Comprehensive Mental Health Assessment

Identifying Information:
[text name="name" memo="Patient name" size="20"] is a [text memo="age" size="2"]-year-old, [text memo="ethnicity" size="20"], [checkbox value="single|married|partnered"] [checkbox value="female|male|transgender female|transgender male"][text memo="other gender" value="20"] who [select value="lives with their significant other |lives with their family |lives alone |is homeless|lives with their parents |lives with their children |lives with a roommate |lives in a grouphome |"][text size="20"] in [text memo="residing location" size="20"]. [select value="They are their own guardian|They have a DHS guardian |Their guardian is |"][text memo="guardian" size="20"].  [textarea memo="Additional presentation information" rows="5"]

History of Presenting Illness:
[var name="name"] [select value="presents in this initial outpatient appointment| "][select value=" alone| with family| with significant other| with DHHS worker| with case manager|"][text memo="names" size="20"][select value=" for evaluation and management of the chief complaint of | due to reports of |"][text memo="presenting problem" size="20"].[checkbox name="depression" memo="depression" value=""][checkbox name="anxiety" memo="anxiety" value=""][checkbox name="sleep" memo="sleep" value=""][checkbox name="mood" memo="mood" value=""][checkbox name="ptsd" memo="ptsd" value=""][checkbox name="adhd" memo="adhd" value=""][checkbox name="autism" memo="autism" value=""]
[conditional field="depression" condition="(depression).is('')"]  



[var name="name"]'s depression is characterized as [checkbox value="little interest or pleasure in doing things|hopelessness|self harm|helplessness|sleeping too much|difficulty getting to sleep|difficulty staying asleep|feeling tired or having little energy|poor appetite|overeating|feelings of inadequacy|irritability|poor concentration|psychomotor retardation|psychomotor agitation|suicidal ideation"].  [select value="Depressive symptoms are present most of the day, nearly every day for the past |Depressive symptoms are mostly present |"][text size="20"][select value=", are exacerbated by |"][text size="20][select value=", are improved by |"][text size="20]. [select value="Depressive symptoms impact|"][select value=" social/work functioning by | "][textarea rows="1"].[textarea memo="Additional Depression information" rows="5"][/conditional][conditional field="anxiety" condition="(anxiety).is('')"]  

[var name="name"]'s anxiety generally presents as [checkbox value="feeling nervous or on edge|worry|panic|difficulty relaxing|feeling restless|difficulty getting to sleep|difficulty staying asleep|irritability|poor concentration|poor appetite|overeating"][text size="20]. [select value="Anxiety is present |"][select value="in the context of multiple different situations/events such as |primarily in social situations such as |no specific situation or event but always there |"][textarea rows="1"]. [select value="Anxiety usually last for approximately |Anxiety is present most of the time on most days "][text size="20"]
[comment memo="How long"][select value=", is brought on by |"][text size="20][select value=", is relieved by |"][text size="20]. [textarea memo="Additional Anxiety information" rows="5"][/conditional][conditional field="mood" condition="(mood).is('')"]

[select value=" Mood instability has been an issue since |"][text size="20"].  [select value="Disordered mood can present as |"][checkbox value="euphoria|excessive energy|excessive self-confidence|insomnia|irritability|agitation|racing thoughts|impulsive behavior|risk taking behavior|paranoia|delusions of grandeur|auditory hallucinations|visual hallucinations|tactile hallucinations|olfactory hallucinations|increased goal directed activity|homicidal ideation| depression|apathy|hopelessness|helplessness|suicidal thoughts|no motivation|hypersomnia"].  [select value="Mood lability is exacerbated by |There are no identified precipitating factors to mood lability|"][textarea rows="1"].  [textarea memo="additional information of mood lability" rows="4"][/conditional][conditional field="autism" condition="(autism).is('')"]

[select value="Per patient,|Per family,|Per record,|"][text size="20"][select value=" they have been | patient has been |"][select value="diagnosed|undiagnosed|"][text size="20"][select value=" autism spectrum disorder "][textarea memo="details of diagnosis/symptom timeframe" rows="4"].  [var name="name"]'s symptoms present as persistent difficulty, in multiple contexts, with social communication and interaction including: [checkbox value="abnormal or failed back and forth conversation|failure to initiate or respond to social interactions|reduced sharing of interests/emotions|limited emotional affect|limited/incongruent nonverbal communication|difficulty with developing/maintaining/understanding relationships|difficulty sharing imaginative play|limited or absent interest in peers"]. They have demonstrated restricted/repetitive patterns of behavior, interests, or activities including: [checkbox value="repetitive motor movements|repetitive speech|infexible adherence to routines|ritualized patterns of verbal or nonverbal behavior|significant difficulty with transitions|rigid thinking patterns|highly restricted and fixated interests|hyper-reactivity to sensory input|hyporeactivity to some sensory input"].  Presentation is [select value="without|with"] intellectual impairment, and [select value="without|with"] language impairment.  [textarea rows="4"][/conditional][conditional field="adhd" condition="(adhd).is('')"]

[var name="name"] has a pattern of [checkbox name=addtype value="inattention and hyperactivity/impulsivity|inattention|hyperactivity/impulsivity"] that interferes with functioning.  [/conditional][conditional field="addtype" condition="(addtype).is('inattention and hyperactivity/impulsivity')||(addtype).is('inattention')"] Inattention manifests as [checkbox memo="At least 6 for ADHD" value="poor attention to details or careless mistakes in work or activities|difficulty sustaining attention|not seeming to listen when spoken to directly|not following through on instructions or failing to finish tasks|having difficulty organizing tasks and activities|avoiding tasks that require sustained mental effort|frequently losing things necessary for tasks|often easily distracted by extraneous stimuli|forgetfulness in daily activities"].[/conditional] [conditional field="addtype" condition="(addtype).is('inattention and hyperactivity/impulsivity')||(addtype).is('hyperactivity/impulsivity')"]  [var name="name"]'s hyperactivity/impulsivity presents as [checkbox memo="six or more for ADHD" value="frequent fidgeting or squirming|often leaving seat when remaining seated is expected|frequently restless|difficulty engaging in leisure activities quietly|often seeming to be on the go or difficult to keep up with|excessive talking|blurting out answers before a question has been completed|difficulty waiting for their turn|interrupting or intruding on others"].[/conditional][conditional field="adhd" condition="(adhd).is('')"]  These symptoms have been present since [text memo="before 12yo" size="20"], and are recognized in multiple settings including [checkbox name="variable_1" value="at home|in public|work|school"]

[textarea rows="3"][/conditional][conditional field="sleep" condition="(sleep).is('')"]


Sleep is reported to be generally [select name="sleep" value="poor |fair |good.|erratic |inconsistent |excessive|"][select value="with difficulty initiating sleep and staying asleep due to |with difficulty initiating sleep due to |with difficulty maintaining sleep due to |"][textarea rows="2"].  They estimate getting approximately [text size="4"] hours of [select value="broken |solid |"]sleep per night.  [select value="Disturbed sleep has been an issue for |Disturbed sleep is a new issue within the last |"][textarea rows="1"].  [select value="There has been no workup for Sleep Apnea |There was a past workup for sleep apnea which indicated |"][textarea rows="1"]. [select value="Current attempts at improving sleep include |The patient is currently attempting no interventions to improve sleep|Current quality of sleep is dependent on |"][textarea rows="2"].  [select value="Past unsuccessful attempts at improving sleep include |There have been no past attempts at improving sleep|"][textarea rows="2"].[/conditional][conditional field="sleep" condition="(sleep).isNot('')"]Sleep is reported to be generally good.  [/conditional]
[conditional field="depression" condition="(depression).isNot('')"]They deny any marked issues with depression.  [/conditional][conditional field="anxiety" condition="(anxiety).isNot('')"]They deny any significant issues with anxiety.  [/conditional]

[conditional field="ptsd" condition="(ptsd).is('')"]      

When asked about any traumatic symptoms the patient[select name="variable_312341" value=" denied having trauma.| stated traumatic symptoms which included|"] [checkbox name="variable_43653241" value="Recurrent, unwanted distressing memories of the traumatic event|flashbacks|upsetting dreams/nightmares|severe emotional distress that reminds pt of trauma|physical reactions to something that reminds the pt of the traumatic event|Trying to avoid thinking or talking about the traumatic event|Avoiding places, activities or people that remind you of the traumatic event|negative thoughts about self|negative thoughts about other people|hopelessness about the future|memory disturbances r/t to not remembering important aspects of the trauma|difficulty maintaining close relationships|feeling detached from family and friends|lack of interest in activities they used to enjoy doing|difficulty experiencing positive emotions|feeling emotionally numb|easily startled|always being on guard for danger|self destructive behavior|difficulty sleeping|aggressive behavior|trouble concentrating|angry outbursts|overwhelming guilt|overwhelming shame"] 
[comment memo="Details about the trauma"]
[textarea name="variable_4534688971" default=" "][/conditional]

[select value="They are not currently receiving individual counseling/therapy |They are currently engaging in individual counseling with |"][textarea rows="1"]. 


[checkbox memo= "Scales" name="scales" value=""][conditional field="scales" condition="(scales).is('')"]
Scales and Screening:
PHQ-9: [select value="unable to assess|N/A|declined|0|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
GAD-7: [select value="unable to assess|declined|N/A|0|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
MDQ: [select value="negative|unable to assess|N/A|declined|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
HITS:[select value="negative|unable to assess|N/A|declined|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
PC-PTSD:[select value="negative|N/A|unable to assess|declined|1|2|3|4"]
AUDIT:[select value="negative|unable to assess|N/A|declined|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
DAST-10:[select value="negative|unable to assess|N/A|declined|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"]
SLUMS:[select value="N/A|unable to assess|declined|1|2|3|4|5|6|7|8|9|10|11|12|13|14|15|16|17|18|19|20|21|22|23|24|25|26|27|28|29|30"][/conditional]


PAST PSYCHIATRIC HISTORY:
[select name="variable_1" value="The patient states a past diagnosis of|The patient denies a past psychiatric diagnosis"][textarea name="variable_1" default="sample text"][select value="There is no history of psychiatric hospitalizations|They have been psychiatrically hospitalized |"][textarea rows="2"]. [select value="When asked about psychotherapy the patient stated | no history of psychotherapy|history of psychotherapy/counseling|"][textarea rows="2"]. [select value="They deny history of diagnosis/treatment for an eating disorder|They report positive for a history of diagnosis/treatment for an eating disorder including |Unable to assess for history of diagnosis/treatment of an eating disorder due to symptomatic presentation|History of diagnosis/treatment of an eating disorder was not assessed in this encounter|"][textarea rows="1"].[select value="They have no history of thoughts of self-harm|History of thoughts of self harm include |"][textarea rows="2"].  [select value="They have no history of attempting to hurt themself|History of self-harm includes |Unable to obtain history of self-harm due to symptomatic presentation"][textarea rows="2"]. [select value="They have no history of hallucinations| They have a history hallucinations|Unable to obtain history of hallucinations due to symptomatic presentation"][textarea rows="2"] [select value="They have no history of delusions| They have a history delusions|Unable to obtain history of hallucinations due to symptomatic presentation"][textarea rows="2"][select value="They have no history of attempting suicide|They have a history of attempting suicide |Unable to obtain history of suicide attempt due to symptomatic presentation"][textarea rows="2"]. [select value="Previous psychiatric medication trials include but may not be limited to: |The patient has no history of taking psychiatric medications|We were unable to cover previous psychiatric medication trials due to symptomatic presentation|The patient is unable to recall past psychiatric medication trials|"][textarea rows="1"].


MEDICAL HISTORY:
Other Providers: [text name="variable_4111631" default="sample text"]
Illness: [text name="variable_4631" default="sample text"]
Surgeries: [text name="variable_43631" default="sample text"]
Allergies: [text name="variable_463451" default="sample text"]
Head Injuries: [select value="They have no history of head injuries or traumatic brain injuries|They have a past history of traumatic brain injuries resulting from |They have an underlying cognitive impairment from |"][textarea rows="2"].
Seizures: [select value="They denied having seizures|They have a past history of seizures|"][textarea rows="2"]. 
[select value="Current psychiatric medications include: |They are not currently taking any psychiatric medications|Patient is unable to recall current medications|Unable to cover current psychiatric medications with patient due to symptomatic presentation|"][textarea rows="4"].[select name="medmed" value=" Other medical medications include: | Other medical medications are noted below."][conditional field="medmed" condition="(medmed).isNot(' Other medical medications are noted below.')"][textarea rows="3"].[/conditional][select value="  Medication list obtained from patient.|  Medication list obtained from medical record.| Medication list obtained from patient's guardian. | Medication list confirmed with patient's pharmacy.| Medication list confirmed with patient's grouphome.| "]


SOCIAL HISTORY:
[var name="name"] identifies [checkbox value="having no one |significant other |extended family |children |friends |church members "][textarea rows="1"] as their social-support network.  The patient has [select value="0|1|2|3|4|5|6|7|"][textarea rows="1"] children. The patients level of education is [select value="highschool|an undergraduate degree in |a graduate degree in |a doctorate degree in |some highschool|some college|currently in grade school|currently in highschool|currently in college.|currently in graduate school|"][textarea rows="1"].  The patient is[select value=" currently on disability due to their mental health condition| currently on disability due to their medical condition| currently employed | currently unemployed |currently retired from |"][textarea rows="1"].Financially the patient has[select value=" no immediate concerns| been burdened by healthcare costs| concerns related to supporting their family|"][textarea rows="1"].The patient source of income is primarily [select value=" disability| social security| unemployment| child support| current employment| family support| retirement|"][textarea rows="1"].The patient has [select value=" no current housing concerns| a currently unstable housing situation related to |"][textarea rows="1"]. [select name="spirituality" value="Spirituality was not addressed this visit|Spirituality is identified as |"][conditional field="spirituality" condition="(spirituality).is('Spirituality is identified as ')"][select value="Christian|Catholic|Muslim|Jewish|Spiritual but not practicing|Athiest|Satanism|Agnostic|Spiritual but no specific religion|Hinduism|"][textarea rows="1"][/conditional].  [select value="Cultural considerations important to care include: |"][textarea rows="1"].Sexual orientation [select name="sexuality" value="is identified as |was not addressed this visit|"][conditional field="sexuality" condition="(sexuality).is('is identified as ')"][select value="heterosexual|homosexual|bisexual|pansexual|asexual|"][textarea rows="1"][/conditional].[select value="No past history of military service|Military history includes |Military history was not addressed this visit|"][textarea rows="1"].  [select value="At this current time the patient has no current legal concerns|At this time the patient has legal concerns which include |legal concerns at this time were not addressed due to symptomatic presentation"][textarea rows="1"].
[select value="The patient reports positive for tobacco use consuming approximately |The patient reports a past history of tobacco but quit approximately |The patient denies any tobacco use|"][textarea rows="1"].[select value="The patient reports positive for alcohol use consuming approximately |The patient reports a history of alcohol abuse quitting approximately |The patient denies any alcohol use|"][textarea rows="2"].  [select value="They deny a history of recreational substance use|The patient reports utilizing cannabis approximately |The patient has a history of substance abuse in the form of |They report utilizing opiates recreationally in the form of |Substance use history was not covered due to symptomatic presentation|"][textarea rows="4"].

DEVELOPMENTAL HISTORY:
[select value="There is no known issue with meeting expected developmental milestones.|All developmental milestones were met with exception to |There were some notable issues with developmental milestones including |"][textarea name="variable_236321" default="sample text"]. Their primary language includes [select name="language" value="English|"][conditional field="language" condition="(language).is('')"][text memo="language" size="15"][/conditional] and utilizes [select name="comskill" value="written and verbal communication|primarily verbal communication|primarily textual communication and sign language| "][textarea rows="1"].


FAMILY HISTORY:
[var name="name"] was born in [text memo="place of birth" size="20"] [select value="to an intact family |to a family structure consisting of |"][textarea rows="1"].
[select value="They deny knowledge of a family history of mental illness|Family history of mental health problems is positive for |Unable to cover family history of psychiatric issues due to symptomatic presentation"]
[textarea rows="4"].[select value="There is no known history of suicides or self-harm in the patient's family|Family history of suicides/self-harm includes |Unable to cover family history of suicides/self-harm due to symptomatic presentation|"][textarea rows="2"].[select value="There is no known family history of substance use issues|Family history of substance use is positive for |Unable to cover family history of substance use issues due to symptomatic presentation|"][textarea rows="4"].

Mental Status Examination:

Appearance -general: [select value="alert and oriented in all spheres|obtunded|disoriented|unknown"],[select value="appears to be of chronological age|appears younger than chronological age|appears older than chronological age|unknown"].
Appearance - accessibility:[select value="cooperative|friendly|uncooperative|irritated but not to the level of anger|angry|hostile|alert|confused|hostile|silent|inappropriate boundaries|seductive|playful|ingratiating|evasive|guarded|sullen|manipulative|contemptuous|demanding|withdrawn"].
Appearance - grooming: [select value="Average/WNL|well-groomed|poorly groomed|meticulously groomed|unknown"].
Appearance - clothing: [select value="clean|dirty|unkempt|neat|tidy|meticulous|worn out|skillfully applied|unconventional|fashionable|unknown|professional"],[select value="appropriate for season| inappropriate to season|unknown"],[select value="appropriate for setting| inappropriate for setting|unknown"].
Appearance - hygiene: [select value="clean|unbathed|dirty|body odor|smells of alcohol|unknown"].
Appearance - build: [select value="average height|tall|short|unknown"],[select value="average weight|thin|overweight|obese|underweight|unknown"].
Appearance - facial expression: [select value="casual(normal)|bland|flat|mobile(rapid changes)|angry|unknown"].
Psycho-motor activity - abnormal movements: [select value="none|grimaces|tics|twitches|foot tapping|rocking back and forth|hand wringing|ritualistic behavior|mannerisms|posturing|nail biting|chewing movements|echopraxia|tardive dyskinesia|catatonic|unknown"].
Psychomotor activity - rate/gait: [select value="normal|hyperactive|slow|retarded|agitated|hesitant|propulsive|shuffling|dancing|ataxic|uncoordinated|unknown"].
Psycho-motor activity - Coordination: [select value="normal/no problems|awkward|clumsy|agile|falling easily|needed assistance|bed ridden|uses wheelchair|uses walker|unknown"].
Psycho-motor activity - posture: [select value="quietly seated|relaxed|stooped|combative|hyperactive|agitated|rigid|stiff|shaky|slouched|bizarre movements|posturing|crouching|erect|restless|unknown"].
Speech: [select value="normal rate and volume|pressured|monotonous|quiet|emotional|loud|forgetful|whispering|yelling|accented|impoverished|neologisms|aphasia|global aphasia|Broca's aphasia|Wernicke's aphasia|dysarthia|preservation|sterotypy"].
Speech - clarity: [select value="clear|slurred|mumbled|lisping|stuttering|inaudible|incoherent|long pauses"].
Speech - quantity: [select value="within normal limits|responds only to questions|scant|mute|verbose|repetitive"].
Mood observed: [select value="euthymic|expansive|euphoric|anxious|depressed|tearful|labile|flat|happy|sad|irritated|angry|enraged|guilty|other (describe)"].
Affect: [select value="euthymic|full range of affect|broad|appropriate|constricted|blunted|flat|labile|anhedonic|blunted|emotional withdrawal|excited"].
Mood/affect congruence: [select value="congruent|not congruent"].
Behavior - general: [select value="in no distress|in mild psychological distress|in moderate psychological distress|in acute psychological distress"].
Behavior - eye contact: [select value="eye contact good|eye contact fair|eye contact avoidant|unknown"].
Orientation: [select value="orientated to person, place, time, and event|not orientated to person, place, time, and event|not orientated to place, time, or event|not orientated to time and event|not orientated to event|lethargic|obtundation|stupor|coma"].
Cognition/Memory - overall functioning: [select value="within normal limits|grossly intact|below average|above average|short-term memory loss|long-term memory loss|amnesia|anterograde amnesia|retrograde amnesia| history of head trauma|transient global amnesia"].
Cognition/Memory - abstraction: [select value="normal ability to abstract|difficulty with abstract thought|inability for abstract thought"].
Thought - form and flow: [select value="logical, relevant, and goal orientated|not logical, relevant, and goal orientated|past orientated|scattered|impoverished|racing thoughts|circumstantial|perservations|flight of ideas|illogical|hopeful|remorseful|enthusiastic|incoherent|neologism|distractable|tangential|overvalued ideas|excited|poverty of though|word salad|clang associations|slow reaction|rapid reaction|doubting|indecisive|blocking|spontaneous|pressured|"].
Thought - perception: [select value="within normal limits|illusions|hallucinations|denationalization|derealization"]
Thought - content: [select value="within normal limits|thought withdrawal|thought insertion|paranoia|thought broadcast|suspiciousness|grandiose delusions|somatic delusions|delusional guilt|nihilistic delusions|ideas of reference|ideas of inference|magical thinking"].
Insight: [select value="good|fair|poor"]. Judgment: [select value="good|fair|poor"].

Suicidality: [select value="no current ideation, plan, or intent|past ideation only|past ideation and plan only|past ideation, plan, and intent|previous attempt|current ideation, no current plan or intent|current ideation and plan, no current intent|current ideation, plan, and intent"]. Client is currently assessed to be at [select value="no|low|moderate|high"] risk for self harm as evidenced by client's self-report of [select value="not having any|having a"] suicidal ideation, and/or plan, and/or intent based upon today's exam. The following action was taken as a result of client having a suicidal ideation/plan/intent:[textarea cols="20" rows="1" default= "No action taken."]

Self-injurious behavior: [select value="no current ideation, plan, or intent|past ideation only|past ideation and plan only|past ideation, plan, and intent|previous attempt|current ideation, no current plan or intent|current ideation and plan, no current intent|current ideation, plan, and intent"]. Client is currently assessed to be at [select value="no|low|moderate|high"] risk for self-injurious harm as evidenced by client's self-report of [select value="not having any|having a"] self-injurious ideation, and/or plan, and/or intent based upon today's exam. The following action was taken as a result of client having a suicidal ideation/plan/intent:[textarea cols="20" rows="1" default= "No action taken."]

Homicidality/bodily injury towards others: [select value="no current ideation, plan, or intent|past ideation only|past ideation and plan only|past ideation, plan, and intent|previous attempt|current ideation, no current plan or intent|current ideation and plan, no current intent|current ideation, plan, and intent"]. Client is currently assessed to be at [select value="no|low|moderate|high"] risk of being a harm to others as evidenced by client's self-report of [select value="not having any|having a"] homicidal ideation, and/or plan, and/or intent based upon today's exam. The following action was taken as a result of client having a homicidal ideation/plan/intent: [textarea cols="20" rows="1" default= "No action taken."]

Additional information: [textarea cols="80" rows="3" default= "No additional information."]


ASSESSMENT
Patient is currently displaying [select value="symptoms of|well managed|moderately managed|poorly managed"] [checkbox value="depression|anxiety|sleep disturbance|psychosis|substance abuse|cognitive impairment|impulsivity|mood lability|alcohol dependence|opiate dependence|autism spectrum disorder"][textarea memo="other" default="" rows="1"] which is [select value="likely caused by|likely exacerbated by|likely the result of"] [checkbox value="their cancer diagnosis|their cancer treatment|their unmanaged depressive disorder|their unmanaged anxiety disorder|their unmanaged bipolar disorder|interpersonal/family conflict|current psychopharmaceutical intervention|current psychotherapy|current psychosocial support systems"][textarea memo="other" default="" rows="1"]. Patient would benefit from [checkbox value="initiation of psychopharmaceutical intervention|continued psychopharmaceutical intervention|adjustments to current psychopharmaceutical intervention|initiation of psychotherapy|continuation of current psychotherapy|engaging in grief therapy|engaging in CBT|engaging in family therapy|enhanced psychosocial supports|increasing personal time and self-care"]. Prognosis is [select value="good|fair|poor"] considering the patient [select value="remains adherent to|actively engages in"] medication and therapy to address [textarea memo="target of treatment" rows="1"][checkbox value=" and whether they are able to engage constructively with social supports"]. [checkbox value="Barriers to success include: "][checkbox value="current apprehension to engage in psychopharmaceutical intervention|current apprehension to engage in structured psychotherapy|current emotional distress of recent cancer diagnosis|limited social supports|dysfunctional interpersonal relationships"][textarea memo="barriers" rows="1"]. [checkbox value="Patient strength for success include: "][checkbox value="expression of willingness to engage in treatment recommendations|positive social supports|are well connected with outpatient supports|history of actively engaging in mental-health treatment"][textarea memo="strengths" rows="1"]. [textarea rows="5"]