Practice Learning Portfolio: A1 Placement log of clinical experiences – Trainee.............................................. Placement type ………………………………………. 3a For of training: Religion Service User Demographics Activity Data Christian Buddhist Clients Hindu Role Sex Jewish Observation Female Muslim Independent Work Male Sikh Joint Work Non-Binary Other Activity Age Not Applicable Assessment Only < 5 Assessment & Intervention 5 - 11 Intervention Only Clinical Data 12 - 18 Mode of Work 19 - 24 Individual 25 - 34 Problem Area Couple 35 - 44 Biological/Health Family 45 - 54 Cognitive Function Group 55 - 64 Emotional/Behavioural Type of Work 65 - 75 Social/Interpersonal Direct 75 + Problem Duration Indirect - Carers Ethnicity < 1 year Indirect - Contact Time White British < 5 years (D = Direct, C = Consultation/Liaison) White Irish < 10 years < 2 hours White Other > 10 years < 5 hours White/Caribbean Problem Severity < 10 hours White/African Mild < 15 hours White/Asian Moderate < 25 hours White/Other Severe 25 + Indian Challenging Behaviour Assessment Methods Pakistani Yes Interview Bangladeshi Life Events Observations Asian Other Bereavement/Loss Self-Report Tools Black Caribbean Health Standardised Tests African Abuse Neuropsychology Tests Black Other Trauma Models Chinese Other Behavioural Other Disabilities Cognitive Behavioural (CBT) Social Class Communication Psychodynamic 1.1 Employers, senior Learning Systemic – managers Cognitive analytic (CAT) Mobility 1.2 Higher professionals Sensory Integrative – 2– Intermediate professionals Other Community/critical 3 Intermediate Other (specify) – 4 Small employers Service Setting – 5 Low supervisory Primary Care – 6 Semi-routine Secondary – 7 Routine In-Patient/Residential – Other e.g. third sector 8 Long term unemployed – (specify) Confirmed and signed by: Trainee: Supervisor: Date: ________
Practice Learning Portfolio: A1 – Placement log of clinical experiences Trainee.............................................. Placement type ………………………………………. 3a For of training: Service User Demographics Religion Activity Data Christian Buddhist Clients Hindu Role Sex Jewish Observation Female Muslim Independent Work Male Sikh Joint Work Non-Binary Other Activity Age Not Applicable Assessment Only < 5 Assessment & Intervention 5 - 11 Clinical Data Intervention Only 12 - 18 Mode of Work 19 - 24 Individual 25 - 34 Problem Area Couple 35 - 44 Biological/Health Family 45 - 54 Cognitive Function Group 55 - 64 Emotional/Behavioural Type of Work 65 - 75 Social/Interpersonal Direct 75 + Problem Duration Indirect - Carers Ethnicity < 1 year Indirect - White British < 5 years Contact Time (D = Direct, C = Consultation/Liaison) White Irish < 10 years < 2 hours White Other > 10 years < 5 hours White/Caribbean Problem Severity < 10 hours White/African Mild < 15 hours White/Asian Moderate < 25 hours White/Other Severe 25 + Indian Challenging Behaviour Assessment Methods Pakistani Yes Interview Bangladeshi Life Events Observations Asian Other Bereavement/Loss Self-Report Tools Black Caribbean Health Standardised Tests African Abuse Neuropsychology Tests Black Other Trauma Models Chinese Other Behavioural Other Disabilities Cognitive Behavioural (CBT) Social Class Communication Psychodynamic 1.1 – Employers, senior managers Learning Systemic Mobility Cognitive analytic (CAT) 1.2 – Higher professionals Sensory Integrative 2– Intermediate professionals Other Community/critical 3 – Intermediate Other (specify) 4 – Small employers Service Setting 5 – Low supervisory Primary Care 6 – Semi-routine Secondary 7 – Routine In-Patient/Residential 8 – Long term unemployed Other e.g. third sector (specify) Confirmed and signed by: Trainee: Supervisor: Date: ________
Appendix-7-Practice-Learning-Portfolio-2016.docx