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Treatment Plan Template 02

This document provides a treatment plan for a patient named Jill Spratt who is being treated for depression and family conflict. The plan involves individual therapy, family therapy, and medication management to help Jill learn coping skills and reduce tensions with her family. Progress will be measured through goals related to Jill's depression symptoms, family interactions, and skill development.

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Muhammad Zubair
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203 views5 pages

Treatment Plan Template 02

This document provides a treatment plan for a patient named Jill Spratt who is being treated for depression and family conflict. The plan involves individual therapy, family therapy, and medication management to help Jill learn coping skills and reduce tensions with her family. Progress will be measured through goals related to Jill's depression symptoms, family interactions, and skill development.

Uploaded by

Muhammad Zubair
Copyright
© © All Rights Reserved
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd
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This is a fictitious case.

All names used in the document are fictitious

Sample Treatment Plan


Recipient Information Provider Information
Medicaid Number :12345678 Medicaid Number:987654321
Name: Jill Spratt Name: Tom Thumb, Ph.D.
DOB: 9-13-92 Treatment Plan Date: 10-9-06

Other Agencies Involved: Plan to Coordinate Services:


Jack Horner, M.D., Child Phone contact during the first month of treatment, then as needed, but at least
Psychiatrist 1 time every 3 months.

Spring Hill Middle School Request teacher to complete Achenbach teacher Report Form (TRF) 1 time
during the first month of treatment. Continued contact by phone as needed.

Medication(s): Dose: Frequency: Indication:


Prozac 20 mg 1 x day depression

1. Problem/Symptom: Depression as manifested by sadness, irritability, poor self-esteem, low energy, excessive
sleep and suicidal ideation.

Long Term Goal: Symptoms of depression will be significantly reduced and will no longer interfere with Jill’s
functioning. This will be measured by a t score of 60 or below on the YSR Withdrawn/Depressed scale at the time
of discharge.
Anticipated completion date: 4-2-07

Short Term Goals/Objectives: Date Established Projected Date Acheived


Completion Date

1. Jill and her father will develop a safety plan/no self-harm


contract 10-9-06 10-9-06 10-9-06
2. Jill will become involved in at least one additional
10-9-06 11-02-06
extracurricular activity or sport
3. Jill will report no suicidal ideation for 3 consecutive
10-9-06 12-02-06
weeks
4. Jill will learn coping skills, including problem solving and
emotional regulation. This will be measured by her 10-9-06 1-16-07
demonstrating these skills during therapy sessions and
bringing in homework assignments for two consecutive
weeks that show she practiced them between sessions.
5. Jill will learn to identify maladaptive, negative thoughts
10-9-06 4-02-07
and how to replace them with more positive, adaptive
thoughts. This will be measured by her demonstrating
these skills during therapy sessions and bringing in
homework assignments for two consecutive weeks that
show she practiced them between sessions.

Intervention/Action Responsible Person(s) 1.


Individual therapy to help Jill learn and implement Tom Thumb, Ph.D.
coping skills and to help her identify, process and
resolve feelings and concerns. 2.Jill Spratt 3.
Intervention/actions: Responsible Person(s): 1.
Family Therapy to develop safety plan/no self harm Tom Thumb, Ph.D.
contract, provide psycho-education about depression 2. 3.
to increase parents’ insight into Jill, and to increase Jill Spratt Jack and Joan Spratt, father and
parents’ ability to support and encourage Jill to utilize step-mother
new coping skills.
Intervention/actions: Responsible Person(s): 1.
Medication Management Jack Horner, M.D.
2. 3.

Intervention/actions: Responsible Person(s): 1.

2. 3.

Review Date: Progress:

Review Date: Progress:

2. Problem/Symptom: Family Conflict as manifested by poor communication between Jill and her father, rude
comments towards her step-mother and frequent arguing between Jill and her step-mother. To establish a
baseline, Mr. Spratt was asked to record for one week: 1) the number of times he attempted to talk to Jill about
concerns and she was evasive or withdrew; and 2) the number of times Jill was rude to her step-mother or Jill and
her step-mother argued. “Rude” behavior towards her step-mother included eye rolling; walking away while her
step-mother tried to talk to her; using a hostile or sarcastic tone of voice; and making comments such as “you can’t
tell me what to do, you’re not my parent.” Jill was evasive/withdrew from her father 8 times in one week and
argued/was rude to her step-mother 26 times in one week.

Long Term Goal: Reduce family conflict and increase positive family interactions. This will be measured by
reducing evasive/withdrawn interactions with her father to 1 time a week for 3 consecutive weeks; reducing
arguing/rudeness towards her step-mother to 7 times a week for 3 consecutive weeks; and family will report at least
one positive interaction/family activity per day for 3 consecutive weeks.

Anticipated completion date: 4-2-07

Short Term Goals/Objectives: Date Established Projected Date Achieved


Completion Date

1. Gather baseline data on evasive/withdrawn interactions


with father and arguing/rudeness with step-mother. 10-2-06 10-9-06 10-9-06
2. Family will establish routine times in the week for
10-9-06 10-23-06
communication and/or family activities (i.e., family meetings,
family fun nights). This will be measured by the family
establishing a schedule for communication/activities and
reporting the number of times each week that they followed
the schedule.
3. Jill and her father will learn communication and conflict
resolution skills. This will be measured by Jill and her father 10-9-06 11-23-06
demonstrating the skills, without coaching, to successfully
discuss and resolve issues in 2 consecutive family therapy
sessions.
4. Jill and her step-mother will learn communication and
conflict resolution skills. This will be measured by Jill 10-9-06 12-23-06
and her step-mother demonstrating the skills, without
coaching, to successfully discuss and resolve issues in
2 consecutive family therapy sessions.
5. Reduce evasive/withdrawn interactions with father to 3
times a week 10-9-06 1-23-07
6. Reduce arguing/rudeness to step-mother to 14 times a
week 10-9-06 2-23-07
7. Reduce evasive/withdrawn interactions with father to 1
time a week. 10-9-06 3-9-07
8. Reduce arguing/rudeness to step-mother to 7 times a
week. 10-9-06 4-2-07

Intervention/actions: Responsible Person(s): 1.


Family Therapy to explore and help family understand . Tom Thumb, Ph.D.
family dynamics, negative patterns and problems in 2. 3.
family structure; and to help family learn and use Jill Spratt Jack and Joan Spratt, father and step-
communication and conflict resolution skills. mother
Intervention/actions: Responsible Person(s): 1.
Individual Therapy to explore, process and resolve Tom Thumb, Ph.D.
Jill’s feelings about family members, rules and 2.Jill Spratt 3.
structure; and to reinforce using good communication,
conflict resolution and coping skills at home.
Intervention/actions: Responsible Person(s): 1.

2. 3.

Intervention/actions: Responsible Person(s): 1.

2. 3.

Review Date: Progress:

Review Date: Progress:

Involvement of Family: Father and step-mother will participate in family therapy and follow through on homework
assignments to improve family functioning. Father and step-mother will formally (behavior counts and homework
assignments) and informally monitor Jill's symptoms, problems and progress. Father will support Jill in
implementing new skills and becoming more active.

Services Needed beyond scope of organization or program:


Medication Management by Dr. Jack Horner

Estimated Completion date for level of care:


4-2-07

Patient /Responsible Party Signature:

Provider Signature: Tom Thumb, Ph.D. Date:


Must be a true signature,
Rubber stamp signatures are not allowed
Electronic signatures are acceptable

Provider Name/Title: (Print)


Tom Thumb, Ph.D., Licensed Psychologist

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