"Strengths, Needs and Cultural Discovery Template - Soc/Ohti Site" - Oklahoma

Strengths, Needs and Cultural Discovery Template - Soc/Ohti Site is a legal document that was released by the Oklahoma Department of Mental Health and Substance Abuse Services - a government authority operating within Oklahoma.

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Name of SOC/OHTI Site
Strengths, Needs and Cultural Discovery
Young Adult’s Name:
Parent/Guardian’s Name (if applicable):
Date of Interview:
Date(s) of Update:
Referral Source:
Person(s) Providing Information:
Name:
Relationship:
Name:
Relationship:
Name:
Relationship:
________________________________________________________________________
Long Range Vision :
Employment and Career:
Educational Opportunities:
Living Situation:
Family :
1
Name of SOC/OHTI Site
Strengths, Needs and Cultural Discovery
Young Adult’s Name:
Parent/Guardian’s Name (if applicable):
Date of Interview:
Date(s) of Update:
Referral Source:
Person(s) Providing Information:
Name:
Relationship:
Name:
Relationship:
Name:
Relationship:
________________________________________________________________________
Long Range Vision :
Employment and Career:
Educational Opportunities:
Living Situation:
Family :
1
Social/Interpersonal Relationships :
Daily Living and Leisure Time Activities/Recreation:
Safety:
Community Partnerships and Responsibilities:
Legal:
Spiritual:
Communication :
Self Determination :
Emotional and Behavioral Well-Being :
Physical Health :
Other (Transportation, Pets, Sports, etc. ):
Priority Needs or Concerns of the Young Adult, Family, and/or Professionals :
Transition Team Members and Relationship to Young Adult and/or Family:
Relationship to
Name
Young Adult and/or Family
2
Signatures:
___________________________________
_________________
Young Adult
Date
___________________________________
_________________
Parent/Guardian(s)
Date
___________________________________
_________________
Family Member
Date
___________________________________
_________________
Family Member
Date
___________________________________
_________________
Family Member
Date
___________________________________
_________________
Care Coordinator/
Date
Transitional Facilitator
___________________________________
_________________
Family Support Provider/
Date
Transitional Mentor
3
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