Core Intake Components Map Lesson Plan Core Intake Components Map
Small Group Professional Development • Tier 2 Support
60 Minutes
Purpose
Consistent, empathy-driven intakes improve student trust, accurate needs assessment, and targeted interventions, strengthening the foundation of Tier 2 support systems.
Audience & Approach
Audience: Small Group of School CounselorsApproach: Interactive mapping, role-play, and reflective application.
Learning Objective
Enable school counselors to apply a structured, empathetic clinical intake process by identifying core components, practicing empathetic interviewing, accurately organizing intake data, and using quality checks for consistent Tier 2 support.
Preparation (10 Minutes)
Reserve a small-group meeting space with chairs arranged in a circle or around a table.
Print or project the Empathy-Driven Interview Guide , Warm Welcome Dialogue , Intake Data Organizer , and Intake Quality Checklist .
Set up a whiteboard or flip chart for mapping core intake components.
Review all materials to familiarize yourself with key prompts and guidelines.
Session Outline
5 MIN
Welcome & Objectives
Greet participants and emphasize the importance of structured, empathetic intakes.
Review session objectives and agenda.
Establish group norms (respect, confidentiality, active participation).
15 MIN
Map Core Intake Components
Introduce the concept of a Core Intake Components Map.
Distribute Intake Data Organizer worksheet.
In small groups, brainstorm essential intake elements (e.g., presenting concerns, history, strengths).
Co-create a visual map on the whiteboard capturing these components.
20 MIN
Empathy-Driven Interview Role-Play
Pair participants; assign roles of counselor and student.
Provide each pair with the Warm Welcome Dialogue script and Empathy-Driven Interview Guide .
Conduct a 5-minute mock intake, focusing on empathetic tone and question flow.
Rotate roles and repeat, observing and providing peer feedback on empathy skills.
15 MIN
Documenting & Quality Checking
Using notes from the role-play, participants complete the Intake Data Organizer .
Apply the Intake Quality Checklist to self-assess completeness and empathetic engagement.
Discuss in groups any gaps or strengths identified through the checklist.
5 MIN
Reflection & Next Steps
Invite participants to share one key takeaway or action step.
Discuss strategies for integrating this intake framework into daily practice.
Highlight follow-up resources and schedule a brief coaching check-in.
Empathy Driven Interview Guide Slides Small Group PD
Empathy-Driven Interview Guide
Building trust and gathering insights through clinical intake.
Counselors
60 Minutes
Introduce the slide deck and set expectations. Emphasize the connection to the Core Intake Components Map.
Why Empathy Matters
Empathy is the foundation of effective intake:
Builds Rapport
Increases student comfort and emotional safety during the initial meeting.
Encourages Sharing
Lowers barriers to honest, open disclosure about difficult topics.
Improved Accuracy
Leads to higher quality data and more precise assessment of student needs.
Strengthens Bonds
Lays the groundwork for ongoing trust and successful Tier 2 interventions.
Explain why empathy matters in building trust and gathering accurate information.
Core Principles of Empathy
1
Active Listening
Full attention, minimal interruption, and processing both words and emotions.
2
Unconditional Positive Regard
Conveying acceptance without judgment; seeing the student as capable of growth.
3
Attuned Non-Verbal Cues
Open posture, appropriate eye contact, and empathetic nodding.
Highlight the three core principles and provide examples of each during the discussion.
Interview Flow Overview
1. Warm Welcome & Rapport Building
2. Exploration & Open-Ended Questions
3. Reflective Listening & Clarification
4. Summarizing Key Points
5. Closing & Next Steps
Walk through each phase of the interview flow before diving into details.
PHASE 1
Warm Welcome
The first 60 seconds set the tone for the entire relationship.
Greet student by name and introduce yourself.
Acknowledge nerves: "I know meeting someone new can feel uncomfortable."
Explain purpose and confidentiality clearly.
Resource Highlight
"See the Warm Welcome Dialogue script for full phrasing examples and scripts to use in your role-play."
Refer counselors to the detailed script in the Warm Welcome Dialogue material for more examples.
PHASE 2
Open-Ended Questions
Sample Prompts to Use:
“Can you tell me more about what brought you in today?”
Warm Welcome Dialogue Script Warm Welcome Dialogue
Practice Script for Clinical Intake
Instructions for Role-Play: Use this script during your 5-minute mock intake. Focus on maintaining an empathetic tone, open body language, and natural pacing.
Counselor
“Hi [Student Name], it’s nice to meet you. I’m [Your Name], one of the school counselors here at [School Name].”
Counselor
“Before we get started, I want you to know that this is a safe and confidential space. That means what we talk about stays between us—unless I’m really worried about your safety or someone else’s safety. If that ever comes up, I’ll let you know right away.”
Counselor
“I know meeting someone new and talking about personal things can feel a little uncomfortable. It’s totally normal to feel nervous.”
Counselor
“My job is to listen and support you, no judgment—just a caring ear. You can share as much or as little as you’re comfortable with, and you can take all the time you need.”
Initial Opening
“To begin, could you tell me what brought you here today? Or, if it’s easier, tell me how your day or week has been so far.”
(Wait for student to respond. Use active listening cues: nodding, eye contact.)
If student hesitates or seems stuck:
“I’m here to help you feel heard. You’re in charge of this conversation—there’s no rush. Sometimes it helps to start by talking about something small, like what you enjoy doing outside of school.”
Follow-up Prompts:
“What’s one thing that’s been on your mind lately?”
“How have things been going at school or at home?”
“Is there anything that feels hard or stressful right now?”
Closing the Opening
“Thank you for sharing. I appreciate you trusting me with what’s on your mind. We’ll move at a pace that feels right for you.”
Intake Data Organizer Worksheet Intake Data Organizer
Confidential Student Record • Clinical Intake Documentation
Student Name
Date of Intake
Grade / Year
Referral Source
I. Presenting Concerns
1. Main reason for referral:
2. Duration and frequency of concerns:
3. Impact on school and home functioning:
II. Background & History
• Academic History (grades, learning challenges, attendance):
• Family & Environmental Context:
• Social & Peer Relationships:
• Behavioral or Emotional History:
III. Strengths & Resources
• Student’s personal strengths, interests, and talents:
• Supports at school (staff, mentors, specific programs):
• Supports at home and in the community:
IV. Observations & Emotional Tone
Affect / Mood:
Nonverbal Behavior:
Notable quotes or key student phrases:
V. Preliminary Assessment & Next Steps
1. Emerging needs or priority areas for support:
2. Recommended next steps (counseling goals, referrals, meetings):
3. Timeline / Scheduled follow-up date:
Additional Notes & Observations
Documentation of clinical intake is confidential and should be stored according to district policy and FERPA/HIPAA guidelines.
Intake Quality Checklist Rubric Intake Quality Checklist
Self-Assessment & Peer Review Rubric
Guidelines
Use this rubric to assess the quality of a clinical intake, focusing on structure, empathy, documentation, and action planning. Score each criterion on a 4-point scale:
4 = Exceeds 3 = Meets 2 = Approaching 1 = Needs Improvement
Criterion 4 – Exceeds 3 – Meets 2 – Approaching 1 – Needs Imp. Core Component Coverage Thoroughly captures all essential intake elements (presenting concerns, history, strengths, observations, emotional tone, preliminary assessment) with rich detail. Addresses most essential intake elements with sufficient detail; minor gaps in information. Covers some key elements but omits important components or provides minimal detail. Many essential components missing or addressed superficially. Empathy & Engagement Demonstrates exceptional empathy: active listening, unconditional positive regard, attuned non-verbal cues, and effective gentle probing throughout. Shows consistent empathy: good use of reflective listening, positive tone, and appropriate non-verbals; minor lapses. Uses some empathetic techniques but inconsistently; minimal non-verbal attunement or probing. Little or no use of empathetic skills; interactions feel rushed, judgmental, or disengaged. Documentation Quality Organizes intake notes clearly and logically; accurately records emotional tone, key quotes, and contextual details; easy to follow. Documentation is clear and organized with minor inaccuracies or omissions; most key details included. Notes are somewhat disorganized or incomplete; missing contextual details or emotional tone. Documentation is disorganized, incomplete, or illegible; fails to capture key details or tone. Next Steps & Action Planning Provides specific, realistic, and measurable next steps or referrals, including timeline/follow-up date. Lists appropriate next steps with general timeline; may lack some specificity or measurability. Suggests vague or partially relevant next steps; timeline or follow-up details missing or unclear. No clear next steps or recommendations; fails to identify areas for support or follow-up.
Total Score _______ / 16
Interpretation
14–16: Exemplary intake practiceExcellent
10–13: Solid practice with room for growthSatisfactory
