Case Conceptualization
Date: / / /
Date Admitted: / / / Target End Date: / / /
Youth Name: ____________________________Age: ______Gender: ( ) M / ( ) F Ethnicity________
Primary Diagnosis__________________________ Secondary Diagnosis_________________________
Please fill this out at the beginning of each case. As you get more information or clarifications, you can update the Case Conceptualization.
Family and Significant Others
In Home:
Outside of Home:
Relevant History/background of youth and parents and others (e.g., parental substance abuse, neglect and/or abuse of parent and/or child, immigration issues, etc)
Neighborhood/Community Strengths and Weaknesses
Parent Domain
1. Parent view of problem
2. What does parent want changed?
3. Parental stress and burden
4. Parental social support (who helps or can help parent?)
5. Parents attitude about drugs, delinquency, high-risk sex, and other behavior problems
6. What are the current parenting practices
6a. List competent parenting practices (e.g., Good Monitoring—good at following through with consequences).
6b. List parenting practices that are less than ideal
7. Parents hopes and dreams for self and family
8. Parental and individual functioning (parent as person, adult)
9. Conflict and agreement between parents (extent to which they do or do not work as a team)
10. Parent’s strengths (e.g., good job, family support, involvement with church, etc)
Adolescent Domain
1. Adolescent view of problem
2. What does adolescent want changed in parent, family, self?
3. Adolescent substance abuse: History and current patterns (age of first use, type of substance used, how often, etc. (This information should be obtained from youth, parents and others).
4. Peers (positive and negative influences) (This information should be obtained from youth, parents, and others).
5. Adolescent mental health problems (history, treatment history, diagnoses, medication, etc.) (This information should be gotten from youth, parent, and others).
6. Adolescent strengths
Family Domain
1. Family conflict, warmth, communication
2. Family rules and routines
3. Monitoring (How much do they try to monitor, How successful, Do they know where, when, with whom, etc?)
4. Limit setting and follow through with consequences (Do they do this? Assess success or lack thereof)
5. Family strengths (e.g., loving family, will do anything to help each other, etc.)
Extrafamilial Domain—Identify Potential Problem Areas as well as Strengths
1. School functioning
2. Legal issues
3. Recreational
4. Health
5. Financial
6. Other
