Transcript Social data report - Southeast Missouri State University

Social data report
Identifying information: name, DOB,
age, gender, address and phone of
parent or guardian
Physical description: height, weight,
handedness, eye and hair color, race
Social data
Presenting problem
Current offense or referral reason (date and
type, events)
Arresting officer or petitioner
Prior record
Functional analysis: onset, any
precipitating factors, frequency, severity
Maintenance factors
Social data
Methods used to deal with the problem
School data
Schools attended, current school, current
grade in school, failed any grades
Grades, attendance, behavior in school
(fights)
Involvement in school activities
Special ed: MR, LD, ADD, ADHD, ED
Family data
Father, stepfather, guardian (might have
more than one of these)
Address, phone number, occupation, age
Educational level, health, court record
Nature of relationship of youth to this
(these) person(s)
Physical or sexual abuse
Alcohol and drug use
Family
Mother, stepmother, guardian
Address, phone number occupation, age
Educational level, health, court record
Nature of relationship of youth to this
(these) person(s)
Physical or sexual abuse
Alcohol and drug use
Family data
Family income, status of welfare and other
Current living arrangement, marital status
If parents are separated or divorced, when
If father abandoned family, when
Nature of relationship between parents,
step-parents
Family data
 Children in family and/or stepfamily, ages,
whether they are living in the same home
 Birth order
 Discipline in home: by male, female, both,
neither
 Nature of discipline used
 Level of supervision
 Level of violence
 Running away from home
Socioeconomic environment
Number of people in the home
Number of rooms (number of bedrooms)
Type of area: high crime, low crime, rural
urban, isolated, slum, housing project
Modern conveniences
Housekeeping standards
Own home, rent, living with other relatives
or non-relatives
Physical history of youth
Current state of health, any physical
problems
Past problems (hospitalizations, diseases,
injuries: lead poisoning, head injuries)
Diagnoses, medications
Other health problems in parents, family
Pregnancy/birth difficulties
Psychiatric history
DSM-IV diagnoses
Inpatient, outpatient, medication
Psychiatric history of family members
Suicide attempts (number, nature, when)
Self-mutilation
Alcohol and drug use (amount, frequency,
duration, starting age)
History
History of residences
Vocational history: jobs, length, problems
with employers and employees
Sexually active (age)
Hetero/homosexual, children
Contraceptive knowledge/use
History
Number of acquaintances, friends
Close friends, boy friends, girl friends
Enjoy peer interactions?
Nature of interactions
Delinquent friends
Dating
History
Leisure/recreational activities
Organized activities
Hobbies
Special skills, talents
Religious affiliation, church attendance,
influence
Future plans
Further education
Jobs
Marriage and children
Description of self
Testing
Mental status exam
Appearance, attitude, behaviors
Speech (rate, production)
Appetite, sleep
Mood: anxiety, crying
Orientation: person, place time
Language
Name (use two common objects, such as
pencil, and a watch)
Repeat a phrase (no ifs, ands or buts)
3 stage command (take this paper in your
right hand, fold it in half and put in on the
floor)
Memory: digit span (average 7 digits)
Mental status
 Serial numbers
 Fund of general information (50 x 5, capital of
Missouri)
 Abstract reasoning: how are a cat and a mouse
alike, explain a proverb)
 Unusual experiences: obsessions, hallucinations,
compulsions, delusions, depersonalization
 Insight
Psychological tests
Intelligence test (Peabody Picture
Vocabulary Test (PPVT-R), Wais
Intelligence Scale for Children (WISC),
Stanford Binet—individualized. Also a
variety of group tests that vary in quality
Bender Visual Motor Gestalt Test (can look
at planning ability, impulsivity)
Psychological tests
Academic achievement test: some given
by schools, Metropolitan, SAT, etc.), Wide
Range Achievement Test (WRAT)
Personality test (MMPI, CPI)
Projective tests (Draw-a-person, the House
Tree Person, the Thematic Apperception
Test (TAT)