SAMPLE - Progress Report Template SLF training

Sample Reports

Progress ReportSLF Training

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Progress Report (Post-session #4)

From: (Add your name and title)

Arete Human Resources

Suite 210, 8180 Macleod Trail S

Calgary, AB, T1H 2B8

Telephone: 1-888-255-5196 ext

Fax: 1-403-252-6161

AUTOPOPULATED

CLAIMANT Mr John Doe D.O.B. March 2, 1960

CONTROL # 12345-00678-00 POLICY # 12345

ADDRESS 1001 Nowhere St. PHONE 987-654-3210

D.O.D. December 10, 2012 C.O.D. March 10, 2015

EMPLOYER Canada Post ACM Ms Smith

phone 123-456-7890

DIAGNOSIS

depressive episode OCCUPATION letter carrier

DATE of

4th

SESSION

March 21, 2013 REFERRAL

DATE

February 12, 2013

REPORT

DATE

March 22, 2013

Arete Client Code: 12345 Professional ID: abcd

Therapists Estimate of RTW start date

within the next 4 weeks (M/D/Y) (if

changed since initial report, please provide

explanation)

April 20, 2013. Client had a few setbacks

that caused relapse, these have been

addressed. Conflict will be discussed with

employer and case manager on April 10,

2013 Therapists Estimate of Client’s

probability of successful RTW within

next 4 sessions (%): ( if changed since

initial report, please provide explanation)

90%

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Resolved Barriers since Initial report

Barrier mentioned in

initial report

Comments/Explanation (if needed)

1) poor daily rhythm

client is able to get up at 9 am every day and intends to move this

up with 30 minutes per week, client eats three healthy meals per

day and goes to bed at 11 pm, client has a more or less regular

daily rhythm with walks and household chores

2) poor self-care

client gets dressed every day and takes a shower every other day

3) poor physical

stamina

client is consistent in following the exercise program and has

improved physical stamina

Ongoing Barriers to RTW (defined by therapist and discussed with client)

Summary of

current ongoing

barriers (may

include symptoms,

life circumstance,

workplace issues,

addiction history

or any other

influencing

factors)

Impact

Severity

(1)Mild

(2)Moderate

(3)Severe &

Serious

Observations of

impact on RTW/

Solutions

Current treatment plan

1) sleeping problem

still existing barrier

moderate client would still

not be able to get

up and start

working at 6 am,

but is improving

regular daily rhythm helps

further restore sleeping pattern

and focus

2) conflict at work


severe conflict needs to

be discussed at

work prior to RTW

meeting is scheduled on April

10, 2013

3) poor support

network


mind client expects to

return to work and

find support

network there

client could not think of any

activity to restore his support

network, other than finding

contacts at work

4) financial problems

new barrier

moderate client worries that

he is not able to

pay child support

and ex-wife will

sue him, however

when he starts

RTW income will

be higher

discussed how he can approach

ex-wife and explain that he is

currently not able to pay all

child support until back at work

Additional Comments: Client has not been in touch with coworkers since DOD

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Analysis of Job Tasks (based on therapist discussion with client)

Main tasks Duration Freq. Feasibility

1----3-----5

Explanation

1. sorting mail 2-3 hrs once

per day

2-3 focus has improved but

would still need additional

time to do sorting without

mistakes, would also find it

hard to be around co-

workers in a noisy

environment

2. delivering mail 5 hrs once

per day

3 physical stamina has

improved but could currently

not walk for 5 hours

still experiences difficulties

in dealing with people

Ancillary tasks

1. helping out co-workers

with lifting mail containers

5

minutes

5 times

per day

3-4 depends on weight container

2. participating in

meetings

1 hour once

per

month

4-5 could not be around so

many people and focus on

meeting

3. asking customer

signature for priority mail

5

minutes

once

per

week

3-4 still experiences difficulties

with dealing with people

Feasibility of the task between 1 and 5, where a “5” means that it is not feasible, and “1”

means that it is easy to perform at the current level of psychological complaints.

Which homework tools have you utilized with client?

Stress Inventory Yes was helpful

Worrying assignment Yes client used worrying assignment to

work on ruminating over conflict and

financial issues, was helpful

Time management Yes / No

Rationale tool Yes used in the first session to clarify

balance in life and issues that need to be

worked on

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Writing/Journaling assignment Yes, client is using this instrument and finds

it helpful in preventing ruminating

Anti-depressant skills Yes / No

Handouts Managing Anger, Managing

Worry, Relationship building,

Relaxation Skills

Yes, managing worry and relationship

building

if Yes, name which handout

Other Please List: thought records

If you have not used home work tools,

please provide explanation and

suggestions

Which other tools have you used in preparing client for RTW and increasing RTW

self-efficacy?

Practiced role play for conversation with ex-wife about child support and practiced role play

for meeting at work to address conflict

Client treatment evaluation

Client’s Progress in Resolving barriers to RTW: (please provide evaluation)

None Low Moderate Good Very Good

0________________________________5_x____________________________10

Evaluation/suggestions: client has not yet improved to the extent that he can start a

RTW in own job, sleeping problem is still existing and conflict is not yet addressed

Client’s Level of Engagement in Resolving barriers to RTW: (provide

explanation/suggestions for improvement)


0________________________________5____x__________________________10

Explanation/suggestions for improvement: client has participated in restoring daily

rhythm, online diary and exercise program but has not been able to find a support

network

Client’s progress with self efficacy efforts: (please provide evaluation and

suggestions for improvement)


0_________________________________5______x________________________10

Evaluation/suggestions: through role play client feels more confident in addressing

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conflict and through thought records client feels more confident in solving unhelpful

thinking

Rate the progress in increasing client’s overall functioning thus far: (please

provide explanation and suggestions for improvement)


0_________________________________5__x_____________________________10

Explanation/suggestions for improvement: improved daily rhythm and daily

activities

Has client worked with the online diary? (if not daily, please provide explanation and

suggestions)

Not at all Half of Time Daily

0_________________________________5____________________x__________10

Explanation/suggestions for improvement: none

Has client participated in the individual exercise program or increased physical

activity otherwise? (if not daily, please provide explanation and suggestions)

Not at all Half of Time Daily

0_________________________________5__________________x______________10

Explanation/suggestions for improvement: none

Update/Restatement of Therapeutic Treatment Plan to Achieve RTW

Outcome (Summarize the key elements that will constitute the focus for therapy and the

anticipated outcome)

Consider options like: Bolster Self Management skills (i.e.: exposure exercises, etc) ,

Modified duties (to be explored), Suggested Modified Hours, Conflict resolution,

Medication review/ medication management, improve physical stamina or improve daily

routine (eating/ sleeping/activities)

Goal Method Estimated

timeframe

Who is involved

1. Client needs to

further restore daily

rhythm and sleeping

pattern

Diary and

exercise program

are assisting him

Has improved

but needs further

improvement

3-4 weeks client and therapist

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2. Discussed client

still finds it hard to

find solutions for

building a support

network

Client will

continue to think

about this and

we will continue

in next sessions

Client needs to

continue going

out and talking

to people


3. Conflict needs to

be discussed prior to

starting RTW,

appointment with

employer is

scheduled on

April 10, 2013

2 weeks client and employer

4. RTW needs to be

very gradual maybe

with a work trial

preceding to make

sure that client can

have positive

experiences

creating gradual

GRTW schedule

with feasible job

tasks

see information

in problem

analysis

3-4 weeks , GRTW

scheduled to start

April 20, 2013

case manager and

employer

5. Client needs to

work on catastrophic

thinking

Thought records

to assist client in

recognizing

patterns of

unhelpful

thinking and

behavior, needs

to continue doing

this to establish

new thinking

pattern


6. Address financial

problem

When client

returns to work,

financial

problems will

diminish, not

sure if there are

alternate options

to assist client?

Client discussed

issue with ex-

wife to be

flexible in child

support

3-4 weeks, GRTW

scheduled to start

April 20, 2013

Client, employer?

Case manager?

ex-wife?

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Specific Input for RTW Coordinator or Case Manager (elements that need to be

addressed/considered based on consideration of barriers and job task analysis)

Conflict needs to be addressed

RTW needs to start with feasible job tasks, later start and preceded by work trial

Are there alternate options to assist client with financial issues?

Documents

SAMPLE - Progress Report Template SLF training