برنامج خاص جدا لدراسة الحالة

دراسة حالة فردية
اولاً:بيانات عامة :-

*الاسم (الحروف الاولى):.................................................................................................................................
*تاريخ ومحل الميلاد:..........................................................................................................................................
*العمر: .........................................................................................................................................................................
*السنة الدراسية والصف: ................................................................................................................................
*تاريخ سجل الحالة : .........................................................................................................................................
*مصدر التحويل : ..................................................................................................................................................

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ثانياً :معلومات عن المشكلة او الاضطرابات :

*وصف المشكلة :

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*الوقت الذى ظهرت فيه المشكلة :

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*الإجراءات التى اتخذتها المدرسة منذ ظهور المشكلة :

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*تحديد مستوى المشكلة من جانب العميل :

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ثالثاً : الحالة الجسمية والصحية :

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رابعاً :الحالة التعليمية :

*التحاق الطالب بالحضانة : .............................................................................................................................................................................................

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*السن الذى التحق به بالمرحلة الأبتدائية :
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*الصف الدراسى :

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*مستوى التحصيل الدراسى :

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*المواد الدراسية المتفوق فيها :

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*المواد الدراسية المتعثر فيها :

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خامساً : سلوك الطالب فى حجرة الدراسة :

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سادساً : العلاقات الأسرية والمشكلات المرتبطة بها :
*اهم المشكلات داخل الاسرة والتى تؤثر على الطالب :

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*ما اهم الاحداث الضاغطة التى تعرض لها الطالب :

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سابعاً : الحالة الأنفعالية :

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ثامناً : العلاقات الأجتماعية
*العلاقة بالمعلمين وادارة المدرسة :

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* العلاقة بالأصدقاء داخل المدرسة وخارجها :

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*الهويات وانشطة وقت الفراغ :

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* المهارات الأجتماعية :

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تاسعاً :مواجهة الضغوط والمشكلات واتخاذ القرارات :

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1- تحديد المشكلة أو الأضطراب :

*وصف المشكلة :

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*الاعراض المصاحبة لحدوث المشكلة :

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*مرات تكرار حدوث المشكلة :

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*بداية حدوث المشكلة :

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*الظروف التى تحدث فيها المشكلة :

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*العوامل التى ساعدت على استمرار المشكلة :
1-عوامل فى محيط المدرسة :

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2- عوامل فى محيط الأسرة :

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3- عوامل فى محيط العلاقات الأجتماعية :

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2- الاهداف التى يسعى الى تحقيقها الأخصائى النفسى:

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3- الاختبارات والمقاييس التى استخدمت مع العميل :

اسم الأختبار : .....................................................................................................................................................

موضوعه : .........................................................................................................................................................

تاريخ التطبيق : .................................................................................................................................................

اهم النتائج : ........................................................................................................................................................

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اسم الأختبار : .....................................................................................................................................................

موضوعه : .........................................................................................................................................................

تاريخ التطبيق : .................................................................................................................................................

اهم النتائج : ........................................................................................................................................................

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4- مصادر المعلومات :

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5- طرق وأساليب الخدمة النفسية المقترحة :

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6- الطرق والأساليب التى تم اختيارها للتطبيق :

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* الأجراءات الإدارية المطلوبة لدراسة الحالة :
1- الأتصال بالمعلمين :

*اسم المعلم : .................................................... * المادة : .........................................................................

* تاريخ المقابلة : ..........................................................................................................................................................

*الغرض من المقابلة : ..................................................................................................................................................

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* النتيجة : ........................................................................................................................................................................

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*اسم المعلم : .................................................... * المادة : .........................................................................

* تاريخ المقابلة : ..........................................................................................................................................................

*الغرض من المقابلة : ..................................................................................................................................................

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* النتيجة : ........................................................................................................................................................................

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*اسم المعلم : .................................................... * المادة : .........................................................................

* تاريخ المقابلة : ..........................................................................................................................................................

*الغرض من المقابلة : ..................................................................................................................................................

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* النتيجة : ........................................................................................................................................................................

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2- الأتصال بالإدارة المدرسية :


* تاريخ المقابلة : ..........................................................................................................................................................

*اسباب لمقابلة : ..............................................................................................................................................................

* النتيجة : .........................................................................................................................................................................

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3- الأتصال بالأسرة (ولى الأمر) :


* تاريخ المقابلة : ..........................................................................................................................................................

*اسباب لمقابلة : ..............................................................................................................................................................

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* النتيجة : .........................................................................................................................................................................

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7- جلسات المقابلة :
* الجلسة الأولى :
* اليوم : ....................................................................... * التاريخ : ........................................................................

* المكان : ..................................................................... * زمن المقابلة : .............................................................

*هدف المقابلة : .............................................................................................................................................................

*محتوى الجلسة :

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* الجلسة الثانية :
* اليوم : ....................................................................... * التاريخ : ........................................................................

* المكان : ..................................................................... * زمن المقابلة : .............................................................

*هدف المقابلة : .............................................................................................................................................................

*محتوى الجلسة :

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* الجلسة الثالثة :
* اليوم : ....................................................................... * التاريخ : ........................................................................

* المكان : ..................................................................... * زمن المقابلة : .............................................................

*هدف المقابلة : .............................................................................................................................................................

*محتوى الجلسة :

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* الجلسة الرابعة :
* اليوم : ....................................................................... * التاريخ : ........................................................................

* المكان : ..................................................................... * زمن المقابلة : .............................................................

*هدف المقابلة : .............................................................................................................................................................



*محتوى الجلسة :


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8-الأحالات التى تمت للطالب :
* اسم الجهة : ............................................................. * تاريخ التحويل :......................................................

*اسباب التحويل : ......................................................................................................................................................

*النتائج : .......................................................................................................................................................................

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9- متابعة الطالب :
* تاريخ المتابعة : ......................................................................................................................................................

* اهم النتائج : .............................................................................................................................................................

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10- النتائج بعد التطبيق :
1- بالنسبة للهدف الأول :........................................................................................................................................

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2- بالنسبة للهدف الثانى :..................................................................................................................................

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3- بالنسبة للهدف الثالث:........................................................................................................................................

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4- بالنسبة للهدف الرابع:........................................................................................................................................

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11- إقفال الحالة :
* تاريخ إقفال الحالة : ..............................................................................................................................................

*ملخص ما تم :

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* توصيات الإخصائى النفسى بشأن الحالة :

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* تقويم الإخصائى النفسى لمدى تحقق الأهداف الخاصة بالحالة :

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* اسباب عدم تحقيق الأهداف :


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التاريخ توقيع الإخصائى النفسى