Assessments should be completed on persons served at the students’ internship placement. Placement:

Assessments should be completed on persons served at the students’ internship placement. Placement: woman’s shelter for domestic violence Example Assessment Adult Comprehensive Assessment Name (First, MI, Last): Record #: DOB: Page 1 of 4 Clinician Name: Location of Service: Date: Time: Referral Source: Referral Relationship: Demographics Name: Gender: Marital status: Street Address: City, State, Zip: Phone: Living Situation: Homeless: Yes No Emergency Contact (name, relation, phone): Primary Language: Interpreter used: Yes No; if yes, explain: Presenting Concerns Presenting Problem: Precipitating Factors: Legal Legal guardian: Yes No; if yes, explain: Rogers guardian: Yes No; if yes, explain: Healthcare proxy: Yes No; if yes, explain: Does the person have involvement in the legal system (i.e. legal charges, parole/probation, registered sex offender, other)? Specify if current or historical: Yes No; if yes, explain: Collaterals Type Name Telephone Contacted Agency PCC / PCP Y N LM Clinician Y N LM Psychiatric Prescriber Y N LM DHHS Y N LM Y N LMDSS Y N LMDPS Y N LMSchool / Residential Y N LMFamily / Sig. Other Y N LM Other Y N LM Comments: Other Cousineau- 2022; based on MSDP ESP Adult Comprehensive Assessment Name (First, MI, Last): Record #: DOB: Page 2 of 4 Medical / Physical Please note any special medical considerations (i.e. recent medical admissions, pregnancy, diabetes, sleep apnea, catheters, O2, dialysis, sutures, open wounds, seizures, infectious diseases, other): Medical equipment needed (i.e. CPAP, wheelchair, other): Yes No; if yes, does the person have equipment? Explain: Can person ambulate without assistance? Yes No; if no, explain: Can person perform ADLs independently? Yes No; if no, explain: Allergies reported (food, medications, other): Yes No; if yes, explain: (If Opioid overdose) Immunodeficiency virus, Hep C, and Tuberculosis RISK: Medications Medication Dosage Frequency Route Prescriber Comments on medications (past or present): Relevant History Family History (past or present): Trauma History: Addiction Current use of substances and / or addiction? Yes No; if yes, explain: Was a toxicology screen performed? Yes No; if yes, results: Was Narcan administered in the past 30 days? Yes No; if yes, explain (include date / time): Substance / Type First use / Age of Onset Last Use Quantities Duration / Frequency Comments Alcohol Cannabis Cocaine / Crack Heroin Opiates / Narcotics Benzodiazepines Stimulants Hallucinogens Prescription Other (i.e. food, sex, gambling, tobacco, etc.): Additional Information (may include non-current history and must include consequences of use in case of opioid overdose): Name (First, MI, Last): Record #: DOB: Page 3 of 4 Most Recent Acute Admission(s) and Treatment History (Inpatient, Detox, CCS, EATs, PHP, Outpatient, other) Dates of Service Type of Service Provider Response to Treatment Comments: Mental Status Exam / Risk Assessment (within normal limits unless checked, items checked are addressed in clinical formulation / narrative) Appearance Memory Weight Change Eye Contact Insight Energy Speech Judgment Future Oriented Sleep Impulsivity Concentration *Harm to Self Mood Appetite *Harm to Others Affect Thought Content Perception: Delusions, Hallucinations Orientation: person, time, place, situation Cognitive Functioning: Intellectual Disability, other Elopement Sexualized Behavior Fire Setting *Harm to Self and Others include: means, accessibility (including access to firearms), lethality of means, suicidal / assault history, lethality of attempts / assaults, family history, self-injurious behavior Risk and Protective Factors Strengths and Service Preferences Person’s strengths and service preferences: Is there a Safety Plan? Yes No; if yes, explain or attach: Clinical Formulation / Narrative / Medical Necessity for Further Treatment Name (First, MI, Last): Record #: DOB: Page 4 of 4 Diagnosis Code Diagnosis Primary Secondary Other Other Identified Needs and Goals for Treatment 1. 2. 3. Resolution / Disposition / Treatment Recommendations (check all that apply) Inpatient Psychiatric CCS Unit Narcotic Treatment Services Outpatient MH / SA ESP Follow-up Visit Pregnancy Enhanced SA Services Obs. / Intensive Obs. Med Management Visit Urgent Outpatient Medical Admission Level IV Detox Self-help / Peer Partial Hospitalization EATS (DDART) Returned to Police / Court Day Treatment SOAP Refused / Declined Treatment CSP ATS Other (i.e. DDAT, IOP) describe: If Applicable Next Appointment (date, time, location): Provider: Accepting Facility: Accepting Doctor: Transported by: Medications administered: Yes No; if yes, explain: Restraints used: Yes No; if yes, explain: Medical clearance provided by: Psychiatric consult with: Insurance Information Primary Insurance: Policy number: Authorization number: Number of days: Next review date: Person Authorizing: Phone number: Secondary Insurance: Policy number: Authorization number: Number of days: Next review date: Person Authorizing: Phone number: Comments (i.e. subscriber): Signatures Name Date Clinician (print name / credentials: Clinician Signature: Consulted with (print, if applicable): Other (print, if applicable): Other signature: Rubric This criterion is linked to a Learning OutcomeAssessment Body/ Introduction and Conclusion 2.5 pts Full Marks – Thoroughly identifies and describes all essential components using a biopsychosocialspiritual perspective (including addendums as required). (i.e. no blank areas in key parts of the assessment) – Assessment includes supports/obstacles, client strengths, spiritual considerations, and socioeconomic context of client/population. OR – Describes the diagnosis and population to be explored – Explains the importance of the topic to social work at the micro, mezzo, and macro levels – Conclusion thoroughly summarizes the main points of the paper body 0 pts No Marks 2.5 pts This criterion is linked to a Learning OutcomeClinical Formulation/ Paper Body 7.5 pts Full Marks – Formulation moves beyond mere description to explanation (insight and clinical judgment) regarding the symptoms shown and possible causes of concerns. – Provides clinical information not otherwise noted elsewhere in the assessment. – Mental Status Exam narrative fully explains the person’s presentation. OR – Thoroughly illustrates the prevalence of the diagnosis within the chosen population/ community – Comprehensively explains the possible causes of the problem with the chosen population or community – Examines the impact on the community as a whole 0 pts No Marks 7.5 pts This criterion is linked to a Learning OutcomeDiagnosis and Treatment/ Paper Body 7.5 pts Full Marks – Diagnosis is accurate (or closely sufficient) based on the information gained in the assessment and in line with the mental status exam. – Indicates DSM 5 Diagnostic Code along with specifiers as needed. – Indicates how diagnostic criteria is met, along with how other diagnoses were ruled out. (Note: This will be written at the end of the clinical formulation) – Social work interventions that could be used by the writer to resolve the issues are noted. OR – Thoroughly examines attempts to address the problem with the chosen population – Extensively explains possible barriers to resolution of the issue – Student’s professional judgement about the diagnosis and impact on the population/community is noted along with how the student would address the needs of the community/population 0 pts No Marks 7.5 pts This criterion is linked to a Learning OutcomeProfessional Writing 2.5 pts Full Marks – Writing is organized and free from spelling and grammatical errors. – Uses social work terminology. – Minimal use of acronyms, initials, and colloquial language. OR – Writing is organized and free from spelling and grammatical errors. – Uses social work terminology. – Minimal use of acronyms, initials, and colloquial language. – Utilizes at least 6 references from peer reviewed journals

******CLICK ORDER NOW BELOW AND OUR WRITERS WILL WRITE AN ANSWER TO THIS ASSIGNMENT OR ANY OTHER ASSIGNMENT, DISCUSSION, ESSAY, HOMEWORK OR QUESTION YOU MAY HAVE. OUR PAPERS ARE PLAGIARISM FREE*******."