Week 4: Documentation
For this week’s discussion, please discuss how you documents (eg: progress notes) and what is the procedure for tx goal. How do complete a progress note and how/when do you create/revise a tx plan, for instance?
Students are required to turn in a sample progress note from their site. Progress note needs to include client’s presenting problem, mental status exam, summary of session, client’s level of participation, direction of next session.
Here is an article on clinical progress notes, called SOAP notes. its very informative and will help structure your notes, for the ones that are looking for a little bit more guidance with their progress notes. Also, I attached several sample progress notes for you to review: individual therapy, group therapy, and family therapy.
Week 5: Treatment choice
For this week’s discussion, please talk about your treatment approach of choice and why. Provide us with a little background of your treatment approach. Also, what is your treatment selection strategy when working with clients.
Week 6: Biopsychosocial Report
For this week, please go ahead and take this time and work on your Biopsychosocial report (BPS and ask questions on the discussion board if you need to. In addition, please post a copy of your BPS to the discussion board. You will need to read at
least 2 other peers’ BPS and provide some comments in regards to their BPS.
February 6, 2019
The biopsychosocial report should consist of the following sections in report: presenting problem, history of problem, developmental/medical history, family history, educational/social history, special considerations, mental status and client’s strengths, clinical findings, diagnostic impressions, and tentative treatment recommendations.