BrICC CASE PORTFOLIO CLIENT (Dx, age, primary concern) INTERVENTION VARIABLES OUTCOME MEASUREMENT Cognitive Domain Functional Domain Approach Check all that apply; fill in the blanks with specific approach where indicated How to measure progress in the session Note: Standardized may be used pre/post if intervention was impairment-based. How to measure generalization or impact on daily life Specify what the client or caregiver is tracking or rating where indicated by blank lines Attention Orientation Memory Executive Function Problem Solving Self-Awareness Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing Other academic strategy instruction performed accurately during probe using systematic instruction Time to complete task Accuracy at _________________ Tracking filled out by client: _________________ Tracking sheet filled out by caregiver: _________________ Self-rating Direct Observation: _________________
Social Communication Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion of performance Other Functional Domain: _________________ Computer-based prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: _________________ Videofeedback _________________ support/counseling Number of correct information units recalled Self-rating scale: _________________ Other: _________________ _________________ Other: _________________
Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance Other Other Functional Domain: _________________ Spaced Retrieval Training GMT Social communication intervention: _________________ Videofeedback _________________ support/counseling Environmental modification: _________________ _________________ Attention Orientation Academic: Reading Writing Note-taking Attending to lecture DAT w/strategies Metacognitive strategy Steps performed accurately during probe using Tracking sheet filled out by client: _________________
Memory Executive Function Problem Solving Self-Awareness Social Communication Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ instruction: _________________ SRSD for writing Other academic strategy instruction prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: _________________ systematic instruction Time to complete task Accuracy at _________________ Number of correct information units recalled Self-rating scale: _________________ _________________ Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ _________________ Other: _________________
Vocational: Job task completion Speed/Accuracy of performance Other Other Functional Domain: _________________ Videofeedback _________________ support/counseling Environmental modification: Other: _________________ Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing academic strategy instruction prompting for writing Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at _________________ Number of correct information units recalled Tracking sheet filled out by client: _________________ Tracking filled out by caregiver: _________________ Self-rating Direct Observation: _________________
Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance Other Functional Domain: _________________ External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: _________________ Videofeedback _________________ support/counseling Environmental modification: Self-rating scale: _________________ Other: _________________ _________________ _________________
Other: _________________ Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing academic strategy instruction prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training performed accurately during probe using systematic instruction Time to complete task Accuracy at _________________ Number of correct information units recalled Self-rating scale: _________________ Other: _________________ Tracking filled out by client: _________________ Tracking filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ _________________ _________________
Problem Solving Self-Awareness Social Communication Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion Speed/Accuracy of performance academic strategy instruction Computer-based prompting for writing External aid training:/Assistive Technology for Cognition Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: _________________ Videofeedback _________________ Accuracy at _________________ Number of correct information units recalled Self-rating scale: _________________ Other: _________________ Direct Observation: _________________ _________________ Other: _________________
Other Other Functional Domain: _________________ support/counseling Environmental modification: Other: _________________ Attention Orientation Memory Executive Function Problem Solving Self-Awareness Social Communication Academic: Reading Writing Note-taking Attending to lecture Homework completion Other_________________ Communication: Participating in conversations Increasing social involvement Social cognition Texting/emailing Recalling details of conversations Other_________________ Psychosocial/Personal Care Managing symptoms Behavioral health DAT w/strategies Metacognitive strategy instruction: _________________ SRSD for writing Other academic strategy instruction prompting for writing External aid training:/Assistive Technology for Cognition Steps performed accurately during probe using systematic instruction Time to complete task Accuracy at _________________ Number of correct information units recalled Self-rating scale: _________________ Tracking filled out by client: _________________ Tracking sheet filled out by caregiver: _________________ Self-rating scale: Direct Observation: _________________ _________________ Other:
Increasing social/community functioning Self care Other_________________ Community/Home: Transportation Recreation Bill paying: Cooking Money management Household chores Shopping/Errands Parenting Scheduling Other_________________ Vocational: Job task completion of performance Functional Domain: _________________ Functional skills instruction: Spaced Retrieval Training GMT Social communication intervention: _________________ Videofeedback _________________ support/counseling Environmental modification: Other: _________________ Other: _________________ _________________