VIRTUAL UNIVERSITY OF PAKISTAN FORMAT OF THE INTERNSHIP REPORT FOR BS Psychology (Clinical Setting)

Size: px
Start display at page:

Download "VIRTUAL UNIVERSITY OF PAKISTAN FORMAT OF THE INTERNSHIP REPORT FOR BS Psychology (Clinical Setting)"

Transcription

1 VIRTUAL UNIVERSITY OF PAKISTAN FORMAT OF THE INTERNSHIP REPORT FOR BS Psychology (Clinical Setting) 1. Title page The title page of the report will include: Clinical Case Studies The name of the internee, Student ID and session The date of the final report Name of the university Submitted to (name of the department) VU logo 2. Acknowledgement 3. Scanned copy of the internship certificate (provided by the department) 5. Table of contents List the important headings and sub headings in the report with page numbers. Also make a separate list of tables and figures in the table of contents if you have used any. Appendixes For collecting case studies and writing your clinical report, you have to follow a proper format that may include the following sections: Background Information/ History: The first section of your report will present your client s background. Including, IDENTIFICATION FACTORS such as name, gender, age, education, occupation, income, date of admission. Main reasons for referral: Presenting complaints: Family History: Father: Alive/dead: Education: Occupation: Cause of death: Physical health: Any psychiatry problem Personality

2 Nature of relationship with patient Relationship with wife: Mother: Alive/dead: Education: Occupation: Cause of death: Physical health: Any psychiatry problem Personality Nature of relationship with patient Relationship with husband: Siblings: Total No: Brothers Sisters Patient Birth order Physical health Relationship with siblings Overall family atmosphere: Personal History Birth Early development Physical health/ Medical history Traumatic experiences Any psychological problem Schooling Milestone Adolescence Occupation Sexual inclination Marital History: Spouse Alive/dead: Age: Education: Occupation: Cause of death : physical heath: Any psychiatric problem: Personality Nature of relationship with patient Relationship with spouse family If strained, why/cause Children: Total No: Son: Ages:

3 Daughter: Physical health: Any psychiatric problem: Relationship with children: Overall home atmosphere: Age: Premorbid Personality Social interest Social relationships Mood Moral and religious values Habits Reactions to stress Smoking/ Drug abuse Psychiatric traits/problem Previous and Present Psychological Problem: Mental Status Examination: Do assess Global assessment of functioning (GAF) (What is GAF and how to score on it is given below) General Behavior: Appearance Manners Speech (Form and Content) Mood: Thoughts: Delusions: Perceptions: Hallucinations Orientation: Time Place Personal Memory: Long term memory

4 Short term memory Immediate memory General information/intelligence: General knowledge questions Administration of psychological tests: Summery of Formal Psychological Assessment Any other important information: Diagnosis and Prognosis: Recovery (Satisfactory/Unsatisfactory) Management and Treatment: Pharmacological Psychological/psychotherapy Social Follow up Plans: Any Suggestions/Recommendations: Case Formulation: Appendixes: This part would include the scanned copies of tests being used for the assessment of the client.

5 Instructions: 1. Take case studies of two clients for report writing 2. Preferable one female and one male client 3. Possibly try to take the cases of clients with neurosis and not from the category of severe mental disorders. Mainly your report should encompass following sections: 1. Background Information/ History For instance, marital status, no of children (if any), work, health status, family mental health history, family and social relationships, drug and alcohol history, life difficulties, goals, and coping skills and weaknesses. 2. Description of the Presenting Problem In the next section of your case study, you will describe the problem or symptoms that the client presented with. Describe any physical, emotional, or sensory symptoms reported by the client. Thoughts, feelings, and perceptions related to the symptoms should also be noted. Any screening or diagnostic assessments that are used should also be described in detail and all scores reported. Do assess Global assessment of functioning (GAF) (What is GAF and how to score on it is given below) 3. Your Diagnosis Provide your diagnosis and give the appropriate DSM-IV code. Explain how you reached your diagnosis, how the clients symptoms fit the diagnostic criteria for the disorder(s), or any possible difficulties in reaching a diagnosis. 4. Intervention and Recommendations The second section of your report will focus on the interventions that can be used to help the client. You may summarize two or more possible treatment approaches. Identify all the possible social, psychological and biological factors that can contribute to the problem of your client and provide recommendations accordingly. 5. Case formulation: This section will include the comprehensive report of the gathered information. 6. Appendixes

6 GLOBAL ASSESSMENT OF FUNCTIONING TABLE The Global Assessment of Functioning (GAF) is a numeric scale (0 through 100) used by mental health clinicians and doctors to rate the social, occupational and psychological functioning of adults. The scale is presented and described in the DSM-IV-TR on page 32. Children and adolescents under the age of 18 are evaluated on the Children s Global Assessment Scale, or C-GAS Superior functioning in a wide range of activities, life's problems never seem to get out of hand, is sought out by others because of his or her many qualities. No symptoms Absent or minimal symptoms, good functioning in all areas, interested and involved in a wide range of activities, socially effective, generally satisfied with life, no more than everyday problems or concerns If symptoms are present they are transient and expectable reactions to psychosocial stresses; no more than slight impairment in social, occupational, or school functioning Some mild symptoms OR some difficulty in social, occupational, or school functioning, but generally functioning pretty well, has some meaningful interpersonal relationships Moderate symptoms OR any moderate difficulty in social, occupational, or school functioning Serious symptoms OR any serious impairment in social, occupational, or school functioning Some impairment in reality testing or communication OR major impairment in several areas, such as work or school, family relations, judgment, thinking, or mood Behavior is considerably influenced by delusions or hallucinations OR serious impairment in communications or judgment OR inability to function in all areas Some danger of hurting self or others OR occasionally fails to maintain minimal personal hygiene OR gross impairment in communication Persistent danger of severely hurting self or others OR persistent inability to maintain minimum personal hygiene OR serious suicidal act with clear expectation of death. 0 Not enough information available to provide GAF.

7 ****Note: I. Complete all the required parts of your report. II. Though report would be written on only two cases but for presentation & viva voce, do prepare yourself to talk about the other cases and your experiences during your internship. III. The internship report should be double space typed on A4 size with bold headings and sub headings, with margins set at top, bottom and right 1 inch whereas left margin should be 1.5 inch, consisting of at least 10,000 to 15,000 words. IV. Internship Report should be uploaded on LMS as an assignment. V. Students will be provided reference letter by the university on request. They have to specify the name and address of the organization and concerned person, along with their own complete address and phone number. Students can send their request for internship letter at this mailing address:

Mental Disorders (Except initial PTSD and Eating Disorders) Examination

Mental Disorders (Except initial PTSD and Eating Disorders) Examination Mental Disorders (Except initial PTSD and Eating Disorders) Examination Name: Date of Exam: SSN: C-number: Place of Exam: The following health care providers can perform initial examinations for Mental

More information

Initial Evaluation for Post-Traumatic Stress Disorder Examination

Initial Evaluation for Post-Traumatic Stress Disorder Examination Initial Evaluation for Post-Traumatic Stress Disorder Examination Name: Date of Exam: SSN: C-number: Place of Exam: The following health care providers can perform initial examinations for PTSD. a board-certified

More information

Al Ahliyya Amman University Faculty of Arts Department of Psychology Course Description Special Education

Al Ahliyya Amman University Faculty of Arts Department of Psychology Course Description Special Education Al Ahliyya Amman University Faculty of Arts Department of Psychology Course Description Special Education 0731111 Psychology and life {3} [3-3] Defining humans behavior; Essential life skills: problem

More information

CRITERIA CHECKLIST. Serious Mental Illness (SMI)

CRITERIA CHECKLIST. Serious Mental Illness (SMI) Serious Mental Illness (SMI) SMI determination is based on the age of the individual, functional impairment, duration of the disorder and the diagnoses. Adults must meet all of the following five criteria:

More information

D. Clinical indicators for psychiatric evaluation are established by one or more of the following criteria. The consumer is:

D. Clinical indicators for psychiatric evaluation are established by one or more of the following criteria. The consumer is: MCCMH MCO Policy 2-015 Date: 4/21/11 V. Standards A. A psychiatric evaluation shall be done as an integral part of the assessment process. It serves as the guide to the identification of medical and psychiatric

More information

North Bay Regional Health Centre

North Bay Regional Health Centre Addictions and Mental Health Division Programs Central Intake Referral Form The Central Intake Referral Form is used in the District of Nipissing by the North Bay Regional Health Centre s Addictions and

More information

UWM Counseling and Consultation Services Intake Form

UWM Counseling and Consultation Services Intake Form UWM Counseling and Consultation Services Intake Form Dear Student, Date Affix Label Here (Office Use Only) Thank you for giving us the opportunity to better serve you. Please help us by taking a few minutes

More information

Depression Assessment & Treatment

Depression Assessment & Treatment Depressive Symptoms? Administer depression screening tool: PSC Depression Assessment & Treatment Yes Positive screen Safety Screen (see Appendix): Administer every visit Neglect/Abuse? Thoughts of hurting

More information

NEW PATIENT INFORMATION

NEW PATIENT INFORMATION NEW PATIENT INFORMATION Date Patient Name Sex Age DOB / / Address City State Zip Phone Email Emergency Contact: Relationship to patient: Phone #(s) How did you hear about my practice? RESPONSIBLE PARTY

More information

Behavioral Health Consulting Services, LLC

Behavioral Health Consulting Services, LLC www.bhcsct.org infohealth@bhcsct.org 46 West Avon Road 322 Main St. 530 Middlebury Road Suite 202 Suite 1-G Suite 103 B Avon, CT 06001 Willimantic, CT 06226 Middlebury, CT 06762 Office phone- 1-860-673-0145

More information

in young people Management of depression in primary care Key recommendations: 1 Management

in young people Management of depression in primary care Key recommendations: 1 Management Management of depression in young people in primary care Key recommendations: 1 Management A young person with mild or moderate depression should typically be managed within primary care services A strength-based

More information

GLOBAL ASSESSMENT OF FUNCTIONING

GLOBAL ASSESSMENT OF FUNCTIONING GLOBAL ASSESSMENT OF FUNCTIONING The Global Assessment of Functioning (GAF) assigns a clinical judgment in numerical fashion to the individual s overall functioning level. Impairments in psychological,

More information

[KQ 804] FEBRUARY 2007 Sub. Code: 9105

[KQ 804] FEBRUARY 2007 Sub. Code: 9105 [KQ 804] FEBRUARY 2007 Sub. Code: 9105 (Revised Regulations) Theory : Two hours and forty minutes Q.P. Code: 419105 Maximum : 100 marks Theory : 80 marks M.C.Q. : Twenty minutes M.C.Q. : 20 marks 1. A

More information

OK to leave Messages?

OK to leave Messages? Jami Howell, Psy.D., LLC Licensed Clinical Psychologist 1215 SW 18 th Avenue, Portland OR 97205 p (503) 504-5222 f (503) 224-2134 jami@doctorjamihowell.com Client Information Name: Preferred Name: Date

More information

Washington State Regional Support Network (RSN)

Washington State Regional Support Network (RSN) Access to Care Standards 11/25/03 Eligibility Requirements for Authorization of Services for Medicaid Adults & Medicaid Older Adults Please note: The following standards reflect the most restrictive authorization

More information

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D]

SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] SUBSTANCE USE DISORDER SOCIAL DETOXIFICATION SERVICES [ASAM LEVEL III.2-D] I. Definitions: Detoxification is the process of interrupting the momentum of compulsive drug and/or alcohol use in an individual

More information

Al Ahliyya Amman University Faculty of Arts Department of Psychology Course Description Psychology

Al Ahliyya Amman University Faculty of Arts Department of Psychology Course Description Psychology Al Ahliyya Amman University Faculty of Arts Department of Psychology Course Description Psychology 0731111 Psychology And Life {3}[3-3] Defining humans behavior; Essential life skills: problem solving,

More information

City Vision College (Course 414): Help for Alcoholics

City Vision College (Course 414): Help for Alcoholics City Vision College (Course 414): Help for Alcoholics Chapter 3: Treatment Planning (pages 50 64) 1. What should you do for your patient if you only have time to get a chief complaint? a. Take a brief

More information

Presenters: Ahlam Elbedewe, LSW Briannon O Connor, PhD David Eckert, LMHC, NCC, CRC. The Managed Care Technical Assistance Center of New York

Presenters: Ahlam Elbedewe, LSW Briannon O Connor, PhD David Eckert, LMHC, NCC, CRC. The Managed Care Technical Assistance Center of New York Presenters: Ahlam Elbedewe, LSW Briannon O Connor, PhD David Eckert, LMHC, NCC, CRC The Managed Care Technical Assistance Center of New York Who is MCTAC? MCTAC Partners Respond to questions and comments

More information

Occupational Therapy Assisting STARK STATE COLLEGE OF TECHNOLOGY

Occupational Therapy Assisting STARK STATE COLLEGE OF TECHNOLOGY Occupational Therapy Assisting STARK STATE COLLEGE OF TECHNOLOGY Presented by The OTA class of Spring 2010 What is Occupational Therapy? Occupation: Activity in which one engages Therapy: Treatment of

More information

Child s Legal Name: Date of Birth: Age: First, Middle, and Last Name. Nicknames: Social Security #: - - Current address: Apt #:

Child s Legal Name: Date of Birth: Age: First, Middle, and Last Name. Nicknames: Social Security #: - - Current address: Apt #: Parent Questionnaire Child s Legal Name: Date of Birth: Age: First, Middle, and Last Name Nicknames: Social Security #: - - Current address: Apt #: City: State: Zip Code: Home Phone: Cell/Other #: Parent

More information

Assistance and Support Services for Family Caregivers Deborah Amdur, LCSW, ACSW

Assistance and Support Services for Family Caregivers Deborah Amdur, LCSW, ACSW Assistance and Support Services for Family Caregivers Deborah Amdur, LCSW, ACSW Chief Consultant, Care Management & Social Work Caregivers of Veterans 2 *National Alliance for Caregiving (NAC) Study Caregivers

More information

Megan Ogle, PsyD Clinical Psychologist 1215 SW 18 th Avenue, Portland, OR 97205 971.313.4518 dr.meganogle@gmail.com

Megan Ogle, PsyD Clinical Psychologist 1215 SW 18 th Avenue, Portland, OR 97205 971.313.4518 dr.meganogle@gmail.com Megan Ogle, PsyD Clinical Psychologist 1215 SW 18 th Avenue, Portland, OR 97205 971.313.4518 dr.meganogle@gmail.com Client Information Date: Name: Preferred First Name: Date of Birth: / / SSN: - - Address:

More information

Substance Use Disorder Screening and Testing 35-45-3

Substance Use Disorder Screening and Testing 35-45-3 Policy The Department of Children and Families shall screen all adult and adolescent clients for indicators of substance use disorders and refer those in need of further assessment or treatment to an appropriate

More information

Mental Health Needs Assessment Personality Disorder Prevalence and models of care

Mental Health Needs Assessment Personality Disorder Prevalence and models of care Mental Health Needs Assessment Personality Disorder Prevalence and models of care Introduction and definitions Personality disorders are a complex group of conditions identified through how an individual

More information

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1

Presently, there are no means of preventing bipolar disorder. However, there are ways of preventing future episodes: 1 What is bipolar disorder? There are two main types of bipolar illness: bipolar I and bipolar II. In bipolar I, the symptoms include at least one lifetime episode of mania a period of unusually elevated

More information

Professional Standards for Psychiatric Nursing

Professional Standards for Psychiatric Nursing Professional Standards for Psychiatric Nursing November 2012 College of Registered Psychiatric Nurses of B.C. Suite 307 2502 St. Johns Street Port Moody, British Columbia V3H 2B4 Phone 604 931 5200 Fax

More information

Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT

Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT Children s Community Health Plan INTENSIVE IN-HOME MENTAL HEALTH / SUBSTANCE ABUSE SERVICES ASSESSMENT AND RECOVERY / TREATMENT PLAN ATTACHMENT Please fax with CCHP prior authorization form to 608-252-0853

More information

Macalester Health & Wellness Center Counseling Services Page 1 Intake Data Sheet

Macalester Health & Wellness Center Counseling Services Page 1 Intake Data Sheet Macalester Health & Wellness Center Counseling Services Page 1 Intake Data Sheet Date: Student s Name: Student s ID: Local Address: Residence Hall & Room Number or Local Street Address Personal Phone:

More information

Program Plan for the Delivery of Treatment Services

Program Plan for the Delivery of Treatment Services Standardized Model for Delivery of Substance Use Services Attachment 5: Nebraska Registered Service Provider s Program Plan for the Delivery of Treatment Services Nebraska Registered Service Provider s

More information

What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study

What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study What happens to depressed adolescents? A beyondblue funded 3 9 year follow up study Amanda Dudley, Bruce Tonge, Sarah Ford, Glenn Melvin, & Michael Gordon Centre for Developmental Psychiatry & Psychology

More information

Adult Information Form Page 1

Adult Information Form Page 1 Adult Information Form Page 1 Client Name: Age: DOB: Date: Address: City: State: Zip: Home Phone: ( ) OK to leave message? Yes No Work Phone: ( ) OK to leave message? Yes No Current Employer (or school

More information

Depression Flow Chart

Depression Flow Chart Depression Flow Chart SCREEN FOR DEPRESSION ANNUALLY Assess for depression annually with the PHQ-9. Maintain a high index of suspicion in high risk older adults. Consider suicide risk and contributing

More information

TELEMEDICINE SERVICES Brant Haldimand Norfolk INITIAL MENTAL HEALTH ASSESSMENT NAME: I.D. # D.O.B. REASON FOR REFERRAL:

TELEMEDICINE SERVICES Brant Haldimand Norfolk INITIAL MENTAL HEALTH ASSESSMENT NAME: I.D. # D.O.B. REASON FOR REFERRAL: TELEMEDICINE SERVICES Brant Haldimand Norfolk TMS INITIAL MENTAL HEALTH ASSESSMENT NAME: I.D. # D.O.B. (OPTINAL) ADDRESS: CITY: P.C. HOME PHONE: ALTERNATE PHONE: G.P: MARITAL STATUS: AGE: ASSSESSMENT DATE:

More information

Reference document. Alcohol addiction

Reference document. Alcohol addiction Reference document Alcohol addiction Table of content Introduction 2 Definition 2 Signs and symptoms 3 Intervening with an employee 4 Available treatments and resources 5 Conclusion 5 Reference document

More information

Psychiatric Day Rehabilitation MH - Adult

Psychiatric Day Rehabilitation MH - Adult Psychiatric Day Rehabilitation MH - Adult Definition Day Rehabilitation services are designed to provide individualized treatment and recovery, inclusive of psychiatric rehabilitation and support for clients

More information

[Provider or Facility Name]

[Provider or Facility Name] [Provider or Facility Name] SECTION: [Facility Name] Residential Treatment Facility (RTF) SUBJECT: Psychiatric Security Review Board (PSRB) In compliance with OAR 309-032-0450 Purpose and Statutory Authority

More information

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015

ADVANCED BEHAVIORAL HEALTH, INC. Clinical Level of Care Guidelines - 2015 The Clinical Level of Care Guidelines contained on the following pages have been developed as a guide to assist care managers, physicians and providers in making medical necessity decisions about the least

More information

Provincial Youth Addictions Treatment Centre Grand Falls Windsor

Provincial Youth Addictions Treatment Centre Grand Falls Windsor Provincial Youth Addictions Treatment Centre Grand Falls Windsor CAREGIVER ASSESSMENT FORM Thank you for taking the time to complete this assessment form. The information you provide will assist us in

More information

Definition of Terms. nn Mental Illness Facts and Statistics

Definition of Terms. nn Mental Illness Facts and Statistics nn Mental Illness Facts and Statistics This section contains a brief overview of facts and statistics about mental illness in Australia as well as information that may be useful in countering common myths.

More information

Easy Does It, Inc. Transitional Housing Application

Easy Does It, Inc. Transitional Housing Application Easy Does It Inc. of Reading and Leesport Housing Programs Easy Does It, Inc. Transitional Housing Application Welcome Thank you for applying to Easy Does It, Inc. ( EDI ) a non-profit charitable organization

More information

NEUROPSYCHOLOGY QUESTIONNAIRE. (Please fill this out prior to your appointment and bring it with you.) Name: Date of appointment: Home address:

NEUROPSYCHOLOGY QUESTIONNAIRE. (Please fill this out prior to your appointment and bring it with you.) Name: Date of appointment: Home address: NEUROPSYCHOLOGY QUESTIONNAIRE (Please fill this out prior to your appointment and bring it with you.) Name: Date of appointment: Date of birth: Age: _ Home address: _ Home phone: Cell phone: Work phone:

More information

Study Guide - Borderline Personality Disorder (DSM-IV-TR) 1

Study Guide - Borderline Personality Disorder (DSM-IV-TR) 1 Study Guide - Borderline Personality Disorder (DSM-IV-TR) 1 Pervasive pattern of instability of interpersonal relationships, selfimage, and affects, and marked impulsivity that begins by early adulthood

More information

DSM-5: A Comprehensive Overview

DSM-5: A Comprehensive Overview 1) The original DSM was published in a) 1942 b) 1952 c) 1962 d) 1972 DSM-5: A Comprehensive Overview 2) The DSM provides all the following EXCEPT a) Guidelines for the treatment of identified disorders

More information

LEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE)

LEVEL III.5 SA: SHORT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) LEVEL III.5 SA: SHT TERM RESIDENTIAL - Adult (DUAL DIAGNOSIS CAPABLE) Definition The following is based on the Adult Criteria of the Patient Placement Criteria for the Treatment of Substance-Related Disorders

More information

Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines

Optum By United Behavioral Health. 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Optum By United Behavioral Health 2015 Florida Medicaid Managed Medical Assistance (MMA) Level of Care Guidelines Therapeutic group care services are community-based, psychiatric residential treatment

More information

Information for Applicants

Information for Applicants Graduate Studies in Clinical Psychology at the University of Victoria Information for Applicants Program Philosophy and Mission Our CPA-accredited graduate program in clinical psychology is based on the

More information

INPATIENT SERVICES. Inpatient Mental Health Services (Adult/Child/Adolescent)

INPATIENT SERVICES. Inpatient Mental Health Services (Adult/Child/Adolescent) INPATIENT SERVICES Inpatient Mental Health Services (Adult/Child/Adolescent) Acute Inpatient Mental Health Services represent the most intensive level of psychiatric care and is delivered in a licensed

More information

Abnormal Psychology PSY-350-TE

Abnormal Psychology PSY-350-TE Abnormal Psychology PSY-350-TE This TECEP tests the material usually taught in a one-semester course in abnormal psychology. It focuses on the causes of abnormality, the different forms of abnormal behavior,

More information

Glen Davis PhD Maine Child Psychology 2 Elm Street, Waterville, ME 04901 Telephone: (207) 221-2631 Fax: (207) 221-3368 MaineChildPsych.

Glen Davis PhD Maine Child Psychology 2 Elm Street, Waterville, ME 04901 Telephone: (207) 221-2631 Fax: (207) 221-3368 MaineChildPsych. Dear Parent, Glen Davis PhD Maine Child Psychology 2 Elm Street, Waterville, ME 04901 Telephone: (207) 221-2631 Fax: (207) 221-3368 MaineChildPsych.com Thank you for your interest in psychological services

More information

Your Company 123 Company Ave. Philadelphia PA 00000 (215) 000-0000 COMPARISON REPORT. John B Smith

Your Company 123 Company Ave. Philadelphia PA 00000 (215) 000-0000 COMPARISON REPORT. John B Smith Your Company 123 Company Ave Philadelphia PA 00000 (215) 000-0000 COMPARISON REPORT FICTITIOUS CLIENT The following is a report of 's baseline Addiction Severity Index information collected on compared

More information

Registered Charity No. 5365

Registered Charity No. 5365 THE MULTIPLE SCLEROSIS SOCIETY OF IRELAND Dartmouth House, Grand Parade, Dublin 6. Telephone: (01) 269 4599. Fax: (01) 269 3746 MS Helpline: 1850 233 233 E-mail: mscontact@ms-society.ie www.ms-society.ie

More information

Psychiatric Residential Rehabilitation MH - Adult

Psychiatric Residential Rehabilitation MH - Adult Psychiatric Residential Rehabilitation MH - Adult Definition Psychiatric Residential Rehabilitation is designed to provide individualized treatment and recovery inclusive of psychiatric rehabilitation

More information

Declaration of Practices and Procedures

Declaration of Practices and Procedures LOGAN MCILWAIN, LCSW Baton Rouge Christian Counseling Center 763 North Boulevard, Baton Rouge, Louisiana 70802 Phone: (225) 387-2287 Fax: (225) 383-2722 Declaration of Practices and Procedures I am pleased

More information

Evidence Based Approaches to Addiction and Mental Illness Treatment for Adults

Evidence Based Approaches to Addiction and Mental Illness Treatment for Adults Evidence Based Practice Continuum Guidelines The Division of Behavioral Health strongly encourages behavioral health providers in Alaska to implement evidence based practices and effective program models.

More information

Comprehensive,Behavioral,Healthcare,of,Central,Florida,,LLC, Lawrence,B.,Erlich,,M.D., New,Patient,Intake,Forms,

Comprehensive,Behavioral,Healthcare,of,Central,Florida,,LLC, Lawrence,B.,Erlich,,M.D., New,Patient,Intake,Forms, Comprehensive,Behavioral,Healthcare,of,Central,Florida,,LLC, Lawrence,B.,Erlich,,M.D., New,Patient,Intake,Forms, PATIENT INFORMATION Last Name/ First Name/ M.I. Social Security Number: Date of Birth (MM/DD/YY):

More information

Depression Overview. Symptoms

Depression Overview. Symptoms 1 of 6 6/3/2014 10:15 AM Return to Web version Depression Overview What is depression? When doctors talk about depression, they mean the medical illness called major depression. Someone who has major depression

More information

Symptoms of mania can include: 3

Symptoms of mania can include: 3 Bipolar Disorder This factsheet gives information on bipolar disorder. It explains the symptoms of bipolar disorder, treatments and ways to manage symptoms. It also covers what treatment the National Institute

More information

Appendix - 2. One of the most important sources of information for the psychologist is

Appendix - 2. One of the most important sources of information for the psychologist is Appendix - One of the most important sources of information for the psychologist is the experiences which individuals undergo. I request you to help me in my work by sparing your valuable time to answer

More information

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic.

NICE Pathways bring together all NICE guidance, quality standards and other NICE information on a specific topic. bring together all NICE guidance, quality standards and other NICE information on a specific topic. are interactive and designed to be used online. They are updated regularly as new NICE guidance is published.

More information

Borderline personality disorder

Borderline personality disorder Understanding NICE guidance Information for people who use NHS services Borderline personality disorder NICE clinical guidelines advise the NHS on caring for people with specific conditions or diseases

More information

TEEN MARIJUANA USE WORSENS DEPRESSION

TEEN MARIJUANA USE WORSENS DEPRESSION TEEN MARIJUANA USE WORSENS DEPRESSION An Analysis of Recent Data Shows Self-Medicating Could Actually Make Things Worse Millions of American teens* report experiencing weeks of hopelessness and loss of

More information

MENTAL IMPAIRMENT RATING

MENTAL IMPAIRMENT RATING MENTAL IMPAIRMENT RATING Lev.II Curriculum Rev. 6/09 155 OBJECTIVES MENTAL AND BEHAVIORAL DISORDERS 1. Identify the axes used in the diagnostic and statistical manual of mental disorders - DSM. 2. Understand

More information

I. Each evaluator will have experience in diagnosing and treating the disease of chemical dependence.

I. Each evaluator will have experience in diagnosing and treating the disease of chemical dependence. PREVENTION/INTERVENTION CENTER COBB COUNTY PUBLIC SCHOOL SAFE AND DRUG FREE PROGRAM www.cobbk12.org/~preventionintervention CONTRACT FOR SERVICE PROVIDERS As a member of the Cobb County Schools Coalition

More information

Traumatic Stress. and Substance Use Problems

Traumatic Stress. and Substance Use Problems Traumatic Stress and Substance Use Problems The relation between substance use and trauma Research demonstrates a strong link between exposure to traumatic events and substance use problems. Many people

More information

MAIL: Recovery Center Missoula FAX: 406 532 9901 1201 Wyoming St. OR ATTN: Admissions Missoula, MT 59801 ATTN: Admissions

MAIL: Recovery Center Missoula FAX: 406 532 9901 1201 Wyoming St. OR ATTN: Admissions Missoula, MT 59801 ATTN: Admissions Hello and thank you for your interest in Recovery Center Missoula. This letter serves to introduce our program to you, outline eligibility requirements, and describe the application/admission process.

More information

ADULT REGISTRATION FORM. Last Name First Name Middle Initial. Date of Birth Age Identified Gender. Street Address. City State Zip Code

ADULT REGISTRATION FORM. Last Name First Name Middle Initial. Date of Birth Age Identified Gender. Street Address. City State Zip Code ADULT REGISTRATION FORM Last Name First Name Middle Initial Date of Birth Age Identified Gender Street Address City State Zip Code Home Phone Cell Phone FINANCIALLY RESPONSIBLE PARTY (If different from

More information

Assessment of depression in adults in primary care

Assessment of depression in adults in primary care Assessment of depression in adults in primary care Adapted from: Identification of Common Mental Disorders and Management of Depression in Primary care. New Zealand Guidelines Group 1 The questions and

More information

Co-Occurring Disorders

Co-Occurring Disorders Co-Occurring Disorders PACCT 2011 CAROLYN FRANZEN Learning Objectives List common examples of mental health problems associated with substance abuse disorders Describe risk factors that contribute to the

More information

Mental Health 101 for Criminal Justice Professionals David A. D Amora, M.S.

Mental Health 101 for Criminal Justice Professionals David A. D Amora, M.S. Mental Health 101 for Criminal Justice Professionals David A. D Amora, M.S. Director, National Initiatives, Council of State Governments Justice Center Today s Presentation The Behavioral Health System

More information

Pragmatic Evidence Based Review Substance Abuse in moderate to severe TBI

Pragmatic Evidence Based Review Substance Abuse in moderate to severe TBI Pragmatic Evidence Based Review Substance Abuse in moderate to severe TBI Reviewer Emma Scheib Date Report Completed November 2011 Important Note: This report is not intended to replace clinical judgement,

More information

SPOUSE / PARTNER ONE TO COMPLETE THIS SECTION SEPARATELY. Name: (Last) (First) (Middle Initial)

SPOUSE / PARTNER ONE TO COMPLETE THIS SECTION SEPARATELY. Name: (Last) (First) (Middle Initial) Katherine E. Walker, PhD, LPC, NCC, BCIA-C Licensed Professional Counselor 8300 Health Park, Suite 201 Raleigh, NC 27615 Mobile: 919-760-3068 Fax: 919-676-9946 Email: walker@carolinaperformance.net Couples

More information

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí=

`çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå. aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= `çããçå=jéåí~ä= aáëçêçéêëw=^åñáéíó=~åç= aééêéëëáçå aêk=`=f=lâçåü~ jéçáå~ä=aáêéåíçê lñäé~ë=kep=cçìåç~íáçå=qêìëí= Overview: Common Mental What are they? Disorders Why are they important? How do they affect

More information

College of Education. Rehabilitation Counseling

College of Education. Rehabilitation Counseling * 515 MEDICAL AND PSYCHOSOCIAL ASPECTS OF DISABILITIES I. (3) This course is designed to prepare rehabilitation and mental health counselors, social works and students in related fields with a working

More information

AGENCY OVERVIEW MFT & MSW* Intern-Trainee Program 2015-2016 Training Year

AGENCY OVERVIEW MFT & MSW* Intern-Trainee Program 2015-2016 Training Year AGENCY OVERVIEW MFT & MSW* Intern-Trainee Program 2015-2016 Training Year Non-profit mental health agency established in 1945 Recipient of the CAMFT School and Agency Award for 2009 Clients from diverse

More information

Borderline personality disorder

Borderline personality disorder Issue date: January 2009 Borderline personality disorder Borderline personality disorder: treatment and management NICE clinical guideline 78 Developed by the National Collaborating Centre for Mental Health

More information

Community, Schools, Cyberspace and Peers. Community Mental Health Centers (Managing Risks and Challenges) (Initial Identification)

Community, Schools, Cyberspace and Peers. Community Mental Health Centers (Managing Risks and Challenges) (Initial Identification) Community Mental Health Centers (Managing Risks and Challenges) Inpatient Hospitalization (New Hampshire Hospital) (Assessment, Treatment Planning/Discharge) Community, Schools, Cyberspace and Peers (Initial

More information

Therapist: Child History Form. PATIENT IDENTIFICATION First Appointment Date Birth Date Age Sex School Grade

Therapist: Child History Form. PATIENT IDENTIFICATION First Appointment Date Birth Date Age Sex School Grade Therapist: Child History Form In order for us to be able to fully evaluate your child, please fill out the following questionnaire to the best of your ability. We realize there may be information that

More information

Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005

Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005 Mental Health and Substance Abuse Reporting Requirements Section 425 of P.A. 154 of 2005 By April 1, 2006, the Department, in conjunction with the Department of Corrections, shall report the following

More information

Welcome New Employees. Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders

Welcome New Employees. Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders Welcome New Employees Clinical Aspects of Mental Health, Developmental Disabilities, Addictive Diseases & Co-Occurring Disorders After this presentation, you will be able to: Understand the term Serious

More information

PARTNERS IN PEDIATRIC CARE. Intake and History for Mental Health Referral

PARTNERS IN PEDIATRIC CARE. Intake and History for Mental Health Referral PARTNERS IN PEDIATRIC CARE Intake and History for Mental Health Referral This form is designed to give you an opportunity to provide us with background information that will help us help you. Please read

More information

Clinical Practice Guidelines: Attention Deficit/Hyperactivity Disorder

Clinical Practice Guidelines: Attention Deficit/Hyperactivity Disorder Clinical Practice Guidelines: Attention Deficit/Hyperactivity Disorder AACAP Official Action: OUTLINE OF PRACTICE PARAMETERS FOR THE ASSESSMENT AND TREATMENT OF CHILDREN, ADOLESCENTS, AND ADULTS WITH ADHD

More information

Provider Attestation (Expedited Requests Only) Clinical justification for expedited review:

Provider Attestation (Expedited Requests Only) Clinical justification for expedited review: Inpatient Treatment Request Fax completed form to: 866 949 4846 Fill out completely to avoid delays Date: / / Request Type (Check one): Standard Expedited (additional information required below) Provider

More information

ADVANCED DIPLOMA IN COUNSELLING AND PSYCHOLOGY

ADVANCED DIPLOMA IN COUNSELLING AND PSYCHOLOGY ACC School of Counselling & Psychology Pte Ltd www.acc.edu.sg Tel: (65) 6339-5411 9 Penang Road #13-22 Park Mall SC Singapore 238459 1) Introduction to the programme ADVANCED DIPLOMA IN COUNSELLING AND

More information

Policy and Procedure Manual

Policy and Procedure Manual Policy and Procedure Manual Resident Assessment (RA) Table of Contents RA-01 RA-02 RA-03 RA-04 RA-05 RA-06 RA-07 RA-08 RA-09 RA-10 RA-11 RA-12 Physical Health Services Dental Services Initial Nursing Summary

More information

Preadmission Screening. Who Is Subject to PASRR Screens. Who can Complete the ACH PASRR Level I Screen. Getting Help

Preadmission Screening. Who Is Subject to PASRR Screens. Who can Complete the ACH PASRR Level I Screen. Getting Help North Carolina Department of Health and Human Services Update Preadmission Screening and Review (PASRR) Process for Adult Care Homes licensed under G.S. 131D, Article 1 and defined in G.S. 131D-2.1 Preadmission

More information

Co-Occurring Substance Use and Mental Health Disorders. Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs

Co-Occurring Substance Use and Mental Health Disorders. Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs Co-Occurring Substance Use and Mental Health Disorders Joy Chudzynski, PsyD UCLA Integrated Substance Abuse Programs Introduction Overview of the evolving field of Co-Occurring Disorders Addiction and

More information

Psychopathology. Stages of research. Interventions

Psychopathology. Stages of research. Interventions Psychopathology Change in the way look at problems. Similar to change in biology. Also look over life cycle. Look at how they adapt to change. 1 Burden Stages of research Diagnosable symptomatology Positive

More information

Henriëtte van der Horst VUmc Head of Department of General Practice and Elderly Care Medicine

Henriëtte van der Horst VUmc Head of Department of General Practice and Elderly Care Medicine MUS and psychiatry in primary care Henriëtte van der Horst VUmc Head of Department of General Practice and Elderly Care Medicine Double Dutch: two topics Major changes in the mental health care organisation

More information

OUTPATIENT DAY SERVICES

OUTPATIENT DAY SERVICES OUTPATIENT DAY SERVICES Intensive Outpatient Programs (IOP) Intensive Outpatient Programs (IOP) provide time limited, multidisciplinary, multimodal structured treatment in an outpatient setting. Such programs

More information

Psychotic Disorders. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com mhff0101 Last reviewed: 01/10/2013 1

Psychotic Disorders. 1995-2013, The Patient Education Institute, Inc. www.x-plain.com mhff0101 Last reviewed: 01/10/2013 1 Psychotic Disorders Introduction Psychotic disorders are severe mental disorders that cause abnormal thinking and perceptions. These disorders cause people to lose touch with reality. As a result, people

More information

Patient Insurance Information

Patient Insurance Information Improving Lives & Performance Dr. Jeff Eidsvig, D.C., TPI- CGFI 3060 Communications Parkway, Suite #104 Plano, Texas 75093 972-312- 9310 New Patient Information / Change of Information : New Patient Change

More information

POSTPARTUM DEPRESSION: A Guide for Patients and Families

POSTPARTUM DEPRESSION: A Guide for Patients and Families POSTPARTUM DEPRESSION: A Guide for Patients and Families Margaret L. Moline, PhD, David A. Kahn, MD, Ruth W. Ross, MA, Lori L. Altshuler, MD, and Lee S. Cohen, MD www.womensmentalhealth.org The birth of

More information

Intensive Customized Care Coordination Transaction

Intensive Customized Care Coordination Transaction Transaction Code Detail Code Mod 1 Mod 2 Mod 3 Mod 4 Rate Code Communitybased wraparound Community-based wrap-around services H2022 HK services, monthly Unit Value 1 month Maximum Daily Units Initial 12

More information

Clinical Criteria 4.201 Inpatient Medical Withdrawal Management 4.201 Substance Use Inpatient Withdrawal Management (Adults and Adolescents)

Clinical Criteria 4.201 Inpatient Medical Withdrawal Management 4.201 Substance Use Inpatient Withdrawal Management (Adults and Adolescents) 4.201 Inpatient Medical Withdrawal Management 4.201 Substance Use Inpatient Withdrawal Management (Adults and Adolescents) Description of Services: Inpatient withdrawal management is comprised of services

More information

2) Recurrent emotional abuse. 3) Contact sexual abuse. 4) An alcohol and/or drug abuser in the household. 5) An incarcerated household member

2) Recurrent emotional abuse. 3) Contact sexual abuse. 4) An alcohol and/or drug abuser in the household. 5) An incarcerated household member Co Occurring Disorders and the on Children: Effectively Working with Families Affected by Substance Abuse and Mental Illness Definition (Co-Occurring also called Dual Dx) A professional diagnosis of addictive/substance

More information

As the State Mental Health Authority, the office of Mental Health has two main functions:

As the State Mental Health Authority, the office of Mental Health has two main functions: NYSOMH Mission The mission of the New York State Office of Mental Health is to promote the mental health of all New Yorkers, with a particular focus on providing hope and recovery for adults with serious

More information

FACT SHEET. What is Trauma? TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS

FACT SHEET. What is Trauma? TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS FACT SHEET TRAUMA-INFORMED CARE FOR WORKING WITH HOMELESS VETERANS According to SAMHSA 1, trauma-informed care includes having a basic understanding of how trauma affects the life of individuals seeking

More information

JUVENILE AUTOMATED SUBSTANCE ABUSE EVALUATION REFERENCE GUIDE

JUVENILE AUTOMATED SUBSTANCE ABUSE EVALUATION REFERENCE GUIDE JUVENILE AUTOMATED SUBSTANCE ABUSE EVALUATION REFERENCE GUIDE DEVELOPED AND OWNED BY ADE INCORPORATED Copyright (c) ADE Incorporated 2007 Ver. 3.25 Rev.4/07 The JUVENILE AUTOMATED SUBSTANCE ABUSE EVALUATION

More information

Managed Health Care Administration Initial Assessment Child/Adolescent Program Parent Questionnaire Page 1

Managed Health Care Administration Initial Assessment Child/Adolescent Program Parent Questionnaire Page 1 Page 1 Date: Patient Name: Date of Birth: / / Age of Patient: Name of person completing this form Relationship to Patient: Dear Parent: The information that you provide is critical in providing an accurate

More information