Therapy Plan Format Template printable pdf download

Therapy Plan Format

Client(s):

Date:

Student:

Location:

Treatment Objectives

Long-term Goals:

State what you hope to achieve with the patient over the course of the semester or therapy period.

Identify areas to be worked on and degree of improvement thought realistic for the time allotted.

Long-term goals are written in general rather than specific terms.

Short-term Goals:

State your specific goals for each session. Include in each objective:

A description of what response the patient is expected to make;

Under what conditions he/she will make the response and;

How well he/she must perform before moving onto the next step.

Example:

1. The client will imitate initial /s/ with 90% consistency at the elicited word level.

2. The client will refer to the memory book to initiate conversation with clinician 8/10 times within

a 30 minute treatment session.

Procedures

Activity/Materials:

State clearly and specifically the activity and materials you plan to use to achieve each short-term

objective.

Stimulus:

A procedure should contain a description of the stimulus conditions, both verbal and non-verbal (e.g.,

verbal – “What is this?” non-verbal – 20 pictures of common objects, repeated a minimum of 2x).

Response:

A procedure should indicate a description of what the client will say or do (e.g., Client says “sock”)

Cues:

Include both verbal and non-verbal cues which precede or will elicit a response.

Feedback:

The events which follow the response including information regarding response accuracy.

Reinforcement:

Techniques to maintain correct response output.

Sub-steps:

Anticipate how you will modify the task to make it easier for the client if it initially proved too difficult

for him/her.

Super-steps:

Specify what your next step will be if the client achieves immediate success on the goal.

Appendix C-1

School of Human Communication Disorders

Clinical Practicum Handbook 2016-2017 for Speech-Language Pathology

Therapy Plan Format Template