1. Client Identifying Information: Date of the interview, name, (need
to make up a name), address, age gender ethnicity, religion, marital status
and history, referral source, etc.. Caution: Remember confidentiality do
not use the person'sreal name and disguise any other identifying information.
2.Source of the Data: Include the indivuidal(s) who provided
3.Description and developent of the presenting problem. Include the
reason for the interview. Also make sure that you write it from the client's
perspective Ms. Jones states etc.
4. Family History: Include chronological history of the family and
brief descriptive information about family members. Include three
generations of family, including the client's own generation.
5. Client History:Include chronological developmental history including
all major events from prenatal to present. Include information on : medical
and psychiatric history intellectual and emotional functioning homeand
neighborhood environment, drug and alcohol usage including assessment of
addiction risk or history, relationship, intimacy and sexuality issues,
history of violence, legal issues, religion, recreation.
6. Current Situation:Including physical functioning and health practices,
current significant relationships, support systems, problem-solving
capacity, financial situation, housing and transportation issues, use of
community services Draw and complete an eco-map.
7. Assessment: This will be your analysis of the client on the
following levels: individual interpersonal relations, the family unit and
the family's interchange with the social network and other environmentalor
8. Strengths: What are the client's strengths? Think of how the
personhas coped to date withthe problem. Do they have
social, intellectual ,physical, emotional resources? 9. Problem List: What
are theproblems which you and the client feel are relevant? Consider physical,
spiritual, emotional, relational, educational, job related family and others.
10.Course of Treatment: Describe how you expect the treatment to go?
How do you best suggest that the problems are handled, How long might
it take to resolve the problems? What resistance from the client
do you foresee? Why?
This assignment will need to be typed, double-spaced. Suggested
length is 6-10 pages. The assignment will be graded on the following criteria:
1. Organization and Format: The assessment should be well
organized for readability. Topic/section headings are required
2. Thoroughness: All time periods should be included, if information
is unknown or is unavailable, the assessment should indicate this. At the
same time,unnecessary information should not be included. Completion of
3. Objective wording: Differentiation of facts from impressions and/or
4. Relevance of information: usefulness for social work 5. APA and
writing styles. The assessment should be written in a narrative form (no
chekc list or fill in the blank. Writing should be precise in presenting
descriptive information, grammatically correct, and professionally written.