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VOLUME 3: BARRIERS (CHALLENGES)
As with Strengths, a variety of symptoms, impairments, or environmental obstacles are commonly addressed in a comprehensive Assessment. The Treatment Plan should list those Barriers that are likely to be directly interfere with a consumer's/client's efforts to accomplish particular treatment Goals and Objectives. With this in mind, the list of Barriers in a Treatment Plan may change from time to time as Goals or Objectives change.
CHAPTER 1: GENERAL STATEMENTS OF BARRIERS (CHALLENGES)
23 ITEMS, for example…
- consumer/client is challenged by _______ (specify) (Any/All)
- has difficulty using _______ (specify a strength or resource) to achieve_______ (specify) (Any/All)
- has difficulty using _______ (specify a strength or resource) to _______ (specify) (Any/All)
- gives misinformation to others about _______ (specify) (Social)
- is not aware of how _______ (specify a strength) could affect _______ (specify a goal) (Any/All)
CHAPTER 2: PHYSICAL HEALTH
50 ITEMS, for example…
- physical health barriers include _______ (specify) (Physical)
- does not see physical health as relevant to recovery (Physical)
- physical symptoms include _______ (specify) (Physical)
- has trouble losing weight when losing weight is desired (Emotional; Physical)
- does not do enough physical exercise, per recommendation from _______ (specify who recommended more exercise) (Physical)
- is easily fatigued (Emotional; Physical)
- uses non-sterile injection equipment (Physical)
- uses tobacco (Emotional, Physical)
CHAPTER 3: USE OF COMMUNITY RESOURCES
USE OF COMMUNITY RESOURCES: GENERAL
45 ITEMS, for example…
- does not see use of community resources as relevant to recovery (Social)
- doesn't usually turn to community resources for help (Social)
- has difficulty accepting help from _______ (specify) when offered due to suspiciousness of others (Social)
- has difficulty accepting help from family caregivers when offered (Social)
- doesn't actively participate in community resources to meet his/her need for ____ (specify) (Any/All)
- has problems in his/her relationships with staff at ___ (specify a community resource that is important to this individual) (Social)
- lack of community resources available in preferred language: _______(specify language) (Social)
- healthy food choices are of limited availability in consumer's/client's neighborhood (Social; Physical)
USE OF BEHAVIORAL HEALTH CARE SERVICES
26 ITEMS, for example…
- sees seeking help for emotional problems as being _______ (specify negative quality associated with help seeking) (Emotional; Intellectual)
- doesn't recognize how well his/her behavioral health condition has improved as a result of working closely with supportive others (Emotional; Intellectual)
- doesn't regularly work on his/her own chosen treatment plan goals and objectives (Emotional; Social)
USE OF HEALTH CARE SERVICES
20 ITEMS, for example…
- has not been able to find a medical provider whom he/she sees as trustworthy (Social, Physical)
- doesn't recognize how well he/she has followed challenging medical recommendations, and benefited from doing so (Emotional; Intellectual)
- often doesn't follow through on agreed to medical recommendations that he/she has accepted for managing his/her _______ (specify medical condition) (Physical; Social)
- does not go to the health care provider as often as recommended due to _______ (specify) (Emotional; Physical; Social)
- wants to be like ancestors who have "never gone to doctors" (Social, Physical)
RESOURCE AVAILABILITY
13 ITEMS, for example…
- needed _______ (specify type of resource) resources have limited capacity (Social)
- limited availability or accessibility of needed local resources in client's preferred language (Social)
- needed _______ (specify type of resource) resource is located in an unsafe neighborhood (for example, opposing gang territory) (Environmental, Social)
CHAPTER 4: SOCIAL RELATIONSHIPS
GENERAL SOCIAL RELATEDNESS
47 ITEMS, for example…
- does not enjoy recreational activities with others (Emotional; Social)
- doesn't participate in cultural community groups, even though he/she desires to do so (Social)
- feels very uncomfortable with people who are culturally different than himself/herself (Emotional; Social)
- tends to do things that frighten/annoy others (Social)
FAMILY RELATIONSHIPS
29 ITEMS, for example…
- family members do not approve of consumer's/client's use of behavioral health care services (Social)
- is drawn to other kids that are significantly older/younger than the consumer/client (Social)
- difficulty forming meaningful attachments with _______ (specify) (Emotional; Social)
- does not live with the preferred parent/caretaker (Social)
FRIENDSHIPS
13 ITEMS, for example…
- does not see friendships as relevant to recovery (Social)
- current friends have been unsupportive (Social)
COMMUNITY AFFAIRS PARTICIPATION
8 ITEMS, for example…
- interested in community, political, and/or school activities but hasn't gotten involved in any (Social)
- accepts responsibilities at community, political, or school tasks or projects but often doesn't follow through (Social)
CULTURAL COMMUNITY PARTICIPATION
18 ITEMS, for example…
- isn't aware of his/her cultural community's proud history (Intellectual)
- cannot find others who share his/her cultural identity (Social)
- has difficulty feeling like he/she fits in with the predominant culture of his/her local community (Emotional; Social)
FAITH COMMUNITY PARTICIPATION
15 ITEMS, for example…
- does not see participation in a faith community as relevant to recovery, despite having a religious orientation (Social)
- interested in faith community activities but hasn't gotten involved in any (Social)
- cannot find others who share his/her spiritual traditions (Social; Spiritual)
LEGAL
22 ITEMS, for example…
- difficulty obtaining needed restraining order (Social)
- difficulty complying with restraining order (Social)
- difficulty meeting requirements of Child Protective Services reunification plan (Social)
- is behind in making child support payments (Social)
PLAY AND RECREATION
13 ITEMS, for example…
- doesn't enjoy recreational activities because he/she lacks recreational skills (Emotional; Social)
- often ignores the rules during games and other recreational activities (Social)
RESIDENTIAL STABILITY
16 ITEMS, for example…
- has history of evictions (Environmental; Social)
- homeless due to _______ (specify) (Any/All)
- lives in a neighborhood where alcohol and drugs are readily available (Environmental, Social)
- faces foreclosure/eviction (Environmental; Financial; Social)
SUPPORT NETWORKS
14 ITEMS, for example…
- support network issues include _______ (specify) (Any/All)
- often doesn't let supportive friends and family know what his/her needs and wants are (Social)
- experiences prejudice/discrimination from others in current support network (Social)
VOCATIONAL/OCCUPATIONAL
56 ITEMS, for example…
- doesn't fully recognize abilities and strengths that are beneficial for work/school (Occupational)
- has fears about being able to work (Emotional; Occupational)
- service providers unsupportive of consumer's/client's vocational goals (Occupational; Social)
- often doesn't follow through after agreeing to _______ (specify) (Social)
- rejects support from supervisors at work, when offered (Social; Occupational)
CHAPTER 5: ACCULTURATION
LANGUAGE
14 ITEMS, for example…
- speaks a dialect uncommon in his/her local cultural community (Social)
- lacks a common language with some family members (Social)
- over relies on family's culture broker which inhibits learning English (Social, Emotional)
IDENTITY
19 ITEMS, for example…
- cultural identity issues include _______ (specify) (Any/All)
- feels shame about his/her cultural heritage (Emotional)
- distressed by conflicts between the variety of cultures with which he/she identifies (Emotional)
- feels "less than" Americans of other cultures (Social, Emotional)
- feels pressured to conform to a single sexual identity (Social, Emotional)
RITUAL
12 ITEMS, for example…
- unable to practice desired religious/spiritual rituals (Any/All)
- is not/has not been celebrated within a meaningful family group or support network (Social, Emotional)
CULTURAL STRESS
18 ITEMS, for example…
- expresses prejudice toward others of different cultural backgrounds (Social)
- feels uncomfortable being with others of different cultural backgrounds (Emotional; Social)
- has not yet developed coping skills for use when encountering "put downs" or humiliating remarks based on prejudice and/or stigma (Emotional; Intellectual)
- experienced severe trauma in the migration process (Social, Emotional)
CHAPTER 6: CAREGIVER ISSUES
PHYSICAL/BEHAVIORAL HEALTH
8 ITEMS, for example…
- caregiver has physical limitations including _______ (specify) (Social)
- caregiver has substance use issues including _______ (specify) (Social)
INVOLVEMENT
10 ITEMS, for example…
- caregiver is not the "culturally natural" (extended family, kin) caregiver (Social, Emotional)
- consumer/client feels that caregiver does not take him/her seriously (Emotional; Intellectual; Social)
KNOWLEDGE
6 ITEMS, for example…
- caregiver lacks knowledge of _______ (specify) (Social)
- caregiver has not yet become aware of relevant resources for support (Social)
SOCIAL RESOURCES
6 ITEMS, for example…
- caregiver has not yet become engaged with resources for social support (Social)
- caregiver has not yet contacted needed community resources (Social)
FAMILY STRESS
- family problems, including _______ (specify), create stress for the consumer/client (Social)
- family has problems related to involvement with Child Welfare Services (Social)
- family members are not willing to refrain from alcohol and drug use when the consumer/client is present (Social)
SAFETY
13 ITEMS, for example…
- consumer/client has been exposed to witnessing multiple intoxications of caregiver (Emotional; Social)
- consumer/client has been exposed to witnessing domestic violence (Emotional; Social)
- consumer/client feels that caregiver has failed to protect him/her (Emotional; Social)
CHAPTER 7: ISSUES RELATED TO DEVELOPMENTAL ASSETS
(An "Appendix" of "40 Developmental Assets"® will be available)
PART A
ISSUES RELATED TO EXTERNAL ASSETS
EARLY CHILDHOOD: EXTERNAL ASSETS AGE 3 - 5
29 ITEMS related to…
SUPPORT
EMPOWERMENT
BOUNDARIES & EXPECTATIONS
CONSTRUCTIVE USE OF TIME, for example…
- unable to access safe areas for play/recreation (Social; Emotional)
- tends to choose unsafe areas for play/recreation (Social; Emotional)
CHILDREN GRADES K - 3: EXTERNAL ASSETS AGES 5 - 9
27 ITEMS related to…
SUPPORT
EMPOWERMENT
BOUNDARIES AND EXPECTATIONS
CONSTRUCTIVE USE OF TIME
MIDDLE CHILDHOOD: EXTERNAL ASSETS AGES 8 - 12
27 ITEMS related to…
SUPPORT
EMPOWERMENT
BOUNDARIES AND EXPECTATIONS
CONSTRUCTIVE USE OF TIME
ADOLESCENCE: EXTERNAL ASSETS AGES 12 - 18
27 ITEMS related to…
SUPPORT
EMPOWERMENT
BOUNDARIES AND EXPECTATIONS
CONSTRUCTIVE USE OF TIME
PART B
ISSUES RELATED TO "INTERNAL ASSETS"
EARLY CHILDHOOD: STRENGTHS AGE 3 - 5
28 ITEMS relating to…
COMMITMENT TO LEARNING
POSITIVE VALUES
SOCIAL COMPETENCIES
POSITIVE IDENTITY
CHILDREN GRADES K - 3: STRENGTHS AGES 5 - 9
27 ITEMS relating to…
COMMITMENT TO LEARNING
POSITIVE VALUES
SOCIAL COMPETENCIES
POSITIVE IDENTITY
MIDDLE CHILDHOOD: STRENGTHS AGES 8 - 12
26 ITEMS relating to…
COMMITMENT TO LEARNING
POSITIVE VALUES
SOCIAL COMPETENCIES
POSITIVE IDENTITY
ADOLESCENCE: STRENGTHS AGES 12 - 18
27 ITEMS relating to…
COMMITMENT TO LEARNING
POSITIVE VALUES
SOCIAL COMPETENCIES
POSITIVE IDENTITY
CHAPTER 8: PSYCHOLOGICAL BARRIERS (CHALLENGES)
GENERAL STATEMENTS OF PSYCHOLOGICAL BARRIERS
6 ITEMS, for example…
- psychological barriers include _______(specify) (Any/All)
- doesn't recognize how _______ (specify) is relevant to recovery (Any/All)
BEHAVIOR, INTERACTIONS, AND ATTITUDE TOWARD SELF AND OTHERS
62 ITEMS, for example…
- has difficulty reading facial expressions when in conversation with others (insensitive to social cues) (Intellectual; Social)
- has difficulty recognizing when he/she is being tricked by others (naïve for developmental stage) (Intellectual; Social)
- doesn't notice how others are reacting to a situation, unlike other children his/her age (lack of social referencing) (Intellectual; Social)
- often bothers people in a sexual way (sexually intrusive) (Social)
- often insists that other people do things the way he/she wants them to, even when the other person feels bothered by this (demanding) (Social)
- scared to be away from his/her parents/caregivers much more than others his/her age (persisting separation anxiety) (Emotional; Social)
- tends to go against rules and directions from people who have a right to make rules and give directions such as parents, caregivers, teachers, police officers, supervisors (oppositional, defiant) (Social)
- consumer's/client's behavior conforms to local cultural norms but is misunderstood/misinterpreted by members of the client's own culture (Social; Emotional)
BEHAVIOR, PHYSICAL MOVEMENT AND POSTURE
20 ITEMS, for example…
- often feels tired with a low energy level (lethargy) (Emotional; Physical)
- often fidgets, squirms, moves around a lot, and/or feels very restless (hyperactivity) (Emotional; Physical)
- moves very slowly (psychomotor retardation) (Physical)
- rocks or soothes self in a problematic way, as evidenced by _______ (specify) (Physical)
CHILD AND YOUTH ISSUES: GENERAL
47 ITEMS, for example…
- acts very familiar with strangers (diffuse attachments) (Social)
- doesn't feel connected to his/her mother/father or to the person who takes care of him/her (detached) (Emotional; Social)
- doesn't have a "give and take" when in the presence of others (lacks social reciprocity) (Social)
- has difficulty learning as well as he/she should, considering how intelligent he/she is (learning disorder) (Intellectual)
- scared to be away from his/her parents/caregivers much more than others his/her age (persisting separation anxiety) (Emotional; Social)
- uses many words that only he/she knows the meaning of (idiosyncratic language) (Any/All)
- does not have friends in culture of identity (Social)
CHILD AND YOUTH ISSUES: WHAT CHILDREN AND YOUTH
ACCOMPLISH AS THEY GROW (DEVELOPMENTAL)
80 ITEMS, for example…
Early Childhood
- delayed development of being able to control himself/herself, as compared to other children of this age (Emotional)
- doesn't relate to other people in a way that responds to what the other person is saying or doing (social reciprocity) (Social)
- has problems with self-control (Emotional)
Middle Childhood
- has delayed development of the ability to see things from another person's perspective (limited empathy) (Social)
- doesn't get along with others of his/her age (Social)
- doesn't get along with others of his/her age in groups (Social)
- lacks confidence in his/her ability to learn and become more effective, as compared to others his/her age (sense of inferiority) (Emotional)
Adolescence/Transitional Youth (TAY)
- has difficulty with major decisions regarding alienation, assimilation or biculturalism in relation to the mainstream culture, more so than other teens with a cultural identity (Emotional; Social)
- easily yields personal convictions to group pressure, even more so than other teens (Social)
- sees his/her family as unavailable or unsupportive, even more so than other teens (Emotional; Social)
- is bullied by peers due to _______ (specify) (Any/All)
- has difficulty balancing respectfulness and assertiveness (Social; Emotional)
DELUSIONS, HALLUCINATIONS AND OTHER RELATED PROBLEMS (PSYCHOSIS)
26 ITEMS, for example…
- doesn't recognize how serious symptoms are relevant to recovery (Emotional)
- doesn't say many words when speaking with another person (poverty of speech; alogia) (Any/All)
- firmly believes that another other person is treating him/her unfairly or trying to harm him/her, even after being shown proof that it's not true (paranoid delusion) (Intellectual)
- is only able to say a few one line sentences (Any/All)
- has difficulty putting words together to make sentences that others can understand (word salad; incoherence) (Any/All)
- has many things to say, but other people aren't able to figure out what it means (poverty of content) (Any/All)
- sees things that other people can't see when the thing isn't there (visual hallucinations) (Any/All)
EATING
14 ITEMS, for example…
- is preoccupied with body size (Emotional; Physical)
- hoards food due to _______(specify) (Any/All)
- limited food options in consumer's/client's local community contributes to poor food choices (Social, Physical)
FEELING BESIDE YOURSELF (DISSOCIATION)
7 ITEMS, for example…
- forgets important personal events from the past, even though his/her memory is good (dissociative amnesia) (Emotional)
- repeatedly feels as if he/she is in a dream or feels apart from himself/herself (depersonalization) (Emotional)
FEELING CALM AND STEADY (SELF-REGULATION)
18 ITEMS, for example…
- has trouble controlling his/her urges (impulse control undercontrolled; poor impulse control) (Emotional)
- has trouble letting go and having fun because it seems dangerous, even when it's actually safe (impulse control overcontrolled) (Emotional)
- is always on guard or excessively cautious (hypervigilance) (Emotional)
- has sudden strong bursts of anger, almost like an explosion of anger (explosive anger) (Emotional)
FEELING PHYSICALLY ILL WHEN YOU'RE NOT ILL (SOMATOFORM ISSUES)
7 ITEMS, for example…
- has physical symptoms such as _______ (specify) even though there is no medical condition causing the problem (somatization) (Emotional)
- worries a lot about his/her health, even when he/she is healthy (hypochondriasis) (Emotional)
HEARING AND SEEING WHAT'S HAPPENING (PERCEPTION)
14 ITEMS, for example…
- avoids clearly noticing things that are happening around him/her (psychic numbing) (Emotional)
- sees or hears things that aren't there, and these things don't go along with his/her mood (mood incongruent hallucinations) (Any/All)
HOW YOU EXPRESS EMOTIONS (AFFECTIVE EXPRESSION)
14 ITEMS, for example…
- has difficulty expressing feelings of _______ (Emotional; Social)
- emotions don't fit what he/she is thinking about (inappropriate affect) (Emotional)
- has intense anger that scares other people (explosive anger) (Emotions; Social)
- does not differentiate how his/her emotional expressions are experienced by other cultural groups as compared to his/her own cultural group (Emotional; Intellectual; Social)
KNOWING WHAT IT MEANS TO BE WHO YOU ARE (SENSE OF SELF)
17 ITEMS, for example…
- easily backs down from his/her convictions and beliefs (Emotional)
- feels confused about "what it means to be me" (identity disturbance) (Emotional; Intellectual)
- often unaware of how he/she feels or thinks about an issue (limited self-awareness) (Emotional; Intellectual)
KNOWING WHAT'S HAPPENING (ORIENTATION)
6 ITEMS, for example…
- doesn't know who previously familiar people are (disoriented to person) (Any/All)
KNOWING WHEN YOU HAVE PROBLEMS (INSIGHT)
8 ITEMS, for example…
- not aware of having problems that a lot of other people have noticed (lacks insight) (Any/All)
- does not acknowledge impact of _______ (specify a thought, feeling or behavior that has an important impact) on his/her life (Any/All)
MOOD
23 ITEMS, for example…
- doesn't experience interest or pleasure in things, even things that used to be interesting or pleasurable (anhedonia) (Emotional)
- feels worried about the future most of the time (anxious mood) (Emotional)
- often feels exceptionally joyful throughout most of the day, even when presented with problems, risks or bad news (euphoric mood) (Emotional)
NERVOUSNESS (ANXIETY)
31 ITEMS, for example…
- does certain things over and over again, even though it doesn't make sense to him/her to do so, because it helps him/her feel less nervous (compulsions) (Emotional)
- feels as if a very frightening event from the past was happening all over again (reexperiencing) (Emotional)
- has sudden episodes of intense nervousness with a lot of physical symptoms like rapid heartbeat, heart pounding, dry mouth, or trembling (panic attacks) (Emotional; Physical)
RESILIENCE
16 ITEMS, for example…
- difficulty resisting dangerous social/peer pressures and influences (Emotional; Social)
- gives up easily in trying to accomplish a goal when confronted with barriers (poor frustration tolerance) (Emotional; Occupational)
- does not yet gain strength from participating in _______ (specify culture) social or recreational groups (Social)
SELF-CONTROL (IMPULSE CONTROL)
17 ITEMS, for example…
- difficulty resisting impulses to _______ (specify) (Emotional)
- keeps doing things that feel good at the moment but are very likely to lead to serious problems (poor impulse control) (Emotional; Financial; Social)
- has trouble letting go and having fun because it seems dangerous, even when it's actually safe (impulse control overcontrolled) (Emotional)
- uses physically risky behavior in order to soothe distress resulting from _______ (specify an experience of distress) (Emotional; Physical)
SEXUALITY
18 ITEMS, for example…
- has difficulty having gratifying sexual experiences (sexual dysfunction) (Emotional; Physical; Social)
- engages in high risk sexual behavior (Emotional; Physical; Social)
- has difficulty with major decisions regarding how to deal with his/her sexual orientation, more so than others (Emotional; Social)
SLEEP
15 ITEMS, for example…
- doesn't recognize how sleep is relevant to recovery (Emotional; Physical)
- breathing problems interfere with sleep (Physical)
- wakes in the night feeling very frightened and unable to remember what woke him/her (sleep terror) (Emotional)
THINKING: HOW YOU PUT THOUGHTS TOGETHER (COGNITION: THOUGHT PROCESS)
22 ITEMS, for example…
- has difficulty doing tasks that involve planning or organizing, like following a recipe (executive functioning impaired) (Any/All)
- has difficulty saying words, even when he/she knows what he/she wants to say (aphasia) (Any/All)
- not fully awake or alert much of the time (clouded consciousness) (Any/All)
- has trouble paying attention when necessary (distractible) (Any/All)
THINKING: WHAT YOU THINK ABOUT
(COGNITION: THOUGHT CONTENT)
30 ITEMS, for example…
- firmly believes that another person is thinking about him/her or doing things in relation to him/her, even after being shown proof that it's not true (delusion of reference) (Intellectual; Social)
- often doesn't realize the impact of his/her actions on others (Intellectual; Social)
- tends to think that things won't work out (pessimistic attitudes) (Emotional; Spiritual)
- thinks about killing another person with a specific idea of how it will happen (elaborated homicidal ideation) (Any/All)
- thinks in a general way about killing himself/herself (nonelaborated suicidal ideation) (Any/All)
CHAPTER 9: SKILLS
ACTIVITIES OF DAILY LIVING SKILLS
18 ITEMS, for example…
- has limited food preparation skills (Environmental; Physical)
- has limited money management skills (Financial)
- often doesn't follow through with _______ (specify) (Any/All)
- often doesn't follow through with accepted prescribed medications that he/she has chosen to take (Any/All)
- often doesn't follow through with treatment recommendations that he/she has accepted (Social)
COMMUNICATION SKILLS
17 ITEMS, for example…
- has difficulty accepting feedback (Social)
- doesn't make requests clearly (Social)
- has limited negotiation skills (Social)
- lacks experience communicating with people of the _______ (specify) culture (Social)
EDUCATION RELATED PERSONAL SKILLS
22 ITEMS, for example…
- acts inappropriately at school, according to teachers or classmates (Occupational)
- has limited ability to organize learning tasks (Occupational)
- has difficulty accepting critical feedback (Emotional; Social)
- sees it as disrespectful to speak up in class (Emotional; Occupational; Social)
JOB RELATED PERSONAL SKILLS
23 ITEMS, for example…
- job related personal skills issues include _______ (specify) (Any/All)
- doesn't recognize how job related personal skills are relevant to recovery (Occupational)
- has limited understanding of productivity and quality on the job (Occupational)
PARENTING/CAREGIVING SKILLS
34 ITEMS, for example…
- parent/caregiver has limited listening skills with child/youth (Social)
- parent/caregiver is authoritarian in relation to child/youth (Social)
- parent/caregiver models _______ (specify a problematic behavior) (Social)
- parent/caregiver lacks knowledge about child-rearing expectations in the host culture (Intellectual; Social)
- parent/caregiver lacks knowledge about child-rearing expectations in the local community (Intellectual; Social)
PROBLEM SOLVING SKILLS
21 ITEMS, for example…
- has difficulty setting priorities (Intellectual; Occupational)
- has difficulty with goal and objective setting (Intellectual; Occupational)
- limited skills for coping with ______ (a problem, for example, frustration, criticism, rejection, etc.) (Any/All)
SOCIAL SKILLS
28 ITEMS, for example…
- has difficulty making clear requests of others (Emotional; Social)
- doesn't show common courtesies in social situations (Social)
- has limited sense of when to disclose and withhold personal information (Social)
TALENTS AND INTERESTS
11 ITEMS, for example…
- creative/artistic skill in _______ (specify) (Any/All)
- not yet skilled at ______ (specify an area of talent or interest relevant to your goals) (Any/All)
CHAPTER 10: CLINICAL RISK
RISK: GENERAL
13 ITEMS, for example…
- engages in high risk behavior (Physical)
- rejects help to control/manage risk when offered (Social; Physical)
HARM TO OTHERS, VERBAL AND/OR PHYSICAL
25 ITEMS, for example…
- has history of repeated aggressive behaviors that resulted in harm/injury to others (Social)
- doesn't have a sense of guilt with desire for restitution for prior behavior involving verbal and/or physical harm to others (Emotional; Social)
- has weapon(s) and doesn't agree to turn it over to others (Any/All)
- does not yet understand negative impact of prior verbal and/or physical harm to victim (Emotional; Intellectual; Social)
RELAPSE RISK
12 ITEMS, for example…
- continues to get together with "using buddies" (Social)
- lack of support due to _______ (specify) (Any/All)
SELF-HARM RISK
26 ITEMS, for example…
- doesn't share thoughts about harming self with supportive and trusted others (Social)
- repetitive physical harmful behavior which serves as self-soothing functioning (mutilates/cuts/burns) (Emotional; Physical)
- not yet aware of harm reduction strategies (Intellectual)
- aware of, but does not use harm reduction strategies (Any/All)
SUICIDE RISK
23 ITEMS, for example…
- has history of suicide by significant others (Social)
- has engaged in suicidal behavior such as _______ (specify) during last _______ (specify timeframe) (Physical)
- has command hallucinations to hurt self (Any/All)
VICTIMIZATION
10 ITEMS, for example…
- doesn't turn to his/her support system when threatened (Social)
- easily provoked to escalate arguments (Social)
- tends to see self, not others, as responsible for their hurtful behavior (Emotional; Social)
CHAPTER 11: SUBSTANCE USE
CHEMICALLY CAUSED SYMPTOMS (SUBSTANCE INDUCED SYMPTOMS)
4 ITEMS, for example…
- substances cause _______ (specify mental health symptom) (Any/All)
SUBSTANCE USE/ABUSE/DEPENDENCE
56 ITEMS, for example…
- doesn't recognize how substance use is relevant to recovery (Emotional; Physical)
- uses _______ (specify substance) (Any/All)
- abuses _______ (specify substance) (Any/All)
- dependent on _______ (specify substance) (Any/All)
- unsafely stores prescribed substance abuse treatment medications (Emotional; Social)
- unsafely stores prescribed medications (Emotional; Social)
- diverts or sells prescribed medications (Emotional; Social)
- relies on substance use to _______ (specify what substance are used to accomplish, for example, to get tasks done, work longer, have sex longer) (Any/All)
- continues to use _______ (specify substance) despite having a physical health condition which is caused or made worse because of substance use (Physical)
RELAPSE RISK
9 ITEMS, for example…
- issues related to relapse risk include _______ (specify) (Any/All)
- doesn't recognize how relapse risk is relevant to recovery (Emotional; Intellectual)
- does not yet have techniques to prevent drug/alcohol relapse (Emotional; Intellectual)
- continues to get together with "using buddies" (Social)
- doesn't participate in any recovery support group (Social)
- isn't familiar with early warning signs of relapse (Intellectual)
- isn't familiar with relapse triggers (Intellectual)
- has limited alcohol/drug relapse prevention skills (Any/All)
- has limited coping techniques for dealing with early warning signs of relapse (Any/All)
- has limited coping techniques for dealing with relapse triggers (Any/All)
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