Adults/Parents: Select identifier/abbreviation for use in rest of case conceptualization.Based on the client’s social location—age, gender race, ethnicity, sexual orientation, gender identity, social class, religion, geographic region, language, family configuration, abilities, etc.–identify potential resources and challenges:

Adults/Parents: Select identifier/abbreviation for use in rest of case conceptualization.Based on the client’s social location—age, gender race, ethnicity, sexual orientation, gender identity, social class, religion, geographic region, language, family configuration, abilities, etc.–identify potential resources and challenges:

: Age:       Occupation:       Other:

: Age:       Occupation:       Other:

Children/Adult Children: Select identifier/abbreviation for use in rest of case conceptualization

: Age:      Grade: Other:

: Age:      Grade: Other:

: Age:      Grade: Other:

: Age:      Grade: Other:

Others: Identify all:

Presenting Concerns
Describe each significant person’s description of the problem:

:

:

:

:

Additional:

Broader System: Description of problem from extended family, referring party, school, legal system, etc.:

Extended Family:

Name:

Name:

Background Information
Trauma/Abuse History (recent and past):

Substance Use/Abuse (current and past; self, family of origin, significant others):

Precipitating Events (recent life changes, first symptoms, stressors, etc.):

Related Historical Background (family history, related issues, previous counseling, medical/mental health history, etc.):

Client/Family Strengths and Social Location
Strengths and Resources:

Personal:

Relational/Social:

Spiritual:

Based on the client’s social location—age, gender race, ethnicity, sexual orientation, gender identity, social class, religion, geographic region, language, family configuration, abilities, etc.–identify potential resources and challenges:

Unique Resources:

Potential Challenges:

Family Structure
Family Life Cycle Stage (Check all that apply):

|_| Single Adult

|_| Committed Couple

|_| Family with Young Children

|_| Family with Adolescent Children

|_| Divorce

|_| Blended Family

|_| Launching Children

|_| Later Life

Describe struggles with mastering developmental tasks in one or more of these stages:

Boundaries with/between:

Primary couple |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

& Children |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

& Children |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

Siblings |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

Extended Family |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

Friends/Peers/Others |_| Enmeshed |_| Clear |_| Disengaged |_| NA Example:

Triangles/Coalitions:

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The post Adults/Parents: Select identifier/abbreviation for use in rest of case conceptualization.Based on the client’s social location—age, gender race, ethnicity, sexual orientation, gender identity, social class, religion, geographic region, language, family configuration, abilities, etc.–identify potential resources and challenges: appeared first on My Nursing Papers.

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