حمادة
ادارة الموقع
عدد المساهمات : 30
تاريخ التسجيل : 26/12/2009
الموقع : مركز الحسينية شرقية جزيرة عليوة
 |  موضوع: برنامج خاص جدا لدراسة الحالة الأحد نوفمبر 14, 2010 4:20 pm | |
| دراسة حالة فردية
اولاً:بيانات عامة :-
*الاسم (الحروف الاولى):.................................................................................................................................
*تاريخ ومحل الميلاد:..........................................................................................................................................
*العمر: .........................................................................................................................................................................
*السنة الدراسية والصف: ................................................................................................................................
*تاريخ سجل الحالة : .........................................................................................................................................
*مصدر التحويل : ..................................................................................................................................................
.............................................................................................................................................................................................
ثانياً :معلومات عن المشكلة او الاضطرابات :
*وصف المشكلة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
*الوقت الذى ظهرت فيه المشكلة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
*الإجراءات التى اتخذتها المدرسة منذ ظهور المشكلة :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
*تحديد مستوى المشكلة من جانب العميل :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
ثالثاً : الحالة الجسمية والصحية :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
رابعاً :الحالة التعليمية :
*التحاق الطالب بالحضانة : .............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
*السن الذى التحق به بالمرحلة الأبتدائية :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
*الصف الدراسى :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
*مستوى التحصيل الدراسى :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
*المواد الدراسية المتفوق فيها :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
*المواد الدراسية المتعثر فيها :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
خامساً : سلوك الطالب فى حجرة الدراسة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
سادساً : العلاقات الأسرية والمشكلات المرتبطة بها :
*اهم المشكلات داخل الاسرة والتى تؤثر على الطالب :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
*ما اهم الاحداث الضاغطة التى تعرض لها الطالب :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
سابعاً : الحالة الأنفعالية :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
ثامناً : العلاقات الأجتماعية
*العلاقة بالمعلمين وادارة المدرسة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
* العلاقة بالأصدقاء داخل المدرسة وخارجها :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
*الهويات وانشطة وقت الفراغ :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
* المهارات الأجتماعية :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
تاسعاً :مواجهة الضغوط والمشكلات واتخاذ القرارات :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
1- تحديد المشكلة أو الأضطراب :
*وصف المشكلة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
*الاعراض المصاحبة لحدوث المشكلة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
*مرات تكرار حدوث المشكلة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
*بداية حدوث المشكلة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
*الظروف التى تحدث فيها المشكلة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
*العوامل التى ساعدت على استمرار المشكلة :
1-عوامل فى محيط المدرسة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
2- عوامل فى محيط الأسرة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
3- عوامل فى محيط العلاقات الأجتماعية :
.............................................................................................................................................................................................
............................................................................................................................................................................................
2- الاهداف التى يسعى الى تحقيقها الأخصائى النفسى:
1- .......................................................................................................................................................................................
2- .......................................................................................................................................................................................
3-........................................................................................................................................................................................
4- ......................................................................................................................................................................................
3- الاختبارات والمقاييس التى استخدمت مع العميل :
اسم الأختبار : .....................................................................................................................................................
موضوعه : .........................................................................................................................................................
تاريخ التطبيق : .................................................................................................................................................
اهم النتائج : ........................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
اسم الأختبار : .....................................................................................................................................................
موضوعه : .........................................................................................................................................................
تاريخ التطبيق : .................................................................................................................................................
اهم النتائج : ........................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
4- مصادر المعلومات :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
5- طرق وأساليب الخدمة النفسية المقترحة :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
............................................................................................................................................................................................
6- الطرق والأساليب التى تم اختيارها للتطبيق :
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
* الأجراءات الإدارية المطلوبة لدراسة الحالة :
1- الأتصال بالمعلمين :
*اسم المعلم : .................................................... * المادة : .........................................................................
* تاريخ المقابلة : ..........................................................................................................................................................
*الغرض من المقابلة : ..................................................................................................................................................
.............................................................................................................................................................................................
* النتيجة : ........................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
****************************************************
*اسم المعلم : .................................................... * المادة : .........................................................................
* تاريخ المقابلة : ..........................................................................................................................................................
*الغرض من المقابلة : ..................................................................................................................................................
.............................................................................................................................................................................................
* النتيجة : ........................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
****************************************************
*اسم المعلم : .................................................... * المادة : .........................................................................
* تاريخ المقابلة : ..........................................................................................................................................................
*الغرض من المقابلة : ..................................................................................................................................................
.............................................................................................................................................................................................
* النتيجة : ........................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
2- الأتصال بالإدارة المدرسية :
* تاريخ المقابلة : ..........................................................................................................................................................
*اسباب لمقابلة : ..............................................................................................................................................................
* النتيجة : .........................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
***********************************************
3- الأتصال بالأسرة (ولى الأمر) :
* تاريخ المقابلة : ..........................................................................................................................................................
*اسباب لمقابلة : ..............................................................................................................................................................
.............................................................................................................................................................................................
* النتيجة : .........................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
............................................................................................................................................................................................
7- جلسات المقابلة :
* الجلسة الأولى :
* اليوم : ....................................................................... * التاريخ : ........................................................................
* المكان : ..................................................................... * زمن المقابلة : .............................................................
*هدف المقابلة : .............................................................................................................................................................
*محتوى الجلسة :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
* الجلسة الثانية :
* اليوم : ....................................................................... * التاريخ : ........................................................................
* المكان : ..................................................................... * زمن المقابلة : .............................................................
*هدف المقابلة : .............................................................................................................................................................
*محتوى الجلسة :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
* الجلسة الثالثة :
* اليوم : ....................................................................... * التاريخ : ........................................................................
* المكان : ..................................................................... * زمن المقابلة : .............................................................
*هدف المقابلة : .............................................................................................................................................................
*محتوى الجلسة :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
****************************************************
* الجلسة الرابعة :
* اليوم : ....................................................................... * التاريخ : ........................................................................
* المكان : ..................................................................... * زمن المقابلة : .............................................................
*هدف المقابلة : .............................................................................................................................................................
*محتوى الجلسة :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
8-الأحالات التى تمت للطالب :
* اسم الجهة : ............................................................. * تاريخ التحويل :......................................................
*اسباب التحويل : ......................................................................................................................................................
*النتائج : .......................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
9- متابعة الطالب :
* تاريخ المتابعة : ......................................................................................................................................................
* اهم النتائج : .............................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
10- النتائج بعد التطبيق :
1- بالنسبة للهدف الأول :........................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
2- بالنسبة للهدف الثانى :..................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
3- بالنسبة للهدف الثالث:........................................................................................................................................
.............................................................................................................................................................................................
............................................................................................................................................................................................
4- بالنسبة للهدف الرابع:........................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
11- إقفال الحالة :
* تاريخ إقفال الحالة : ..............................................................................................................................................
*ملخص ما تم :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
* توصيات الإخصائى النفسى بشأن الحالة :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
* تقويم الإخصائى النفسى لمدى تحقق الأهداف الخاصة بالحالة :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
.............................................................................................................................................................................................
* اسباب عدم تحقيق الأهداف :
.............................................................................................................................................................................................
.............................................................................................................................................................................................
التاريخ توقيع الإخصائى النفسى | |
|
