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Mental Health Counselor Template

Guidance Counsellor School-Based Intervention Case Note

A professional Mental Health Counselor template for healthcare professionals.
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About this template

Streamline your school counselling documentation with Heidi's Guidance Counsellor School-Based Intervention Case Note template. Perfect for mental health counselors, school psychologists, and guidance officers, this template helps you meticulously record essential details of student interventions. From documenting the type of support provided – such as academic planning or social-emotional assistance – to summarising key discussions, consultations, and agreed outcomes, every aspect of your case management is covered. This structured approach ensures clear, comprehensive notes, making it easier to track student progress and maintain a consistent record of care within the educational setting. Enhance your workflow and ensure no critical detail is missed with this intuitive template.

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**Type of intervention:** Academic Planning and Social-Emotional Support **Background / Context** Student, [Name: Emily Davis], aged 15, was referred by her English teacher, Ms. Thompson, due to a noticeable decline in academic performance (from B's to C's and D's in the last month) and increased social withdrawal. Emily has historically been a high-achieving student with a good peer group. Her parents recently separated, and she has moved to a new home with her mother. She reports feeling overwhelmed with schoolwork and struggling to connect with her friends since the move. Prior support included informal check-ins from Ms. Thompson and a brief conversation with the Year Level Coordinator. **Actions / Discussion Summary** During the session, Emily expressed feelings of sadness, anxiety, and difficulty concentrating in class. She reported feeling isolated from her previous friend group and overwhelmed by the change in her home environment. We discussed her current academic load and strategies for time management and prioritisation. Emily identified specific subjects she is struggling with (Maths and Science). We explored her feelings about the separation and relocation, acknowledging the significant impact these life changes are having. We collaboratively brainstormed ways to re-engage with her hobbies and social activities. Key decisions included setting up a weekly check-in with the guidance counsellor, exploring after-school study support for Maths, and discussing a potential meeting with her parents to establish a consistent study routine at home. Emily agreed to try one new social activity this week. **Consultation / Communication** Consulted with Ms. Thompson (English Teacher) regarding Emily's academic decline and social changes, which prompted the initial referral. Discussed with Year Level Coordinator, Mr. Henderson, to inform him of the initial assessment and planned interventions, ensuring a coordinated approach within the school environment. **Outcomes** Emily committed to attending weekly counselling sessions, attempting the suggested study strategies, and participating in one new social activity. Agreed to review academic progress and emotional well-being in two weeks. A parent meeting will be scheduled to discuss home support strategies. **Plan / Follow-up** Next steps include scheduling a follow-up session for 15 November 2024 to review progress on academic strategies and social engagement. The case will remain open for monitoring for the remainder of the term, with a reassessment planned for the beginning of the next term. Referral to external mental health services will be considered if no significant improvement is observed within the next month. A meeting with parents is scheduled for 8 November 2024.
**Type of intervention:** [type of intervention] (An example of an intervention is AARA, QTAC, attendance, academic planning, parent meeting. Only include if explicitly mentioned in transcript, context or clinical note; else omit section entirely.) **Background / Context** [background and context] (Summarise the reason for contact or referral. Include relevant background, prior support, or documentation. Only include if explicitly mentioned in transcript, context or clinical note; else omit section entirely.) **Actions / Discussion Summary** [actions and discussion summary] (Summarise main discussion points and actions taken. Include student/parent/staff input, key decisions, and next steps. Only include if explicitly mentioned in transcript, context or clinical note; else omit section entirely.) **Consultation / Communication** [consultation and communication] (Summarise who was consulted and why, such as staff, parent, or external service. Record only factual communication relevant to intervention. Only include if explicitly mentioned in transcript, context or clinical note; else omit section entirely.) **Outcomes** [outcomes] (Summarise agreed outcomes or follow-up responsibilities. Only include if explicitly mentioned in transcript, context or clinical note; else omit section entirely.) **Plan / Follow-up** [plan and follow-up] (Outline next steps and timeframe. Include if case will remain open for monitoring or be closed. Only include if explicitly mentioned in transcript, context or clinical note; else omit section entirely.)
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Specialty

Mental Health Counselor

Used

7 times

Type

Note

Last edited

6/3/2026

Created by

Anonymous

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