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COUN 6360 Week 3 Assignment; Client Intake Assessment; Part 1

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COUN 6360 Week 3 Assignment; Client Intake Assessment; Part 1

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  • March 9, 2022
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  • 2021/2022
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Clinical Intake Assessment, Part 1


Student Name
Clinical Mental Health Counseling, Walden University

COUN 6360: Assessment in Counseling and Education

Dr. Oberheim

March 21, 2021

, 2

Summary of Assessment Report

Demographic Information

Name: Mikayla Doe Phone: (555)555-5555

Address: Ethnicity: N/A

Date of Interview: 3/18/2021 Sex: Female

DOB: 02/13/2013 Name of Interviewer:

Age: 8 years old E-Mail Address: name@yahoo.com

Reason for Referral

Mikayla is an 8-year-old girl who has been referred to counseling for a clinical intake by

her school counselor, after breaking the classroom fish tank during quiet time. Mikayla is said to

get a long with her peers and is popular but has some behavioral issues in class. Mikayla

struggles to follow her teacher’s instructions, staying on task and remaining seated. Her teacher

says she is constantly in motions, shouts when she should talk quietly, and is easily distracted.

These behavioral issues have resulted in her repeating the second grade due to low test scores

and poor grades (Neukrug & Fawcett, 2015).

Family Background

Mikayla lives with both parent’s and her younger brother. Mikayla’s mother says she is “a

handful, but very sweet” (Neukrug & Fawcett, 2015).

Significant Medical/Counseling History

Mikayla was previously seeing the school counselor before being referred. Mikayla’s

current teacher had consulted with her kindergarten and first grade teachers to discuss some of

the issues she has in the classroom. Her teachers do not think Mikayla has communication issues

a specific learning disorder, as she performs above grade-level expectations in small groups or

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