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SCHOOL COUNSELING CASE CONCEPTUALIZATION FORM
A School Counseling Case Conceptualization Form is a structured tool used by school counselors to assess, plan, and evaluate interventions for students. This form typically includes sections that help gather comprehensive information about the student, identify problems, and plan appropriate interventions. Below is an example template for a School Counseling Case Conceptualization Form:
School Counseling Case Conceptualization Form
Student Information:
- Name:
- Age:
- Grade:
- Gender:
- Date of Referral:
- Referred By:
Background Information:
- Family Background:
- Parental status (e.g., married, divorced, single parent)
- Siblings (names, ages)
- Socioeconomic status
- Any relevant family history (mental health, substance abuse, etc.)
- Academic History:
- Previous schools attended
- Academic performance (grades, standardized test scores)
- Learning difficulties or disabilities
- Attendance record
- Behavioral History:
- Discipline record
- Social interactions with peers
- Teacher reports/comments
Presenting Problems:
- Description of the main issues or concerns:
- Academic
- Behavioral
- Social/emotional
- Duration and intensity of the problems
- Triggers or antecedents to the problems
- Student’s perspective on the issues
- Parents’ perspective on the issues
Assessment Data:
- Observations (classroom, playground, etc.)
- Standardized assessment results (if applicable)
- Teacher reports
- Student self-reports
- Parent reports
Strengths and Resources:
- Academic strengths
- Personal/social strengths
- Extracurricular activities
- Support systems (family, friends, mentors)
Formulation/Hypothesis:
- Potential underlying causes of the presenting problems (e.g., environmental stressors, developmental issues, learning disabilities, mental health concerns)
- Theories or models guiding the hypothesis (e.g., developmental, cognitive-behavioral, systemic)
Goals:
- Short-term goals (e.g., improve attendance, enhance social skills)
- Long-term goals (e.g., improve academic performance, resolve behavioral issues)
- Specific, measurable, achievable, relevant, time-bound (SMART) goals
Intervention Plan:
- Individual counseling sessions
- Group counseling sessions
- Classroom interventions
- Referrals to external resources (e.g., psychologists, social workers)
- Parent meetings and involvement
- Collaboration with teachers and staff
- Timeline for interventions
Evaluation and Follow-Up:
- Methods for monitoring progress (e.g., weekly check-ins, progress reports)
- Criteria for evaluating success
- Follow-up schedule (e.g., monthly reviews, end-of-term evaluation)
Counselor’s Notes:
- Additional observations or insights
- Adjustments to the intervention plan as needed
This template provides a comprehensive framework for understanding and addressing a student’s needs within the school environment. It can be customized based on specific cases and school policies.
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