VAN BUREN COUNTY SBMH
851 Yellowjacket Lane
Clinton, AR 72031
MASTER TREATMENT PLAN
1.
Client
Date of Plan
Next Review By
Projected D/C date, # of Sessions
Place of MTP/TPR Clinton JR High
DSM-IV Diagnosis
CODE
AXIS I
Time In
Time Out
DESCRIPTION
AXIS II
AXIS III
AXIS IV
Problem with
AXIS V
GAF
Recent Loss
Abuse
Legal
Custody/Placement
Financial
Other
Highest GAF in past year
Separation/Divorce
Education
Change in Living Situation
Parent/Client Input regarding treatment/progress
Reviewed by
Phone Conference
Therapy Session
Parent’s/Guardian signature ________________________________________________ Date____________________
Client’s signature (if 5 or older)____________________________________________ Date____________________
Current Medications/dosage
No medications
Changes in medical/nutritional status
no change
Signatures of the Treatment Team Members:
Supervisor/Licensed Clinician
Title
Date
Name
Title
Date
Therapist
Title
Date
Name
Title
Date
Created 3/1/06
VAN BUREN COUNTY SBMH
851 Yellowjacket Lane
Clinton, AR 72031
MASTER TREATMENT PLAN
2.
Client
Discharge Plan:
Projected D/C date:
Level of care needed at transfer/discharge:
Out Patient
Day Treatment
Special Education
Residential
Services needed at discharge/transfer: Individual
Crisis Intervention/Stabilization Other:
Community resources needed at discharge:
Shelter
School Counselor
No Services Anticipated
Maintenance
Acute
Group
Family
Medication
Social Skill group
Case management
Other, Specify:
Parenting and/or Community Resources
On-site/Off-site
Other:
Living situation:
Educational placement:
Goal #1-Describe current symptoms with particular f ocus on nature, severity,
extent, and duration of symptoms.
Problems depressive behaviors
#1
Severity
Frequenc y
Duration
a. Sad affect
mild
weekly
3-6 months
b. Mood irritability
mild
daily
3-6 months
c.Lack of interest in previously enjoyed activities
mild
daily
3-6 months
Behaviors exhibited
d.
e.
Goal
#
1 Client will meet objectives 1, 2, and 3 for 30 consecutive days without impairment of functioning
Problems Addressed #a-c Goal/Discharge Criteria #1 (behaviorally specific and measurable) Client will express feelings for 4 consecutive
weeks without any impairment in school or at home.
Start Date
Target Date of Completion
Actual Date of Completion
Objective #1 - Client will verbally acknowledge the depression and will express feelings of sadness/anger/frustration for 4
consecutive weeks with parent(s)/guardian(s) responding calmly to these verbalizations.
Start Date
Target Date
Service and Rationale: Individual, Group, and/or Family therapy, On/Offsite and Collateral Interventions, Medication evaluation and/or management
Client will complete depression assessment and family will be educated about
depressive symptoms and the results of the assesment.
Teach client to chart daily emotions in order to establish patterns and process
this information in therapy
Support the client’s expression of emotional needs to family members and
significant others and work with the parents to develop their abilities to
encourage, support, and tolerate this expression of the client’s thoughts and
feelings
Medication evaluation and management to decrease depressive behaviors and
thoughts
Frequency
Responsible Staff
2-4 times
therapist
2-6 times monthly
therapist
2-6 times monthly
therapist
1-2 times monthly
Psychiatrist/Physician
Objective #2 - Client will detect automatic negative thinking/behaviors and replace with positive thinking and healthier behavior patterns.
Start Date
Target Date
VAN BUREN COUNTY SBMH
851 Yellowjacket Lane
Clinton, AR 72031
MASTER TREATMENT PLAN
3.
Client
Service and Rationale: Individual, Group, and/or Family therapy, On/Offsite and Collateral Interventions
Assess the cognitive messages that the client gives to him/herself that reinforce
feelings of helplessness and hopelessness.
Teach, monitor, and reinforce the use of positive cognitive messages that
facilitate the growth of the client’s self-confidence and self-acceptance.
Role-play situations involving negative and positive reactions, modeling
positive cognitive/behavioral responses.
Frequency
Responsible Staff
2-6 times monthly
therapist
2-6 times monthly
therapist
2-6 times monthly
therapist
Objective #3 - Client will reduce irritability and anger as evidenced by an increase in levels of pleasant social interactions with
family and friends, energy, and participation in usual activities.
Start Date
Target Date
Service and Rationale : Individual, Group, and/or Family therapy, On/Off- Frequency
Responsible Staff
site and Collateral Interventions
Encourage the client’s participation in social/recreational activities that enrich
life.
2-6 times monthly
therapist
Facilitate the expression of conflict with family members.
2-6 times monthly
therapist
Objective #4
Start Date
Target Date
Frequency
Service and Rationale
Responsible Staff
G o al #2 - Desc ribe curre nt s ym ptoms w ith pa rticula r foc us on na ture, s e ve rit y, e x te nt, a nd
dura tion of s ym ptoms .
Problems
#
Severity
Frequenc y
a. Little or no eye contact and frequent verbalizations of low self-esteem
moderate
daily
3-6 months
b.Feelings of hopelessness, worthlessness, or inappropriate guilt
moderate
daily
3-6 months
Behaviors exhibited
Duration
c.anxiety and fear
d.
e.
Goal #
2 Client will meet objectives 1and 2 for 30 consecutive days without impairment of functioning
Problems Addressed: #a-c Goal/Discharge Criteria #2 (behaviorally specific and measurable)Client will openly discuss feelings of
unhapiness for 4 consecutive weeks without any impairment in school or home.
Start Date
Target Date of Completion
Actual Date of Completion
Objective #1 - Specify what in the past or present life or what is missing from life that contributes to the feelings of unhappiness that the
client experiences.
Start Date
Target Date
Service and Rationale: : Individual, Group, and/or Family therapy,
Frequency
Responsible Staff
VAN BUREN COUNTY SBMH
851 Yellowjacket Lane
Clinton, AR 72031
MASTER TREATMENT PLAN
4.
Client
On/Off-site and Collateral Interventions
Reinforce the client’s open expression of underlying feelings of anger, hurt,
and disappointment
Probe present aspects of the client’s life that contribute to the sadness.
2-6 times monthly
therapist
2-6 times monthly
therapist
Ask the client what is missing from his/her life that contributes to the
unhappiness.
Reinforce, support, and monitor eye contact while promoting high self esteem
2-6 times monthly
therapist
2-6 times monthly
therapist
Objective #2 Client will identify areas of conflict or anxiety provoking situations in his/her life and learn to resolve them in order to
reduce anxiety
Start Date
Service and Rationale: : Individual, Group, and/or Family therapy,
Frequency
Target Date
Responsible Staff
On/Off-site and Collateral Interventions
Develop a coping plan including use of relaxation techniques
2-6 times monthly
therapist
Determine past and present conflicts within the family and with peers
2-6 times monthly
therapist
teach, monitor and reinforce client utilization of anxiety decreasing methods.
2-6 times monthly
therapist
Clarify cognitions in anxiety provoking situations (negative unrealistic
thoughts or expectations)
2-6 times monthly
therapist
Objective #3
Start Date
Service and Rationale :
Objective #4
Frequency
Target Date
Responsible Staff
Progress at Review
Start Date
Service and Rationale
Frequency
Target Date
Responsible Staff
VAN BUREN COUNTY SBMH
851 Yellowjacket Lane
Clinton, AR 72031
MASTER TREATMENT PLAN
5.
Client
G o al #3 - Desc ribe curre nt s ym ptoms w ith pa rticula r foc us on na ture, s e ve rit y, e x te nt, a nd
dura tion of s ym ptoms .
Problems
Severity
Behaviors exhibited
Frequenc y
Duration
a.
b.
c.
d.
e.
Goal #
3
Problems Addressed #
Start Date
Goal/Discharge Criteria #
(behaviorally specific and measurable)
Target Date of Completion
Objective #1
Service and Rationale
Start Date
Actual Date of Completion
Target Date
Frequency
Responsible Staff
Objective #2
Start Date
Service and Rationale
Frequency
Target Date
Responsible Staff
Objective #3
Start Date
Service and Rationale
Frequency
Target Date
Responsible Staff
Objective #4
Start Date
Service and Rationale
Frequency
Target Date
Responsible Staff
VAN BUREN COUNTY SBMH
851 Yellowjacket Lane
Clinton, AR 72031
MASTER TREATMENT PLAN
Client
6.