County Probation Alternatives Program Name: Collette Rose DOB: 12/04/1978 Client number: 10409 Date of Initial Contact: Dec 12, 2011 Date of Evaluation: Dec 12, 2011 Primary Counselor: Barbara Jackson, CSAC Address: c/o Stephanie Montaine 20 Court Place Some Town, YY 12345 Collaterals: Stephanie Montaine, sister Phone: (111) 222-3487 (Stephanie Montaine) Diagnosis: Alcohol abuse, Bipolar Disorder Referral Ms. Rose was ordered into treatment as a term of her probation upon release from Any County Jail. Psychosocial History Collette Rose is a thirty-three year old Caucasian female. She is a single mother with a long history of alcohol abuse. She is currently experiencing homelessness. She has been diagnosed with Bipolar Disorder at Any County Jail and County General Hospital. Much of the information for this evaluation was obtained from her half-sister Stephanie Montaine or with her encouragement. Current Substances of Abuse Ms. Rose prefers drinking alcohol. She does not drink every day because she does not have access. When she does have money she will buy 750ml of vodka and finish the bottle. She reports that it helps her sleep while she is living in her car. Personal and family history suggest that Ms. Rose has a long history of alcohol use, but her current use is intermittent based on lack of access. Substance Use History Age of Onset Alcohol age 12 Marijuana age 16 Cocaine age 20 33 Third Street, Phone: (111) 323-3223 Some Town, YY 12347 Fax: (111) 323-3224
County Probation Alternatives Program Ms. Rose claims that she started drinking alcohol when she was 12 and her stepfather began abusing her. He would give her beer and she felt that the alcohol helped numb the pain. She says that later when she would drink to excess that she would pass out and wake up in the emergency department. She reports that she has tried other drugs that boyfriends have offered her but that she didn t get addicted to anything else. She would just use to numb the pain. She has a past history of experimentation with other drugs. She has no specific drug of choice, besides alcohol. Family History of Substance Use Ms. Rose reports that her mother used to be an alcoholic but stopped drinking when she was 11 years old. She was exposed to alcohol and other drug use by her mother s boyfriends and then later by her foster parents. Participation in Self-Help Programs Ms. Rose has not consistently participated in AA meetings. She says that when she goes she feels like everyone is judging her. She also complains of not having enough energy to make it there. Detox and Other Substance Use Treatment (outside this program). Ms. Rose reports that she was sober during both of her pregnancies and that she did this without the help of a treatment program. Legal History In 2006, Ms. Rose had two charges of driving while under the influence of alcohol and her license was suspended. She participated in a six-week educational program and her license was restored. Various arrests for larceny, trespassing and other minor crimes. Health Issues Diabetes and high blood pressure. Not currently under control. Referral to Local Charities Health Clinic should be made. Psychiatric History Diagnosed with bipolar disorder. Previous diagnosis of major depression. She has been hospitalized at County General Hospital for mental illness crises including suicide attempts. She was also treated at Any County Jail mental health services. Family Background Ms. Rose is single and has never been married. She has had many relationships in which she experienced domestic violence. She is not currently seeing anyone. 33 Third Street, Phone: (111) 323-3223 Some Town, YY 12347 Fax: (111) 323-3224
County Probation Alternatives Program Ms. Rose has two children, a 16 year old boy who is in a juvenile detention center and a 3 year old girl who is in foster care. Ms. Rose was raised by her mother and stepfather until she was thirteen. She was then raised by numerous foster families. She experienced both physical and sexual abuse in both her family of origin and with the foster families. Education Finished 8 th grade, left school in the 9 th grade. Work History Ms. Rose has worked at a handful of low-skill jobs the last few years. She has not been able to maintain those jobs for more than a few weeks. Military History None. Plan Weekly urine screens, weekly group sessions and individual sessions Re-assess in 60 days 33 Third Street, Phone: (111) 323-3223 Some Town, YY 12347 Fax: (111) 323-3224