The SOAPnote Project > Assessment & Plan Elements > IPV-FAIR Face to Face

IPV-FAIR Face to Face

posted 2018-11-16, updated 2022-05-24

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[date name="variable_1" default="today"]
DATA:
[checkbox name="participants" value="Client|IPV-FAIR Clinician|IPV-FAIR Family Navigator|DCF Social Worker|Other"][text name="oth-prtcpnt" default="" size="60"] attended this session 
[checkbox name="location-today" value="at the client's home| at the office|community location| via telehealth "]
The main topics of this session were:[comment memo="(choose all that apply)"] 
[checkbox name="ipvfTopics" value="Intake| Assessment| Father/child play assessment| Completion of Treatment Contract and Change Plan| VIGOR Safety Planning| Introduction to Fathers for Change| IPV Psychoeducation| Impact of IPV on Children| What Does it Mean to be a Caregiver?|  Father Child Relationship - play session review| Multigenerational Influences - Genogram| Identifying Triggers for Hostile Cognitions| Coping skills - Anger Thermometer| Relaxation and Physiological Arousal| Cognitive Coping, perspective-taking| Co-Parenting-Increasing Positive interactions| Increased Understanding of Co-parenting context| Co-Parenting Communication skills| Co-Parenting - Ground Rules for Healthy Relationships| Co-parenting Problem-solving| Parenting skills, Daily routines| Preparing for Father-Child Sessions| Father-Child Session - Taking responsibility| Father-Child Session - Child guided play| Father-Child Session - Feelings Identification and Expression| Psychoeducation - What is IPV| Psychoeducation - Impact on Children| Processing IPV with your Children| Healthy Relationship Patterns| Coping Skills & Mindfulness| Cognitive Coping| Co-parenting after IPV| Parent-child Communication Skills| Parenting Skills| Talk with kids about violence and safety| Mother-child coping skills| Review of treatment| Post-assessments| None this session| Other"][text name="topix" default="" size="75"]
[comment memo="Other client/clinician statements or actions"]
[textarea name="otherData" default="" rows="3"]
This clinician provided the following interventions to the client during this appointment: [comment memo="(check all that apply)"]
[checkbox name="interventions" value="Initial visit/engagement|Initial assessment|Goal/objective planning|Genograms|Therapeutic engagement around:| thought interruption/replacement| power and control| co-parenting communication| physiological reactivity| trauma| tolerating negative emotions| societal influences| multigenerational influences| child development and the impact of violence|Reflective thinking about self, partner and child|Visualization practice|Relaxation training|Grounding technique training/practice|Cognitive Behavioral Therapy(CBT)|Cognitive Processing Therapy(CPT)|Psychodynamic Psychotherapy|Beyond Trauma|Healing Trauma|Seeking Safety|Dialectical Behavior Therapy Skills|Post assessment|Discharge planning/discussion| Other"][text name="services" default="" size="75"]

[comment memo="To your knowledge were there any verbal incidents of IPV since the last appointment?"][checkbox name="incidents" value="To this clinician's knowledge there was an incident of verbal IPV since the last appointment.| To this clinician's knowledge, there have not been any incidents of verbal IPV since the last appointment.| To this clinician's knowledge, there has been a new report of verbal 
 IPV since the last session. | To this clinician's knowledge, there has not been any new reports of verbal IPV since the last session."]
[comment memo="To your knowledge were there any physical incidents of IPV since the last appointment?"][checkbox name="incidents" value="To this clinician's knowledge there was an incident of physical IPV since the last appointment.| To this clinician's knowledge, there have not been any incidents of physical IPV since the last appointment.| To this clinician's knowledge, there has been a new report of physical  IPV since the last session. | To this clinician's knowledge, there has not been any new reports of physical IPV since the last session."]  
[comment memo="Were there any DCF reports made or children removed since the last appointment?"] [checkbox name="dcfreports" value="Yes there was a report made to DCF| Yes there were children removed from the home| There were no reports made to DCF| No children were removed from the home"] 
[comment memo="Please describe this Client’s current living situation"] [checkbox name="living" value="Client is living with co-parent who was part of the referral| Client is not living with the co-parent who is part of the referral| Client is not living with the co-parent who was part of the referral and the co-parent is missing| Client is not living with the co-parent because the co-parent  is incarcerated| There was no co-parent connected to this referral| Unsure/unclear"][text name="living" default="" size="30"]
[comment memo="Did partner participate in this session?"] [checkbox name="partner-participate" value="The co-parent participated in this session.| The co-parent did not participate in this session.| Co-parenting sessions will not be appropriate/possible with this client"]
[comment memo="Did child/children participate in this session?"] [checkbox name="child-participate" value="Children did participate in this session| Children did not participate in this session| Sessions with the child/children will not be appropriate/possible with this client"]
[comment memo="What referrals did you make to another agency or a community resource for this client?"] [checkbox name="referral" value="No referrals are needed at this time| This clinician has made referrals for the following services:| batterer intervention| intimate partner violence| substance abuse outpatient| substance abuse inpatient| parenting classes| mental health inpatient| individual counseling| group therapy| psychotropic medication management| other"][text name="otherref" default="" size="75"]
ASSESSMENT:
[comment memo="Client Participation and response to intervention:"] [checkbox name="response" value="Client is engaged in services| Client is guarded in communication during treatment sessions| Client is compliant with interventions and the treatment plan| Client is resistant to services| Client is having difficulty moving forward with goals| Client is open in communication during treatment sessions| Client's mental status impedes therapeutic process| Client denies use of intimate partner violence| Client minimizes own use of intimate partner violence behaviors| Client struggles to take ownership of intimate partner violence behaviors| Client blames co-parent for their own use of intimate partner violence behaviors| Client blames self for co-parent's use of intimate partner violence| Client is meeting treatment goal objectives"]
[checkbox name="stageOfChange" value="Client seems unaware that a problem exists| Client has no intention of making changes at present| Client is aware that a problem exists, but has not made a commitment to making changes| Client is aware that a problem exists| Client has identified changes he/she would like to make| Client has not identified changes he/she would like to make| The client believes these changes are important| The client is confident that he/she can make the identified changes| The client lacks confidence that he/she can make the identified changes| The client is ready to make the identified changes| The client is not ready to make the identified changes| The client is actively making the identified changes| The client has sustaied the changes he/she has made| Client has fallen back into old patterns of behavior"]

[comment memo="Progress towards goals:"]
[textarea name="goal_progress" default=" " rows="3"]
[comment memo="Barriers to treatment/participation:"]
[textarea name="goal-progress" default=" " rows="3"]
[comment memo="Client Insight:"]
[textarea name="insight" default="" rows="3"]
[comment memo="Reflective Capacity:"]
[textarea name="reflective" default=" " rows="3"]
[comment memo="Other:"]
[textarea name="other" default=" " rows="3"]

[checkbox name="tx-assessment" value="There are no current outstanding therapeutic issues or concerns.| Resistance to treatment recommendations remains a significant concern.| The client's help-rejecting behaviors remain a significant therapeutic concern.| The client's current regressive state is a significant concern.| Treatment continues to show good evolution and development.| Treatment to continue as indicated."]
PLAN:
The ongoing treatment plan includes: [checkbox name="plan" value="support of the client's self-exploration and understanding|support of the client's capacity for thought and reflection| therapeutic work on building and maintaining self-esteem and self-confidence|therapeutic work on building and maintaining self-care| therapeutic interventions aimed at helping with target behaviors and difficulties| addressing problematic coping strategies and mechanisms| continued exploration of meaning and significance of client's difficulties in light of past relational patterns and underlying beliefs|better understanding the impact of the client's traumatic history on present day relationships and experiences| helping the client gain greater awareness, understanding, and expression of underlying emotions| crisis management and supportive assistance|helping client to keep them self/co-parent/children safe from physical and emotional violence|helping client to gain a basic understanding of how ipv affects them self/co-parent/children|helping client to identify behaviors which are their own responsibility and reduce the use of blaming others|helping the client and their family to feel connected and know how to repair their relationships|helping the client to learn & implement new strategies for effective co-parenting|helping client to decrease substance use|helping client to increase coping skills to improve mood and mood regulation when faced with opposition and stress|addressing client's past trauma and how it affects their present day needs| helping client to build positive self-esteem through recognizing and replacing negative self-talk.|helping client to learning to tolerate negative emotions through thought replacement| continued provision of ipv-fair treatment| continued provision fathers for change intervention| continued provision mothers and more intervention| to continue with comprehensive assessment| to continue administering post-assessments| planning for termination of the treatment| this is the last session with client due to discharge from program"]
[comment memo="Upcoming Intervention:"]
This clinician will focus on the following IPV-FAIR topics:[checkbox name="ipvfNextTopics" value="intake| assessment| father/child play assessment| completion of treatment contract| introduction to fathers for change| safety planning| ipv psychoeducation| impact of ipv on children| what does it mean to be a caregiver?| completion change plan| father child relationship - play session review| multigenerational influences - genogram| identifying triggers for hostile cognitions| coping skills - anger thermometer| relaxation and physiological arousal| cognitive coping, perspective-taking| co-parenting-increasing positive interactions| increased understanding of co-parenting context| co-parenting communication skills| co-parenting - ground rules for healthy relationships| co-parenting problem-solving| parenting skills, daily routines| preparing for father-child sessions| father-child session - taking responsibility| father-child session - child guided play| father-child session - feelings identification and expression| psychoeducation - what is ipv| psychoeducation - impact on children| processing ipv with your children| healthy relationship patterns| coping skills & mindfulness| cognitive coping| co-parenting after ipv| parent-child communication skills| parenting skills| talk with kids about violence and safety| mother-child coping skills| review of treatment| post-assessments| discharge planning| none this session| other"]
[text name="nexttopc" default="" size="75"]
Next Appointment is scheduled for [date name="variable_2" default="today"] at [text name="appttime" default="time" size="10"]
[checkbox name="location-next" value="at the client's home| at the office|community location| via telehealth "]

DATA:
Client IPV-FAIR Clinician IPV-FAIR Family Navigator DCF Social Worker Other attended this session
at the client's home at the office community location via telehealth
The main topics of this session were:(choose all that apply)
Intake Assessment Father/child play assessment Completion of Treatment Contract and Change Plan VIGOR Safety Planning Introduction to Fathers for Change IPV Psychoeducation Impact of IPV on Children What Does it Mean to be a Caregiver? Father Child Relationship - play session review Multigenerational Influences - Genogram Identifying Triggers for Hostile Cognitions Coping skills - Anger Thermometer Relaxation and Physiological Arousal Cognitive Coping, perspective-taking Co-Parenting-Increasing Positive interactions Increased Understanding of Co-parenting context Co-Parenting Communication skills Co-Parenting - Ground Rules for Healthy Relationships Co-parenting Problem-solving Parenting skills, Daily routines Preparing for Father-Child Sessions Father-Child Session - Taking responsibility Father-Child Session - Child guided play Father-Child Session - Feelings Identification and Expression Psychoeducation - What is IPV Psychoeducation - Impact on Children Processing IPV with your Children Healthy Relationship Patterns Coping Skills & Mindfulness Cognitive Coping Co-parenting after IPV Parent-child Communication Skills Parenting Skills Talk with kids about violence and safety Mother-child coping skills Review of treatment Post-assessments None this session Other
Other client/clinician statements or actions

This clinician provided the following interventions to the client during this appointment: (check all that apply)
Initial visit/engagement Initial assessment Goal/objective planning Genograms Therapeutic engagement around: thought interruption/replacement power and control co-parenting communication physiological reactivity trauma tolerating negative emotions societal influences multigenerational influences child development and the impact of violence Reflective thinking about self, partner and child Visualization practice Relaxation training Grounding technique training/practice Cognitive Behavioral Therapy(CBT) Cognitive Processing Therapy(CPT) Psychodynamic Psychotherapy Beyond Trauma Healing Trauma Seeking Safety Dialectical Behavior Therapy Skills Post assessment Discharge planning/discussion Other

To your knowledge were there any verbal incidents of IPV since the last appointment? To this clinician's knowledge there was an incident of verbal IPV since the last appointment. To this clinician's knowledge, there have not been any incidents of verbal IPV since the last appointment. To this clinician's knowledge, there has been a new report of verbal
IPV since the last session. To this clinician's knowledge, there has not been any new reports of verbal IPV since the last session.
To your knowledge were there any physical incidents of IPV since the last appointment? To this clinician's knowledge there was an incident of physical IPV since the last appointment. To this clinician's knowledge, there have not been any incidents of physical IPV since the last appointment. To this clinician's knowledge, there has been a new report of physical IPV since the last session. To this clinician's knowledge, there has not been any new reports of physical IPV since the last session.
Were there any DCF reports made or children removed since the last appointment? Yes there was a report made to DCF Yes there were children removed from the home There were no reports made to DCF No children were removed from the home
Please describe this Client’s current living situation Client is living with co-parent who was part of the referral Client is not living with the co-parent who is part of the referral Client is not living with the co-parent who was part of the referral and the co-parent is missing Client is not living with the co-parent because the co-parent is incarcerated There was no co-parent connected to this referral Unsure/unclear
Did partner participate in this session? The co-parent participated in this session. The co-parent did not participate in this session. Co-parenting sessions will not be appropriate/possible with this client
Did child/children participate in this session? Children did participate in this session Children did not participate in this session Sessions with the child/children will not be appropriate/possible with this client
What referrals did you make to another agency or a community resource for this client? No referrals are needed at this time This clinician has made referrals for the following services: batterer intervention intimate partner violence substance abuse outpatient substance abuse inpatient parenting classes mental health inpatient individual counseling group therapy psychotropic medication management other
ASSESSMENT:
Client Participation and response to intervention: Client is engaged in services Client is guarded in communication during treatment sessions Client is compliant with interventions and the treatment plan Client is resistant to services Client is having difficulty moving forward with goals Client is open in communication during treatment sessions Client's mental status impedes therapeutic process Client denies use of intimate partner violence Client minimizes own use of intimate partner violence behaviors Client struggles to take ownership of intimate partner violence behaviors Client blames co-parent for their own use of intimate partner violence behaviors Client blames self for co-parent's use of intimate partner violence Client is meeting treatment goal objectives
Client seems unaware that a problem exists Client has no intention of making changes at present Client is aware that a problem exists, but has not made a commitment to making changes Client is aware that a problem exists Client has identified changes he/she would like to make Client has not identified changes he/she would like to make The client believes these changes are important The client is confident that he/she can make the identified changes The client lacks confidence that he/she can make the identified changes The client is ready to make the identified changes The client is not ready to make the identified changes The client is actively making the identified changes The client has sustaied the changes he/she has made Client has fallen back into old patterns of behavior

Progress towards goals:

Barriers to treatment/participation:

Client Insight:

Reflective Capacity:

Other:

There are no current outstanding therapeutic issues or concerns. Resistance to treatment recommendations remains a significant concern. The client's help-rejecting behaviors remain a significant therapeutic concern. The client's current regressive state is a significant concern. Treatment continues to show good evolution and development. Treatment to continue as indicated.
PLAN:
The ongoing treatment plan includes: support of the client's self-exploration and understanding support of the client's capacity for thought and reflection therapeutic work on building and maintaining self-esteem and self-confidence therapeutic work on building and maintaining self-care therapeutic interventions aimed at helping with target behaviors and difficulties addressing problematic coping strategies and mechanisms continued exploration of meaning and significance of client's difficulties in light of past relational patterns and underlying beliefs better understanding the impact of the client's traumatic history on present day relationships and experiences helping the client gain greater awareness, understanding, and expression of underlying emotions crisis management and supportive assistance helping client to keep them self/co-parent/children safe from physical and emotional violence helping client to gain a basic understanding of how ipv affects them self/co-parent/children helping client to identify behaviors which are their own responsibility and reduce the use of blaming others helping the client and their family to feel connected and know how to repair their relationships helping the client to learn & implement new strategies for effective co-parenting helping client to decrease substance use helping client to increase coping skills to improve mood and mood regulation when faced with opposition and stress addressing client's past trauma and how it affects their present day needs helping client to build positive self-esteem through recognizing and replacing negative self-talk. helping client to learning to tolerate negative emotions through thought replacement continued provision of ipv-fair treatment continued provision fathers for change intervention continued provision mothers and more intervention to continue with comprehensive assessment to continue administering post-assessments planning for termination of the treatment this is the last session with client due to discharge from program
Upcoming Intervention:
This clinician will focus on the following IPV-FAIR topics: intake assessment father/child play assessment completion of treatment contract introduction to fathers for change safety planning ipv psychoeducation impact of ipv on children what does it mean to be a caregiver? completion change plan father child relationship - play session review multigenerational influences - genogram identifying triggers for hostile cognitions coping skills - anger thermometer relaxation and physiological arousal cognitive coping, perspective-taking co-parenting-increasing positive interactions increased understanding of co-parenting context co-parenting communication skills co-parenting - ground rules for healthy relationships co-parenting problem-solving parenting skills, daily routines preparing for father-child sessions father-child session - taking responsibility father-child session - child guided play father-child session - feelings identification and expression psychoeducation - what is ipv psychoeducation - impact on children processing ipv with your children healthy relationship patterns coping skills & mindfulness cognitive coping co-parenting after ipv parent-child communication skills parenting skills talk with kids about violence and safety mother-child coping skills review of treatment post-assessments discharge planning none this session other

Next Appointment is scheduled for at
at the client's home at the office community location via telehealth