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COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

COSIG CONFERENCE BROCHURE.pdf - Drexel University College ...

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8<br />

Treatment Attendance Functional Analysis<br />

form 4<br />

Date: ______________________<br />

Patient: ______________________<br />

Directions to Therapist: Try to keep the interview in a non-judgmental, conversational format. Use the<br />

probes to keep the flow of the conversation steady and on track. If at any time, the patient becomes<br />

uncomfortable checkout your impression by asking:<br />

“It seems you're uncomfortable, distressed. What is it about these questions that are hard for<br />

you?”<br />

We asked what you wanted to get out of treatment before. In summary, what are three things you want to<br />

get out of outpatient treatment?<br />

Probes: Tell me more<br />

In what ways?<br />

What would you like from your outpatient therapist?<br />

Probes:<br />

Good listeners? A way to get in touch when things go wrong? On time? They will help me meet my<br />

goals?<br />

Which of the following would make it easier for you to get to your outpatient appointments?<br />

1. Transportation: __________________________________________________________<br />

2. Childcare: ______________________________________________________________<br />

3. Money: ________________________________________________________________<br />

4. Information: _____________________________________________________________<br />

5. Other: _________________________________________________________________<br />

Who would encourage your efforts to get treatment? How for each person?<br />

____________________________________________________________________________________<br />

____________________________________________________________________________________<br />

____________________________________________________________________________________<br />

Who would help you get to outpatient treatment?<br />

____________________________________________________________________________________<br />

____________________________________________________________________________________<br />

____________________________________________________________________________________<br />

What could you do to make sure you get to your outpatient appointments?<br />

____________________________________________________________________________________<br />

____________________________________________________________________________________<br />

Would any of the following be helpful:<br />

1. Phone reminder of upcoming appointments?

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