Violence
(put here information from the Irritability question from the mental state examination)
Current Behaviours: Do you have a problem controlling your temper?
Current Opportunity: Do you have access to or carry weapons such as knives?
Support: Have you networks in place that would stop you becoming violent?
Past History: Have you ever been violent to anyone else? Have you been in trouble with the police in regards to violence?
Motivation & Commitment
Change? Do you think that you are ready to start making any changes in your life? Or are you ready to talk about making changes?
Commitment: Will other current life events cause you not to be able to focus on this treatment? Will you get support from family or friends?
Expectations & Goals
What do you expect to get out of this intervention? What would you like to be able to do in the near future that you can’t do now because of the issue in question?
Problems & Goals (optional)
Definition of problem:
I feel ______________ about ________________ and this leads me to _____________. I have stopped __________and have started ___________This has been a problem for ___months/years.
On the scale below please rate how much your problem upsets you and/or interferes with your normal activities:
0 1 2 3 4 5 6 7 8
does not slightly/ definitely/ severely/ extremely/
sometimes often very often continuously
Definition of Goal:
I would like to be able to _______________ under the following conditions / without _____________. I would like to do this for ___ mins/hours. A __% reduction in ________ would indicate success.
On the scale below please rate how difficult it would be if you had to achieve this goal now:
0 1 2 3 4 5 6 7 8
not at all slightly moderately very much extremely
Outcome
CONCLUSION
Thank the client for their time.
Check the client’s opinions about the decisions.
Check client’s agreement with further action plan (e.g. write to the GP/referrer, make further referral, make another appointment for continuing the assessment, set homework etc.)
Ask whether there is anything else the client wants to add or ask.
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