Answers to Clinical Reasoning Questions Are Used to Guide Case Formulation and Intervention Planning
Presented below are clinical reasoning questions intended for use by practitioners, clinicians, and supervisors. These questions may be applied throughout a personís service process. Answers to these questions can help guide the clinical case formulation for a person receiving services as well as guide intervention planning, implementation, and completion of interventions. These questions work well in group supervision situations that involve case presentation and analysis.
- People Involved: Who are the people involved in supporting and serving this person? How well are they engaged, involved, and committed to helping this person get better, do better, and stay better?
- Expectations: What outcomes of intervention are people expecting to be achieved? The person? The family, life partner, and/or key supporters? The school or employer? The court? Service providers?
- Causes & Contributors of Presenting Problems: What bio-psycho-social factors, life circumstances, and underlying issues explain the personís presenting problem(s) and current unmet needs?
- Risk Factors: Based on history and tendencies, what things could go wrong in this personís life? What must be done to avoid or prevent future harm, pain, loss, or undue hardship?
- Functional Strengths & Assets: What are the personís functional strengths, aspirations for change, and life assets that can be built up to solve the problem(s) that brought the person into services?
- Critical Unmet Needs: What presently unmet needs would have to be fulfilled in order for this person to get better, do better, and stay better?
- Points of Consensus & Dispute: On what key matters, if any, do the people involved agree at this time? What other key matters, if any, may be in dispute at this time? What impact, if any, are unresolved disputes having on decision-making about needs, risks, outcomes, interventions or commitments to the change process?
- Necessary Changes: What things in the personís life would have to change in order for the person to achieve adequate well-being, have essential supports for living, function adequately in daily activities, and fulfill key life roles - as appropriate to life stage, capacities, and preferences?
- Essential Outcomes: What life conditions, when met, will indicate that the personís problem(s) is/are solved and critical needs are met (e.g., achieved adequate well-being, has essential supports for living, functions adequately in daily activities, and fulfills key life roles)?