Sample Individual Treatment Plan (Page 3 of 7) in pdf

Goals, Objectives and Strategies

Med.

Time Frame to be

Type of Service

Frequency

Person (s)

(objective must be outcomes and

Nec.

achieved

(of service

Responsible

measurable)

Y/N

contact, length

(recipient and

(strategies define actions to be taken and

and frequency)

providers)

who does what)

Goal #1A: Improving my health and mental illness.

(Illness management)

Yes

Goal 1A: by

Medication

Goal 1A :weekly

Tony and

Objective: I will name my symptoms of schizoaffective

10/3/04

education/IMR

until Tony

Best ARMHS

disorder, name the medications and what symptoms

1 to 1

understands meds

nurse.

they

etc. and then

treat and the potential side effects of the medications I

take.

every other week.

Strategies: I will meet with the ARMHS nurse weekly.

I will read information that she gives me and ask

questions. I will learn about how the medications

work and what to tell my psychiatrist by role playing

with the nurse.

Yes

Goal 1B: by 8/4/04

1 to 1

Goal #1B:

Goal #1B: Improving my health and mental health

Skills Programming

ARMHS nurse

Tony and Best

( Illness management, health management)

to have worked up

(helping Tony set

weekly contacts

ARMHS nurse

Objective: I will exercise 3X’s a week for 20 minutes

to 3X’s a week.

up a plan for

and then every

and

mark my calendar each day that I do this.

exercising)

other week as

Strategies: Exercises that I can choose from: I can go to

exercise is

the YWCA. I can shoot baskets with the other guys at

established.

XYZ CSP, with staff or my family. I can walk six

blocks to XYZ CSP. I will talk to the ARMHS

nurse about my exercise and eating.

Goal #2: Keeping myself safe and where I live safe.

Yes

By 1/3/05 when I

1 to 1’s

Goal #2 weekly

Tony and Best

(Independent living skills, maintaining housing)

move into

Skills Teaching,

visits with

ARMHS

Objective: I will make a safety plan and use it so that I

independent

Skills strengthening,

ARMHS worker

worker

have no unsafe incidents over the next six months

housing.

Resource

where

acquisition and

I am living.

Strategies: I will talk to my ARMHS worker about past

development.

Incidents and come up with safe ways to handle the

Community

problems that I had. I will make a list of people and

intervention as

resources to call in an emergency or when I don’t know

needed

what to do and put it by my phone. I will role play

unsafe or emergency situations with my ARMHS

worker.

Sample Individual Treatment Plan Page 3

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