Group Design: Patient Demographics and Screening Questions

Patient Demographics and Screening Questions
Doris Williams
August 18, 2016
Patient Information:
Name: Jane Doe
Age: 25
Home address: 3429 W 41st ST, Cleveland OH 44109
Presenting Issue: History in Cocaine, alcohol abuse and rehabilitation
Aim: Relapse prevention
Contact information: Janedoe@hotmail.com | 216 – 98756174
Screening questions (please answer the following, confidentiality will be assured):
1 What is your cultural background? What are the cultural traditions that you follow?
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2 What is your Socio-economic status? Any financial circumstances that I should be aware about?
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3 Kindly give a brief description of your hobbies, wants, and daily routine. How free is your schedule?
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4 What are your specific ideals or beliefs? Are there any beliefs or opinions that you are strongly opposed to?
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5 Do you think that you would be able to work well with a group with individuals from different age groups? Why or Why not?
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6 What other sessions and therapies are you taking aside from this? Briefly describe it below
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7 Do you have any specific needs or conditions that your future group needs to know? (disclosure of your answer with your group on this part depends on your preference)
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8 Are there any specific therapeutic sessions that you are opposed to? Are you open in group counseling sessions? What about individual counseling sessions? Why?
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9 Have you understood the ethical limitations of the counseling group? Do you have any comments or suggestions to it?
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10 Are you open to sharing any personal feelings or opinions with everyone in the group? Why or why not? Are there any specific circumstances that affect your answer?
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Descriptions of the screening questions chosen:
Criteria used during the selection process
In a counseling session, the group leader must be able to (1) fully understand and grasp the reality of every member of the group and (2) the group as a whole. But even before this, he must be able to create a group that is composed of individuals having varied backgrounds that would not disrupt the session, but would rather help make the most out of it. Thus, in order to realize this, I developed a set of screening questions that would help the group and the members realize their goals. The screening questions include (1) individual, cultural, psychological, emotional, and spiritual beliefs in their "everyday lives" or ...