Write a tentative assessment outline for your assigned client using the sample Description, Assessment, and Contract (DAC) format provided below. The outline should be written as an APA style document with a cover page, (no abstract needed), 12 point font, and double-spaced. In your outline, use the numbering, headings and subheadings in the instructions to direct the reader through your assessment. As an appendix, attach an ecomap for your assigned client and their family/community system. It should have a title and brief description of the ecosystem. Be sure to include lines of references for relationships and a symbol key for interpreting the lines. 

Tentative Client Assessment Outline

Description, Assessment, and Contract for: (insert assigned client name)

I. Cover Page

II. Description

A. Client Identification and Contact Information

1) Date and Time of Interview

2) Person Interviewed

3) Residence/address

4) Home Phone

5) Employment

6) Business Phone

7) Household Composition

8) Referral Source

B. Person, Family and Household, and Community Systems

1) Person System

2) Family and Household System

3) Community System

C. Presenting Issues

D. Assets, Resources and Strengths

E. Referral Source and Process; Collateral Information

F. History

1) Developmental

2) Personal, Familial, and Cultural

3) Critical Events

4) Sexual

5) Alcohol and Drug Use

6) Medical/Physical/Biological

7) Legal

8) Educational

9) Employment

10) Recreational

11) Religious, Spiritual, Philosophical

12) Prior Psychological, Social, or Medical Services

II. Tentative Assessment of the Person-Issue-Situation

A. Focal Issues

1) Nature, Duration, Frequency, Severity and Urgency

2) Risk and Protective Factors; Exceptions

B. Contributing Factors

1) Client System Factors

2) Situational, Environmental, and Systemic Factors

3) Motivation and Readiness; Stage of Change

4) Challenges and Obstacles

5) Risk Assessment

III. Appendix

A. Ecomap of Client Ecosystem (sample ecomaps are on Blackboard in the module)

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