The Write Stuff: Intake Notes, Progress Notes, and Group Notes

The Write Stuff: Intake Notes, Progress Notes, and Group Notes

October 21, 2016

Agenda

Session I: Intake Notes and Progress Notes

? Review intake notes ? Progress notes ? Progress note practice activities

Session II: Progress Notes and Group Notes

? Additional practice with progress notes ? Progress note challenge! ? Group progress notes

Intake Note

Intake sets the stage for all future documentation.

Almost everything you need to write in an intake note is already completed in eCOMPAS during the assessment.

Include information to make it all flow together as a narrative.

Intake Notes: What goes in?

Gen Tab: Where they heard about the FRC

? Initial reason for coming in

History Tab:

? Parent: history of mental illness and/or substance abuse

? Youth: MH diagnosis, History of Sub. Ab, number of times youth...(Psych ER, arrest, suspension, etc.)

Intake Notes: What goes in?

Goals:

? Strengths ? Needs ? Goal, action plans, and date of anticipated

completion

Assessment:

? FES score and notable outcomes (positive and room for growth)

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