Client: # County Health Choices Behavioral Health Rehabilitation Services Treatment Plan MEMBER NAME: DOB: ADMISSION DATE:

PLAN DATE:

MAID

AGE: 6 MA ID#

AGENCY NAME: Health Wraparound RELATIONSHIP: Mother

RESPONSIBLE FAMILY MEMBER(S): TREATMENT TEAM:

BEHAVIORAL SPECIALSIST: Amanda Law, M.Ed. THERAPEUTIC STAFF SUPPORT: MOBILE THERAPIST: N/A

CURRENT EVALUATION COMPLETED BY: DIAGNOSTIC IMPRESSION: AXIS I: 299.80 Pervasive Developmental Disorder, NOS 314.01 Attention Deficit Hyperactivity Disorder, Combined Type AXIS II: 799.9 Diagnosis Deferred AXIS III: Allergies; Asthma AXIS IV: Psychosocial Stressors AXIS V: GAF Current 52, LIFE DOMAINS ADDRESSED IN CURRENT TREAMENT PLAN (PLEASE CHECK): X FAMILY ISSUES MENTAL HEALTH ____ HOUSING/INDEPENDENT LIVING SKILLS XSOCIAL EDUCATION FINANCIAL/LEGAL SUBSTANCE ABUSE/USE CULTURAL PHYSCIAL/MEDICATIONS X CRISIS X SPECIAL CONSIDERATIONS

Client: # OTHER SERVICES THE CHILD/FAMILY RECEIVE: REPRESENTATIVE: REPRESENTATIVE: CURRENT MEDICATION (S) AND DOSAGE: N/A None at this time. PHONE: PHONE:

MAID

PRESCRIBING PHYSICIAN:

CRISIS PLAN: Please remain calm in crisis situation! X will need to be redirected in a crisis situation. He may need time to take break without any requests. If after giving X a break he is still in a crisis situation, apply calming strategies as identified by family, if behavior intensifies and X is in danger of hurting himself or others, family members may apply the least amount of physical restraint as possible. If all steps fail, call the appropriate county crisis hotline, or 911. DISCHARGE CRITERIA: X will develop an effective communication system and be able to present his wants and needs with 80% accuracy, respond directives by second prompt with 80% accuracy, engage in community integration outings with positive interaction skills with 80% accuracy, eliminate all safety concerns, and engage in interactive play 80% of the time. AFTERCARE PLAN: X should continue to receive educational supports through the school domain, case management services would also be beneficial to access all available resources, and participating in socialization groups to continue to develop communication and social skills.

Client: #

MAID

LIFE DOMAIN: Social FAMILY STRENGTHS: X family is highly vested in his best interest and is active in his treatment. CHILD STRENGTHS: X enjoys playing outside and shows an interest in football. GOAL: 1 X will increase his age-appropriate socialization skills. Obj # Obj # 1.1 Objective X will maintain appropriate reciprocal play with others for an average length of 5 minutes (preferred & non-preferred). Method Social stories Verbal prompts and cues Role modelin g Positive reinforce ment Data collectio n Discrete trial Social stories Verbal prompts and cues Role modelin g Positive reinforce ment Data collectio n Person Responsible Target Current Date: Progress

Family BSC TSS

9/12

8.3 minutes preferred activities; 3.6 minutes nonpreferred

1.2

X will initiate appropriate interactions with others on 7/10 occasions.

Family BSC TSS

9/12

0 occurrences during TSS Sessions

Client: # 1.3 X will eliminate physical aggression (hitting, throwing objects, pushing, etc.) towards others when angry or frustrated at 100% elimination. Behavior Chart with incentive s Visual schedule Verbal and physical prompts Redirective s Anger manage ment and coping skills Conflict resolutio n Social stories

MAID

Family BSC TSS

9/12

14 incidents observed TSS

LIFE DOMAIN: Communication FAMILY STRENGTHS: X is supported by extended family members, such as his grandmother. CHILD STRENGTHS: X is affectionate and enjoys hugs. GOAL: 2 X will increase his functional communication skills. Obj # Obj # Objective Method Person Target Current

Client: # Responsible 2.1 X will increase his expressive language skills as evidence by his ability to string upwards of the 5 to 7 words with proper articulation on 8 out of 10 occasions. 2.2 X will improve his receptive language skills as evidenced by being able to follow a 2 to 3 step directives on 8 out of 10 occasions. Drills for communi cation Visual schedule Social stories Cues and prompts Role modeling Positive reinforce ment Drills for receptive communi cation Visual schedule Role modeling Cues and prompts Positive reinforce ment Discrete trial drills Positive reinforce ment Visual cues Role modeling Date:

MAID Progress

Family BSC TSS

9/12

50%

Family BSC TSS

9/12

42%

2.3

X will increase his functional language skills by communicating basic wants and needs on 8 out of 10 occasions.

Family BSC TSS

9/12

10%

Client: # 2.4 X will engage in appropriate reciprocal language exchanges with at least 3 exchanges on 8 out of 10 occasions. Promptin g Role modeling Social stories Visual aids Discrete trial drills

MAID

Family BSC TSS

9/12

67%

LIFE DOMAIN: Family FAMILY STRENGTHS: X continues to make progress socially and academically. CHILD STRENGTHS: X participates very well with treatment sessions. GOAL: 3 Obj # Obj # 3.1 X will learn to increase his compliance to the overall structure of the home. Objective X will comply with directives given by his authority figures by 2nd prompt on 8 out of 10 occasions. Method Behavior Chart with incentives Verbal and visual prompts If/then drills to increase complianc e Role modeling Social stories Person Responsible Target Current Date: Progress

38%

Family BSC TSS

9/12

Client: # 3.2 X will reduce the frequency of temper outbursts by 50% from current level. (14 per month: 2 per week) Behavior chart with incentive Positive reinforcem ent Role modeling replaceme nt behaviors Coping and calming strategies Planned ignoring if attention seeking

MAID

Family BSC TSS

9/12

41 incidents observed during TSS sessions

LIFE DOMAIN: Special Considerations (reduce stereotypical autistic tendencies) FAMILY STRENGTHS: X is provided a loving and supportive home environment CHILD STRENGTHS: X shows interest in age-appropriate items such as computers, toys, video games, and television. GOAL: 4 X will reduce his stereotypical autistic tendencies in all settings.

Client: # Obj #Obj # 4.1 Objective X will reduce selfstimulatory behavior (high-pitched noises, chewing on clothing, whirling in circles) by 50% from current level. Method Sensor y integrati on Verbal cues Redirectio n Social stories Positive reinforc ement Sensor y integrati ons Coping strategi es Social stories Succes sful approxi mations of introduc tions Positive reinforc ement Visual bounda ries Social stories Coping and calming strategi es Person Responsible

MAID Target Current Date: Progress

Family BSC TSS

9/12

51 observed incidents- X chewing on clothing

4.2

X will reduce his hypersensitivities (loud noises) by 50 % from current level in home and community settings.

Family BSC TSS

9/12

1 occurrencecovering ears during brothers yelling

4.3 X will eliminate his safety issues (darting off, eloping) at 100% in all settings.

Family BSC TSS

9/12

3 occurrences

Client: # Replac ement behavio rs for anger manag ement Role modelin g If/ then stateme nts Verbal redirectiv es Distract ion method s Sensor y integrati on Visual aids Timed task Social stories Positive reinforc ement for any progres s

MAID

4.4 X will reduce perseverations and obsession/ fixation on objects by 50% from current levels.

Family BSC TSS

9/12

When disengaged in another activity, X will perseverate on ceiling fan, game, mirror, etc.

LIFE DOMAIN: Special Considerations (reduce stereotypical autistic tendencies) FAMILY STRENGTHS: X is provided a loving and supportive home environment

Client: #

MAID

CHILD STRENGTHS: X shows interest in age-appropriate items such as computers, toys, video games, and television. GOAL: 4 X will reduce his stereotypical autistic tendencies and all settings. Continued 4.5 X will increase eye contact and display on 8/ 10 occasions. Discrete Trial Social stories Frequent verbal reminders Role modeling Positive reinforceme nt for any progress Behavior chart with incentive Social stories Step-bypicture schedule

Family BSC TSS

9/12

53% When name is called

4.6

X will initiate toileting and complete the entire process without being prompted 6/10 occasions.

Family BSC TSS

9/12

Needs frequent prompting to remember about toileting needs- X is required to have 2 bathroom breaks during TSS sessions.

Client: #

MAID

1. Member and/or family listed strengths and tools to use for success (during therapeutic services): 3/2012- Family spends quality time together; family wants the best for X; X is intelligent, X has a good sense of humor. Successful treatment tools include: keeping X on a routine, having a classroom aide, and prompting. 2. Progress defined by client and/or family memberclient/the familys goals for progress (list if client unable to the find any progress our goals). 3/2012- X babbles more and he is not as anxious. 3. Symptom Free Period: Family was unable to list any specific symptoms free periods or any time where behaviors were not present (in order to reproduce symptom-free periods).

Client: #

MAID

My signature below verifies that I have participated in the development of this treatment plan, that its content has been explained to me and I fully understand it, and that I agree to actively participate in the implementation of the listed behavioral interventions. CHILD/ADOLESCENT SIGNATURE: PARENT/GUARDIAN SIGNATURE: PARENT/GUARDIAN SIGNATURE: THERAPIST SIGNATURE: DATE: DATE: DATE: DATE: