Q1 Biopsychosocialspiritual
ariellev55
SOW5305-BPSSAssessment.docxBPSS Assessment
I. Biological Domain & Issue Presentation
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Prompt |
Client Details |
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1. Client’s name |
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2. Client’s age |
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3. Client’s pronouns |
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4. Client’s gender, sexual orientation, relationship status |
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5. Client’s race/ethnicity |
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6. Client’s living/housing arrangement |
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7. Client’s overall physical health |
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8. Brief, general description of client’s presentation |
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9. Other diversity factors, identities, beliefs, customs, and values that further support understanding of client and their needs |
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10. Additional information for this domain that may be helpful to further understand the case |
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11. Reason for client’s presentation for care/service/support |
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II. Psychological Domain
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Prompt |
Client Details |
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1. Orientation |
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2. History of mental health and/or social work-related support for mental or behavioral health care, and outcome of said care |
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3. Past or present mental health diagnosis/diagnoses |
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4. Past or present use of medications for mental health |
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5. Additional information for this domain that may be helpful to further understand the case |
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III. Socio-Cultural-Environmental Domain
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Prompt |
Client Details |
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1. Occupational status and workplace environment |
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2. Social support |
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3. Educational background |
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4. Legal history |
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5. Other protective factors |
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6. Other risk factors |
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7. Additional information for this domain that may be helpful to further understand the case |
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IV. Spiritual Domain
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Prompt |
Client Details |
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1. Spiritual identity of the client |
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2. Role of spirituality for the client/in the client’s life |
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V. Social Worker Impressions & Treatment Goals
Objective summation of the client and presenting issue
Insert text here (full sentences)
Goal 1 [*mandatory]
Insert text here (full sentences)
Goal 2 [*mandatory]
Insert text here (full sentences)
Goal 3 [optional; you may delete if you do not list a 3rd goal]
Insert text here (full sentences)
Rationale for treatment plan
Insert text here (full sentences); include in-text citation(s)
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Name of MSW student who completed assessment |
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Date assessment was written: |
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References
Refer to the assignment instructions in Canvas for more details.
Date template was last revised: 12/2023
