For this assignment, please use the vignette from this week’s discussion and complete the “Agency Assessment.” Josephine is a 45-year-old, female who has been admitted to the hospital after her husban
Client Name:
Client Agency Assessment
Initial Screening:
Presenting Problem and Duration of Problem:
Are there any events or circumstances that may have impacted or have contributed to this presenting problem?
Prior Mental Health Treatment?
Yes ___ No___
Past or Current Significant Medical Issues?
Yes ___ No___
DCFS Mandated?
Yes ___ No___
Court Ordered for Treatment?
Yes ___ No___
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For any Yes responses to the question above, please provide further information.
Describe the client’s current housing situation.
Self-Harm and Aggressive Behaviors
Are there current thoughts of self-harm/suicide?
Yes ___ No___
Have there been past thoughts of self-harm/suicide?
Yes ___ No___
Has client had prior suicide attempts?
Yes ___ No___
Does client have current thoughts of harming another person?
Yes ___ No___
Has there been a history of injuring another person?
Yes ___ No___
Have there been current or past incidents of injuring animals?
Yes ___ No___
Has client been accused of being a perpetrator of violence/abuse?
Yes ___ No___
For any Yes responses to the question above, please provide further information.
Trauma and Abuse
Has there been recent trauma and or abuse exposure?
Yes ___ No___
Has there been a recent death in the family?
Yes ___ No___
Has client been a past victim of violence/abuse/neglect?
Yes ___ No___
Additional comments/information:
Daily Functioning
Is client able to care for personal hygiene and grooming?
Yes ___ No___
Is client able to maintain appropriate work/school/household routines?
Yes ___ No___
Are client's current sleeping and eating routines satisfactory?
Yes ___ No___
For any No responses above please provide further information.
Drug & Alcohol Use
Does client use drugs or alcohol?
Yes ___ No___
Types of drugs used (highlight)
Alcohol Cocaine Heroin Inhalant Marijuana Meth
Polysubstance Use Prescription Medication Other
If other, please specify:
Briefly describe past or current substance use/abuse:
Additional comments/Information:
Psychosocial Information
Relevant family history, current living situation, social support, financial situation:
Client’s strengths/areas for growth, additional risk factors:
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