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Please read and follow instructions as stated for this assignment
The intake report helps you to gather a broad range of information about the client. Typically conducted during your first appointment, the data from the initial interview will help you decide appropriate treatment plans and, if necessary, test selection. Therefore, it is important that you gather sufficient background information in the initial interview. Typically, this information will include the client’s family and social/relationship history, work experiences, educational history, and medical and legal histories. The counselor is also interested in a client’s self-perceptions, significant life experiences, and goals or aspirations. You will use this information in the Psychological Report that you will write later in the course.
For this assignment, the client is coming to you for one of three referral questions:
1. Would the client be a good candidate for participation in a summer mission’s trip in a very challenging environment?
. Would the client be a good candidate for Senior Pastor at a large urban church?
3. Would the client make a good Resident Assistant (RA) at Liberty University?
You can either use yourself as the client or develop a character, or “alter ego,” that you will interview. Your paper will be structured according to the categories listed in the Sheperis, Drummond, and Jones (2020) text on page 67 (see template below). This project must be 900–1200 words (excluding the title page), double-spaced, APA formatted, in a Word document, with no abstract.
Important points regarding the
1. If you choose to develop a character, your character must be an adult male or female over the age of 18. You must give your “client” a name. Do not state in the report or in communicating with your instructor whether your character is real or fictitious.
2. Because this psychological evaluation will
be performed for clinical, forensic, or legal reasons, your character must not have a life-threatening medical condition, a chronic or debilitating psychological disorder, or an extensive criminal history.
Format of the Initial Interview:
1. Content: Complete all the information under the headings of your report according to the format below. Identifying information can be in bullet points, but use paragraphs (at least 3-4 sentences) and general APA format for the rest of the report.
2. Write in the third person (e.g., “Mr. Jones is a 42 years old…,” “His greatest strengths are…”).
3. Your paper requires a title page. Head the first page of your paper “Initial Interview”.
4. Be sure to refer to the Initial Interview when completing the Mental Status Exam and Psychological Report later in the course. You want to remind yourself of “who you are” as you complete various tests for those assignments.
Note for those of you who choose to make up a character: Because you will complete all the psychological tests as your character for the Psychological Report, you must know this individual very well. Spend some time thinking about your character and make sure you have a clear image of who he or she is. Make a genuine attempt to visualize this person and to get yourself into the mind of the character you have created. How does this person see himself or herself? How does this person approach life, deal with challenges, and interact with others? Before you complete each of the psychological tests for the next assignment, be sure to review this information so your responses will be reasonably consistent across tests.
Referral Question Information
You must use one of the referral questions provided below as the “Reason for the Referral” portion of the report (you will answer the referral question in another report).
1. Would this examinee be a good candidate for participation in a summer mission’s trip in a very challenging environment?
2. Would this examinee be a good candidate for Senior Pastor at a large urban church?
3. Would this examinee make a good Resident Assistant (RA) at Liberty University?
Remember that this is a referral, which means that a mission’s board, a church, or Liberty University is sending the client to you for an evaluation. This would suggest that the client was vetted and appeared to be a viable candidate for one of the above positions. The referring organization would not pay to have you evaluate someone who is clearly impaired or unsuitable for the position. This is why it is very important that the person you select does not have a life-threatening medical condition, a chronic or debilitating psychological disorder, or an extensive criminal history. Also, make sure that the client’s life circumstances match the job. For example, a mother with three young children would not apply for an RA position at Liberty. Points will be deducted if your client has any of these conditions or is clearly unsuitable for the position.
***Note: Typically, in addition to gathering biographical information, the evaluator uses the initial interview to gather information using the Mental Status Exam (MSE). However, you will focus on the MSE in another assignment.
The outline below is to help you include and organize information important for successful completion of your papers.
Initial Interview (Template)
Client name, address, phone number, DOB, gender, marital status, occupation, work/school, work phone, emergency contact, date of interview
Reason for Referral
Referral source, reason for referral (why has the client been sent to you [e.g., consultation, clinical intake, counseling]); presenting complaint (hint: they are coming in for an evaluation)
Current Situation and Functioning
A description of typical daily activities, ability to complete normal activities of daily living (ADLs); general assessment of coping/character skills (e.g., stress management skills, emotional regulation ability; problem-solving, conflict resolution, empathy, cooperation, etc.); self-perceived strengths and weaknesses
Relevant Medical History
Previous and current medical problems (major illnesses and injuries), medications, hospitalizations, and disabilities; any significant major medical disorders in blood relatives (e.g., cancer, diabetes, seizure disorders, thyroid disease, etc.)
Psychiatric Treatment History
Description of previous treatment received, including hospitalization, medications, psychotherapy or counseling, case management, etc. Include a description of all psychiatric and substance abuse disorders found in all blood relatives (i.e., at least parents, siblings, grandparents, and children, but also possibly aunts, uncles, and cousins)
Information about the client’s family background, including information about first-degree relatives (parents, siblings), the composition of the family during the client’s childhood and
adolescence, and the quality of relationships with family members both past and present.
Social and Developmental History
Significant developmental events that may influence current problems or circumstances. This should include, as applicable, issues surrounding pregnancy or birth; social, behavioral, and cognitive milestones; and relational history (include interaction with peers, people in authority, academic performance, and extra-curricular activities – e.g., sports, clubs, etc.); current and previous marital/non-marital relationships, children, and social supports.
Educational and Occupational History
Schools attended, educational level attained, and any professional, technical, and/or vocational training; current employment status, length of tenure on past jobs, military service (rank and duties), job performance, job losses, leaves of absence, and occupational injuries.
Potential assessment issues when working with a diverse populations.
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