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Can you please help me with this assignment you will have to watch a video from this site http://cahomelessyouth.library.ca.gov/Videos/All_Videos/voices02.html
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Intake Form Assignment
This week, you will be completing an intake form for a client. In the Unit 3 Reading, you were introduced to the concept of an intake form on page 82 (Box 3.1). Completing an intake form is a very common practice for human services professionals, and, as you can imagine, is a task that takes effective listening skills. In this activity, you are going to have the opportunity to create an intake form for a client.
Please note that though you will be completing this Assignment in the course space, you have unlimited time to tackle the task, so you should not feel any more pressure than if you were to complete the form and submit it to the Dropbox. You can re-enter the Assignment and change your answers later if you need to as well.
The sample intake form in your text is different from what you will be completing in this task. Each agency or office has slightly different intake forms, but the general idea is the same. To familiarize yourself with the intake form you will be completing, click here to see a sample intake form. This form explains what information is required in each field. You can see from the very beginning that you will need to use your listening skills as well as observe nonverbal cues and pay attention to the client very closely.
Next, you can take a look at a completed intake form. In Discussion this week, you met Luz. To review her story, click here. Then take a look at Luz's completed intake form to see how her information is compiled. Feel free to use the sample intake form with the instructions for the fields as well as Luz's intake form to help you as you tackle your intake form activity. You may also want to have this blank intake form handy.
Intake Form Client
You have your choice of one of four clients to use for this Assignment. Go to the California Homeless Youth Project website, and watch the following four interviews:
Source: California Homeless Youth: Video Wall. Retrieved from http://cahomelessyouth.library.ca.gov/Videos/All_Videos/voices02.html.
Please keep in mind that some of the language used in the interviews is graphic, reflecting the harshness of the clients lives.
After you have watched all four videos, select one of the videos as your client for the intake form. Remember, the completed example intake form, Luz's intake form, and the information in Chapter 3 pg 81-83 will be your guide to successfully completing an assessment based on the client you select. You can watch the video as many times as you need to while you complete the form as well, so take your time. You may even want to note your client's information before you get started so that you will feel more prepared.
Kaplan University School of Arts and Sciences HN205 Applied Skills for Human Services Intake Form
Client: Luz Acosta Date: 10/30/12 COURSE # Presenting Problem:
Luz is a 75 year old widow who reports loneliness, alienation from her family, and no friends within
her community which is predominately Jewish while she is a Cuban American. Additionally, she
utilizes a wheelchair as her mobility is very limited.
How Client Presented in the Interview:
Luz presented as vacillating between tearful sadness and anger. She was very well dressed and had
outstanding grooming. It is not known if she dresses this way all of the time or because the human
service professional had an appointment with her. On one hand Luz seems very lonely but on the
other she pushes others away from her, finding fault with everyone.
Client’s Expressed Goals, Expectations, Requested Services:
Luz did not express any goals. She noted loneliness and seemed unhappy about this but resisted
outreach by others. Luz’s aides did not meet her expectations and she requested having a Cuban
girl to assist her rather than the aides she currently has. Additional Relevant Information:
Luz is alienated from her son and his wife, primarily as she notes because she feels her son has
married beneath him. She had a fight with a brother, and they have not spoken for several years.
She sums up the neighbors as liars and thieves even though some of them appear to be listed in her
phone book.
Luz is very meticulous about her appearance, so she has pride in self.
Impressions and Recommendations:
Luz appears to be a very lonely woman who perhaps has unresolved grief issues regarding the loss
of her husband. By pushing others away, Luz will not be hurt by any future loss.
Some recommendations include: grief counseling with Luz, assisting her with exploring a
reconnection with her family, exploring activities within the apartment community where she might
participate, connecting Luz with the Cuban-American community, obtaining Luz’s medical
information (only if Luz authorizes) as she may need a physical to see if there are any medical
conditions impacting her attitude and behavior.
Human Services Professional Signature: Jane A. Smith 1