Use this template to create behavioral plans for assignments in Weeks Two and Three. Fill in each section and provide additional information as needed.
| Client Identifying Information
List all pertinent and known identifying information. |
|||
| Name | Age | ||
| Gender | Religion | ||
| History
Describe all pertinent and known history. |
|||
| Medical | |||
| Family | |||
| Substance Abuse | |||
| Developmental and Social | |||
| Course of Treatment
List two target behaviors and two interventions. |
|||
| Target Behaviors | |||
| Frequency and Duration of Target Behaviors | |||
| Severity and Number of Relapses | |||
| Interventions | |||
| Goals and Objectives
List two long-term goals, two short-term goals, and one objective to work towards each goal. |
|||
| Long-Term Goal | |||
| Short-Term Goal | |||
| Objectives | |||
| Discharge and Termination Plans
Describe the discharge and termination plan for the client. |
|||
| Discharge Plan | |||
| Termination Plan |
