Teresa is a 77-year-old, Hispanic female who has been referred by her doctor to the Orange Crest Senior Center. You are meeting with Teresa for an intake case management session. Teresa’s presenting p

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Teresa is a 77-year-old, Hispanic female who has been referred by her doctor to the Orange Crest Senior Center. You are meeting with Teresa for an intake case management session. Teresa’s presenting problems including isolation and difficulty obtaining regular food/basic needs due to her limited ability to walk and drive. Teresa also mentioned it is hard for her to move around her home because of all her personal belongings and she has difficulty throwing anything away. Teresa also discussed concerns about her limited income though she thought her husband left a significant amount of money when he died. Teresa explained that her children have control of the finances and although they pay her bills, they often tell her when she asks for something, that the money has been spent for the month.

Using this vignette and the assessment form, please find a friend, family member, or colleague who can role-play this scenario with you.  The vignette includes some brief information to consider. You can also add to this vignette as you see fit for the assignment or use one of the clients from your practicum or work. Please consider what you have learned about how to engage a client and complete an assessment.  As the Social Worker, you will want to ask the client questions and not provide them the assessment form to complete on their own.  After you have completed the assessment, please ask your role-play partner for feedback about their experience (your strengths and areas for growth). Please consider the following questions for your paper:

  • What techniques did you use to engage the client?
  • What assessment strategies did you use in your roleplay (what specific questions did you ask)?
  • What feedback did your partner provide about this experience (your strengths and areas for growth?

For this assignment, you will submit the completed assessment form, mental status exam form, and a one-page paper with your responses to the above questions.

The paper should be approximately 1-2 pages and include high-quality writing. Please include a title page and double-check all spelling and grammar before submitting. Also, please make sure to cite all relevant information and include references as appropriate.

Please use one of the following assessment forms. You can type in the Word document or print out the PDF form and write your responses. I will attach after the job is accepted.

Teresa is a 77-year-old, Hispanic female who has been referred by her doctor to the Orange Crest Senior Center. You are meeting with Teresa for an intake case management session. Teresa’s presenting p
CLIENT ID # Intake Date Brief Intake – Assessment Referral Date Referred by: (Date Referred to Case Management Program) PRESENTING PROBLEM/IMMEDIATE CASE MANAGEMENT SERVICE NEEDS: NON-MEDICAL SERVICE PROVIDERS: (i.e. Advocacy, Intensive Case Management, Housing, Food, Support Groups) Agency Contact Person Phone Service Are case management services provided through another agency?  Yes  No Case Management Standards Brief Intake/Assessment 3.9.06 Date of Birth: Age: GENDER:  Female  Male  Transgender-ID as Female  Transgender-ID as Male Ethnicity: Hispanic?  Yes, specify:  No Race:  Asian  Black or African American  Native Hawaiian/Pacific Islander  White  American Indian or Alaska Native  Other: Relationship Status:  Single  Single-living w/partner  Married  Divorced  Separated  Widowed Person describes self as:  Heterosexual  Homosexual  Bisexual  Transgender Primary language spoken: English: Read?  Yes  No Write?  Yes  No Other Language: Read?  Yes  No Write?  Yes  No Does the client have difficulty understanding English?  Yes  No Does the client have difficulty using English to navigate the health and social service systems?  Yes  No Citizenship/Immigration Status: Is the client an undocumented U.S. resident?  Yes  No Does the client have pending immigration issues?  Yes  No Living Situation:  On street  Shelter  Transitional  Group Home  Drug Treatment Residence  SRO (specify)  28 Day  Permanent  Rental  Own Home  Other Living Arrangement:  Relations/Friends  Alone  Temporary  Permanent Does the client have temporary, unsafe, and/or inadequate housing?  Yes  No HOUSEHOLD COMPOSITION Number of people in household (including client): Adults Name Relationship HIV Status (+ , – or unknown Age Aware of Client’s HIV+ Status? (Y/N/NA) Children Name Relationship DOB Sex School Grade Aware of Client’s HIV+ Status? (Y/N) Aware Of Own HIV+ Status? (Y/N/NA) / / / / / / / / / / LIVING OUTSIDE OF HOUSEHOLD (partners, children, other close supports) Name Relationship HIV Status (+ , – or unknown) Age Aware of Client’s HIV+ Status (Y/N) Whereabouts Do household members, children or close supports have needs that impact client’s ability to access or maintain treatment or care?  Yes  No Are there disclosure issues that can be assisted by case management?  Yes  No Does the client have a functioning support system?  Yes  No PRIMARY INSURANCE Indicate all that apply:  Medicaid: Number with Sequence # ( ) Is there an exception – 35?  Yes  No Is there a spend-down?  Yes, in the amount of  No  Medicaid Managed Care  Medicare  Private Insurance  HMO/Managed Care  ADAP PLUS  Self Pay  Military  Other: SECONDARY INSURANCE  None or  Yes, (check below)  Medicaid Managed Care  Medicare  Private Insurance  HMO/Managed Care  ADAP PLUS  Self Pay  Military  Other: Effective Date of Secondary Insurance: HASA # (NYC only) Does the client need assistance with insurance for medical care?  Yes  No MEDICAL (This section is optional in medical settings where this information is readily accessible to the case manager.) Primary Medical Care Provider Name: Address: City: State: Zip: Main Phone: Case Manager/Social Worker: Phone: Primary Physician: Phone: Recent Hospitalizations: Last time saw doctor: CD4 Count: Viral load: Other Medical Conditions Pharmacy (Specify): Client restricted to us of a specific pharmacy?  Yes  No Medications (List all taken currently, e.g., HIV, TB, HCV, Psychotropics, etc.): Does the client have difficulty keeping appointments or problems taking medications?  Yes  No Are there debilitating symptoms requiring assistance (i.e., homecare, home delivered meals)?  Yes  No TOTAL MONTHLY HOUSEHOLD INCOME SOURCE & BENEFITS Employment HIV/AIDS Service Administration Social Security Short Term Disability SSI Survivor Benefits SSD Rent Supplement Child Support Veteran’s Assistance Public Assistance Pension Disability Ins. Inc. Long Term Disability Alimony Unemployment Insurance Workman’s Compensation Food Stamps Other: Total Personal Monthly Income: Additional monthly income from household members: Total monthly household income: Annual household income (for URS) : (Monthly income x12) MENTAL HEALTH Is client currently receiving mental health counseling?  Yes  No Clinician: Phone: Has client ever received mental health counseling?  Yes  No When For how long? Ever hospitalized for a psychiatric condition?  Yes  No Most recent date: Where? Reason: Does client mental health treatment include medications? Yes  No (if yes include on medication list – pg 5, Section F) Client’s assessment of mental health/emotional support needs: Comments: Does client have a need for mental health services?  Yes  No Does the client have difficulty keeping mental health appointments?  Yes  No  NA Does the client have difficulty taking psychotropic medication as prescribed?  Yes  No  NA DOMESTIC VIOLENCE Has the client ever been in an abusive relationship?  Yes  No – If yes, explain Does client feel safe in current living arrangement?  Yes  No – If no, explain: Does client ever feel that they or a family member/partner would resort to force when interacting?  Yes  No – If yes, explain: Does the client have needs related to current or recent domestic violence?  Yes  No  NA SUBSTANCE USE Does client have a history of drug/alcohol use?  Yes  No Is client currently using?  Yes  No If Yes, how long? days/weeks/months/years Drug(s) of choice: Frequency of use: Is client currently in SU treatment program?  Yes  No If Yes, how often? Per day/week/month/year Program Name: Contact Person: Phone: If not in treatment, is client interested in SU treatment, syringe exchange, other supports?  Yes  No Does client want assistance to quit smoking?  Yes  No OTHER NEEDS Does the client need assistance obtaining Nutritious food?  Yes  No Appropriate clothing?  Yes  No Transportation?  Yes  No Legal services?  Yes  No Education/training/employment?  Yes  No SUMMARY PAGE Summarize client status, presenting needs, and assessed needs. Elaborate on any questions in the shaded boxes indicating unmet needs. CASE DISPOSITION Client ID#: Client Name: Case management recommended?  Yes  No Model?  Supportive CM  Comprehensive CM (Explain recommended model to client) Case Management accepted?  Supportive CM  Comprehensive CM  Declined If not case management at agency, where referred? IMMEDIATE REFERRALS MADE: (include contact name) Hospital/Clinic: For: Agency: For: Agency: For: Internal: For: Internal: For: CM Consent form signed?  Yes  No Given copy of “Client Rights”?  Yes  No Intake/Assessment Completed by: Date: Reviewed by: Date:

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