B
Tuesday, September 10, 2019 11:52 AM
Examiner: Ummi Norliyana Binti Zainal
Supervisor:
Date:
Day:
Clinical diagnosis:
RN
Contact no.
Session:
Time
Reason for referral -
Preliminaries
1. Set up the room (seating arrangement, lighting, tidy room).
2. Introduce myself and clarify how we should address the client.
3. State purpose of the interview, check client’s understanding of the interview, and clarify anything.
- Tujuan sesi ini ialah untuk - (based on chief complain/referral letter)
4. Explain how the information derived from the interview will be used.
- To plan the appropriate intervention
5. Describe confidential nature of the information, limits to it and special issues (and rights to not disclose anything they do not want to
discuss). Must obtain a signed release of information if the information is sent to other people.
- Exception to
○ Suicidal thoughts
○ For treatment purposes
○ If there is adult/children abused
6. Explain the role and activities for both therapist and client, type of instruments used, and total length of time.
- Role
○ Client needs to corporate in the session. Because it will not work one-way. And we do not want client to be dependent on
therapist
○ Assessment
▪ Eg: WISC - to measure few areas such as
□ Verbal comprehension - to understand spoken language. To understand his/her world.
Example: instructions
In class, teacher teaches new concept
Expressive and receptive
□ Working memory - memory
Verbal and image
□ Processing speed
□ Perceptual reasoning
□ Full score -- show
○ Time: approximately 1.5 hours/ 2 hours.
▪ If client looks tired and cannot focus, can stop earlier
▪ Give break in between if it is needed
Questions for intake interview
Name
Age
Date of birth
Child Practicum Page 1
Date of birth
Gender
Birth order
Ethnicity
Religion
Educations level (history)
- How was he/she doing in school before
and after the accident (applicable for TBI
patients/ any brain injury)
- Any changes?
Mother's age
Mother's occupation
Father's age
Father's occupation
Chief complaint
Description of the problem
- What had happened?
- How it happened?
- Conscious/unconscious
- How long was her/his stay in the hospital
- Did he/she miss school? How long?
- What are the symptoms after the injury
○ Headache
○ Appetite
○ Sleeping pattern
○ Attention
○ Mood
○ Daily activities/routines
○ Senses okay?
- Medication?
○ Any side effects?
- What changes do you see after the accident ?
- Antecedent
- Consequences
• How do you feel about it?
• What do you think?
○ Is it appropriate to behave that way?
○ What are the causes of the problem?
• Family members? Colleagues? Teachers? Friends?
Onset,
- When
- What
- Why
1. Predispose - factors that make the person
vulnerable
2. Precipitate - stressors
3. Perpetuate
4. Protective
Intensity and duration
- Day/night
- What behavior does he/she exhibit
- Is there any changes in frequency
Child Practicum Page 2
- Is there any changes in frequency
○ What are the possible factors?
Attempts to solve the problem
- Previous treatment?
○ Traditional approach
○ Spiritual approach
○ Which hospital
▪ What have been done?
▪ Changes result from the treatment?
Current treatment
- Hospital?
- Understand what it means?
○ Psychoeducate
Background information
Birth history
- Full term
- Spontaneous/ induced/ caesarian/ assisted
- Birth weight
Family information
- Socioeconomic status
- Siblings
○ Their profession
○ Kids?
○ Relationship with patients
- Parents
○ Relationship with parents
Living skills (any changes before and after)
- Toilet
- Eating (hand/cutlery)
- Emotional regulation
○ What are the triggers
Adjustment to school/ workplace/ new place
- School routine
- Taking instructions
- Following rules
- Taking turns
- Requesting
- Attention span
- Communication
- friends
• Can ask, why do you think he/she behaves that way.
• Why he/she has difficulty
• Measures taken to help him/her
Academic achievement
- Academic history (before/after)
- Any difficulties?
○ Math
○ Reading
○ Foreign language
(which one is dominant)
- Favorite subject in school
Child Practicum Page 3
- Favorite subject in school
- Favorite activities/sports in school
○ Any changes before and after
- Favorite teachers
Hobbies/interest/
- When he/she normally do it? After school?
Involvement of parents in school
Developmental history
Physical
- Smiling
- Sitting
- Crawling
- Walking
Speech
- Babling
- First word
- 2 words sentences
- Receptive language at present
- Speech at present
Medical history
- Ear disease
- Eye problem
- Cerebral palsy
- Seizures
Hospitalized
- Meningitis
- Encephalitis
- Measles
- Others
Behavior observation
- Physical appearanc
- Mood
- Speech
- Physical disabilities
Child Practicum Page 4
