6 THE SEVERE AND PERSI STENT MENTAL ILLNESS PROGRESS NOTES PLAN NER D. The client could not identify painful experi ences related to poor performance of basic ADLs and was asked to continue to focus in these areas. 5. Review Medical Risks (5) A. Specific medical risks associated with poor hygiene and nutrition or lack of attention to other ADLs were reviewed. B. Medi cal risks (e. g., dental problems, risk of infection, lice, and other health problems) were identified and discussed. C. The client was assisted in developing an understanding about the medical risks associated with poor nutrition and hygiene or lack of at tention to other ADLs. D. The client agreed that he/she is at a higher medical risk due to poor nutrition and hygiene or lack of attention to other ADLs and was focused on remediation efforts. E. The client rejected the identified concerns regarding medi cal risks. 6. Facilitate Expressing Emotions (6) A. The client was assisted in expressing his/her emotions related to impaired performance in ADLs. B. The client was assisted in identifying specific emotions regarding impaired performance in ADLs (e. g., embarrassment, depression, and low self-esteem). C. Empathy was provided to the client as he/she expressed his/her emotions regarding impaired performance in ADLs. D. The client was reluctant to admit to any negative emotions regarding impaired perform ance of ADLs and was provided with feedback about likely emotions that he/she may experience. 7. Identify Secondary Gain (7) A. The possible secondary gain associated with decreased ADL functioning was reviewed. B. The client identified specific seconda ry gains that he/she has attained for decreased functioning in ADLs (e. g., less involvement in potentially difficult social situations), and these were reviewed within the session. C. The client denied any pattern of secondary gain related to decreased fu nctioning in his/her ADLs and was provided with hypothetical examples of the secondary gains. 8. Refer for Psychological Testing (8) A. The client was referred for an assessment of cognitive abilities and deficits. B. Objective psychological testing was administered to the client to assess his/her cognitive strengths and weaknesses. C. The client cooperated with the psychological testing, and he/she received feedback about the results. D. The psychological testing confirmed the presence of specific cog nitive abilities and deficits. E. The client was not compliant with taking the psychological evaluation and was encouraged to participate completely. 9. Recommend Remediating Programs (9) A. The client was referred to remediating programs that are focus ed on removing deficits for performing ADLs, including skill-building groups, token economies, or behavior-shaping programs. 