COMMUNITY SKILLS (continued) Social Functioning: Difficulty controlling emotions Difficulty expressing feelings   Difficulty interpreting others feelings Draws unnecessary attention to self   Expresses feelings effectively Expresses gratitude / Appreciation    Good communication skills  Impolite / Disrespectful Intrusive Lack of personal boundaries   Lacks self esteem or self confidence Minimal effective communication skills   Outgoing Polite / Respectful    Self absorbed w/little regard for others  Self confident / Self esteem Talks excessively Withdrawn   Other  _____________________________________________ (specify) Social Functioning Comments:   Has Client Ever Volunteered? No Yes Volunteer Activities Comments: INTERVIEW OBSERVATIONS Appearance:  Appears older than stated age  Appears stated age  Appears younger than stated age Clean Clothing inappropriate to season Disheveled    Excessive / Inappropriate make-up Malodorous Neat    Poor grooming Other _____________________   (specify) Appearance Comments: Interview Behavior: Avoidant Cooperative Defiant Destructive      Hyperactive  Hypervigilant  Impulsive  Intrusive Mute Oppositional Pacing Physically aggressive     Resistant Self-injurious Verbally aggressive Withdrawn      Other ____________ (specify) Interview Behavior Comments: 8
COMMUNITY SKILLS (continued) Social Functioning:  Difficulty controlling emotions  Difficulty interpreting others feelings  Expresses feelings effectively  Good communication skills  Intrusive  Lacks self esteem or self confidence  Outgoing  Self absorbed w/little regard for others  Talks excessively  Other (specify) _____________________________________________  Difficulty expressing feelings  Draws unnecessary attention to self  Expresses gratitude / Appreciation  Impolite / Disrespectful  Lack of personal boundaries  Minimal effective communication skills  Polite / Respectful  Self confident / Self esteem  Withdrawn Social Functioning Comments: Has Client Ever Volunteered?  No  Yes Volunteer Activities Comments: INTERVIEW OBSERVATIONS Appearance:  Appears older than stated age  Clean  Excessive / Inappropriate make-up  Poor grooming  Appears stated age  Clothing inappropriate to season  Malodorous  Other (specify) _____________________  Appears younger than stated age  Disheveled  Neat Appearance Comments: Interview Behavior:  Avoidant  Hyperactive  Mute  Resistant  Other (specify) ____________  Cooperative  Hypervigilant  Oppositional  Self-injurious  Defiant  Impulsive  Pacing  Verbally aggressive  Destructive  Intrusive  Physically aggressive  Withdrawn Interview Behavior Comments: 8
54573%20(1-11)%20cws%20rehabilitation%20initial%20assessment.docx