This is the intake used at Pathways Human Services of Florida, generally just known as “Pathways. ” This is the company with whom I am doing my work variance internship. I wanted to complete the intake critique at my internship because their intake packet could use a great deal of improvement. Also, because I work for this company beyond my internship, I have a vested interest in helping them improve their documentation. This intake is separated into two packets. The document that includes questions pertaining to a client’s symptoms and history is an electronic document.
The documents pertaining to privacy, general information, and different consent forms are all paper. The fact that this intake is half electronic and half on paper is something that clinicians at Pathways have always been displeased with. No one is sure why there is this separation, however I have attached the scanned documents at the bottom of the electronic portion of the intake. Does it ask all of the necessary questions to determine the client’s presenting problem? The intake packet does begin by asking for the reason that the client has been referred.
The client and his or her family can then discuss who referred them to Pathways, and why they were referred (Pathways Human Services of Florida, 2014). There are also sections that ask the client to discuss his or her thoughts on the problems and symptoms that brought him or her to the point of needing treatment (Pathways Human Services of Florida, 2014). After, the client has the opportunity to speak, the family is allowed to weigh in and explain their perspectives regarding the client’s issues and how they believe it is affecting how their family is functioning (Pathways Human Services of Florida, 2014).
The client and his or her family is also asked to discuss the settings in which problem behaviors occur, as well as how long these behaviors have been an issue (Pathways Human Services of Florida, 2014). This question would help the clinician determine if anything had been left out by the family or client, and will also help them assess issues that may be under the surface. Are there too many or too few questions? Why or why not? There are a lot of questions in the intake packet including all of the forms that the client is required to approve and sign.
The clients are asked questions regarding their behavior, history, medications, hospitalizations, substance abuse, etc. (Pathways Human Services of Florida, 2014). While there are a lot of questions, I feel it would be difficult to eliminate any of these. These questions are necessary because it is important to gather as much information as possible before treatment begins. Nevertheless, it might be advisable to move some of these questions to the assessment, which is scheduled after the intake. Are the questions reading level appropriate for the clients?
This company expects clinicians to fill out the intake packet for the client and his or her family, with the exception of their signatures. The company asks that the clinician complete the intake because the program targets children and youth, many of whom would not have the ability or attention span to fill out the documents. The parents are discouraged from filling out the forms because this leaves room for bias, in that they may be overly positive or negative. Because the clinician must fill out the intake packet, he or she can explain each question in a way that is age-appropriate for the client’s level of understanding.
If the clinician were not expected to complete the documentation, this would not be age-appropriate for the company’s clientele. Are the intake forms available in the language appropriate for the population the agency serves? If all of Pathway’s clients spoke fluent English, then the forms would be appropriate. However, there have been clients who were fluent in Spanish, and only spoke a minimal amount of English. In such cases, a Spanish-speaking clinician has helped these clients and their families through the documentation process, but the packet itself has not been translated into Spanish, or any other language.
Because this company does have Spanish-speaking clients, it would be appropriate and advisable to translate the documentation into Spanish. Is there enough space to write what is needed in each answer space? Another common complaint among the clinicians at this company, is that there is not enough space to fully explain certain answers. While the portion of the intake packet that requires explaining is electronic, the formatting is easily agitated and cannot be altered.
Therefore, if a clinician would like to document an answer more fully, he or she is forced to print out the intake and write in the margins. Should the intake be re-formatted so it is easier to read? This intake must be re-formatted for many different reasons. It can be difficult to read because the format is often hard to follow. Also, as previously mentioned, the formatting can become a mess if one attempts to add more information, remove something that may not be necessary, or make any other alteration to the format.
Clinicians become very agitated when they are required to spend valuable time attempting to fix this formatting during an intake. Overall, the document needs to be properly aligned, the headings should be cohesive and obvious, the punctuation should not be so sporadic, bolded font should not simply appear in random places, check boxes and signature lines should be appropriately placed, and the spacing should be logical. If these issues were resolved, the intake packet would be much easier to read. What would you include or remove?
First, I would add more sensitive language into the intake. Words like “problem” and “issue” are used a great deal, and can set a more negative tone (Pathways Human Services of Florida, 2014). Therefore, I would replace these words with a different word like “need. ” I would also re-work phrases like, “triggers/factors contributing to problem behaviors/symptoms” (Pathways Human Services of Florida, 2014).
While it is important to ascertain what may trigger a client, I believe a more positive approach would be, “What kinds of situations cause the client to become upset or feel triggered? Simple changes like these could make the intake feel less threatening. Beyond this, I would make an effort to revise this intake in light of a more strengths-based approach. I would want the client and his or her family to begin the intake by discussing what they do well and what the client’s strengths are. This gives the clinician the opportunity to validate and highlight what the family is doing well, rather than focusing solely on what is being done poorly. Moreover, beginning with this line of questioning would likely ease some of the tension and set a more relaxed a positive tone.
I would also add more questions regarding the client and family’s natural support systems. I would want the client and his or her family to begin understanding the importance of these supports from the very beginning, because treatment is only temporary. This would also help the clinician identify gaps in a client’s support system. Understanding where a client may lack support gives the clinician the ability to begin formulating a plan, with the client, as to how new support systems could be developed. Would you change the order/re-organize?
As previously stated, I would start the intake with more positive questions in an attempt to facilitate a more relaxed environment. Beyond this, I would reorganize the intake by merging all of the documentation in to one document. I would do this by making the whole intake packet electronic, rather than half paper and half electronic. These documents would still have to be printed out, but it would be much more practical to have one intake packet rather than two. Also, because the program is community-based, having digital versions of these files is often a much more convenient option for clinicians.