detection software. There is no gap where plagiarism could squeeze in.

Read more

Free-revision policy

Thanks to our free revisions, there is no way for you to be unsatisfied. We will work on your paper until you are completely happy with the result.

Read more

Privacy policy

Your email is safe, as we store it according to international data protection rules. Your bank details are secure, as we use only reliable payment systems.

Read more

Fair-cooperation guarantee

By sending us your money, you buy the service we provide. Check out our terms and conditions if you prefer business talks to be laid out in official language.

Read more
colle writers

Order your essay today and save 30% with the discount code ESSAYSHELP