Treatment with Effective Interventions
This is a fictitious case. All names used in the document are fictitious
Sample Treatment Plan
Recipient Information Medicaid Number:12345678 Name: Jill Spratt DOB: 9-13-92 Other Agencies Involved: Jack Horner, M.D., Child Psychiatrist Spring Hill Middle School Provider Information Medicaid Number:987654321 Name: Tom Thumb, Ph.D. Treatment Plan Date: 10-9-06 Plan to Coordinate Services: Phone contact during the first month of treatment, then as needed, but at least 1 time every 3 months. 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): Prozac
Dose: 20 mg
Frequency: 1 x day
Indication: 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 This will be measured by a t score of 60 or below on the YSR Withdrawn/Depressed scale at the time of discharge.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: 1. Jill and her father will develop a safety plan/no self-harm contract 2. Jill will become involved in at least one additional extracurricular activity or sport 3. Jill will report no suicidal ideation for 3 consecutive weeks 4. Jill will learn coping skills, including problem solving and emotional regulation. 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. 5. Jill will learn to identify maladaptive, negative thoughts 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.
Date Established
Sample Treatment Plan
Recipient Information Medicaid Number:12345678 Name: Jill Spratt DOB: 9-13-92 Other Agencies Involved: Jack Horner, M.D., Child Psychiatrist Spring Hill Middle School Provider Information Medicaid Number:987654321 Name: Tom Thumb, Ph.D. Treatment Plan Date: 10-9-06 Plan to Coordinate Services: Phone contact during the first month of treatment, then as needed, but at least 1 time every 3 months. 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): Prozac
Dose: 20 mg
Frequency: 1 x day
Indication: 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: 1. Jill and her father will develop a safety plan/no self-harm contract 2. Jill will become involved in at least one additional extracurricular activity or sport 3. Jill will report no suicidal ideation for 3 consecutive weeks 4. Jill will learn coping skills, including problem solving and emotional regulation. 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. 5. Jill will learn to identify maladaptive, negative thoughts 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.
Date Established