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Social History Report Template SOWK 321

This social history report is based on Ms. Washburn and the weekly activities that you’ve completed.

This report should be Double-spaced with 1-inch margins, and up to four pages (no more than five). Provide the information in each area identified below, including:

• The questions you would use to gather information from the client.

• A paragraph with the client’s specific and necessary information.

• Guidelines for good reports should be followed.

• At least ONE assessment tool for a section of the social history: the ecomap (for social environment), the culturagram (for cultural environment), OR the genogram (for family).

SOCIAL HISTORY

SOCIAL WORKER INFORMATION

1. What theory did you choose to guide your questions for the client? Why did you choose that theory?

2. What primary social work values guide your work with the client?

3. How will you engage the client in the engagement and assessment stages?

4. Provide a statement to the client as to the need for the social history and why you’re asking him/her/them to share information.

Client name

Birthdate

Contact information

Phone

Address

Social History Report Template SOWK 321

Living situation

social environment

Cultural environment (consider how the client defines culture, which may include ethnicity, country of origin, gender, and others) Religion/spirituality Childhood Family Financial circumstances educational history