Case Manager

Client Intake Report

Directions: Ask to interview a friend or family member to complete this assignment. Use two to three scholarly sources to complete this assignment. Be sure to include APA citations for all resources you incorporate.

Pre-Intake Information
Keep a record of the case manager, client/case number, and date of intake below.
• Case Manager-
• Client/Case Number-
• Date of Intake-
Part 1: Introduction to Client and Significant Others
Identify all relevant client and/or family members upon client intake and notate appropriate background on each individual family member, including:
• Age
• Ethnicity, Race, and Nationality
• Occupation (or grade in school)
• Socioeconomic Status (SES)
• Sexual Orientation
• Gender Identity
• Religion or Spirality
• Ability (mental or physical strengths and/or challenges)
• Medical or Behavior Health History (or previous treatment)
• Marital Status
Answer Here:

Part 2: Presenting Concerns
Describe what concerns the client and/or family members presents, including:
• Description of the problem
• Initial onset
• Frequency
• Intensity
• Duration of problem
• Potential triggers
• Consequences of problem
Answer Here:

Part 3: Background Information
Describe relevant trauma history of client and/or each family member, including:
• Precipitating Events (recent life changes, first symptoms, stressors, etc.)
• Related Historical Background (family history, related issues, previous counseling, medical/mental health history, etc.)
Answer Here:

Part 4: Strengths and Limitations of Client and Family
Analyze strengths and limitations of the client and/or each family member, including:
• Personal (i.e., organized, good listener, personable)
• Relational or Social (i.e., religious or group networks, individual or family friendships, extended family)
• Spiritual (i.e., connection with others, higher power, nature)
• Unique Resources (i.e., job status, cultural privileges, lack of social stressors)
• Limitations/Challenges (i.e., ability, immigration status, health issues)
Answer Here:

Part 5: Risk Assessment
Provide a risk assessment for the client and/or each family member, including:
• Suicidal (i.e., passive, plan, intent, or means)
o If yes, list the action taken to address the issue.
o If yes, did you create a safety plan?
• Homicidal (i.e., passive, plan, intent, or means)
o If yes, is a target identified?
o If so, who is it? What is their contact information? What is their relationship to the person?
o Is duty to warn applicable? If so, list the action taken to warn.
• Substance Use
o What substance or substances? Include the date of last use.
o How much and how often does the client and/or family member use?
o Any risky or aggressive behaviors while under the influence? If so, describe them.
• Domestic Violence (i.e., interpersonal violence, child or dependent adult neglect or abuse)
o If yes, who is the perpetrator? Who is the victim?
o What is the frequency and nature?
o If yes, what action was taken to address the issue?
Answer Here:

Part 6: Solution Attempted
Provide a list of attempted solutions, including:
• Attempted Solutions (solutions that did not work)
• Exceptions and Unique Outcomes (solutions that did work)
Answer Here:

Part 7: Treatment Goals
List three treatment goals and provide two objectives for each goal. Be sure all goals are directly related to behavioral health.
• Goal 1:
o Objective 1:
o Objective 2:
• Goal 2:
o Objective 1:
o Objective 2:
• Goal 3:
o Objective 1:
o Objective 2:
References:
Cite a minimum of two sources in APA format to complete this assignment. Sources must be:
• Published within the past 5 years.
• Appropriate for the assignment criteria.
• Relevant to behavioral health practices.
Answer Here:

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