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Resident Trigger Form
Behavioral Level System Form
Trigger Sheet for Kids
Heart of Florida Youth Ranch: Trigger Sheet for Kids
Name of Child:
Date:
Completed by:
1. Emotional Triggers
Check all that apply:
Feeling rejected or abandoned
Feeling unloved or unappreciated
Fear of failure or not meeting expectations
Criticism or being judged
Sudden changes in routine or environment
Feeling helpless or out of control
Reminders of past trauma
Other emotional triggers:
2. Behavioral Triggers
Check all that apply:
Being told "no"
Not getting immediate attention
Authority figures giving commands
Other behavioral triggers:
3. Environmental Triggers
Check all that apply:
Loud noises or sudden sounds
Crowded spaces
Other environmental triggers:
4. Relational Triggers
Check all that apply:
Being teased or bullied
Arguments or conflicts with peers
Other relational triggers:
5. Coping Strategies
List any known strategies that help the child calm down or cope when triggered:
6. Action Plan
Steps staff members can take when the child is triggered:
Resident All About Me
All About Me
My Name:
Do I Have a Nickname? If Yes, What Is It?
How Old Am I?
My Birthday:
1. My Favorite Things
My Favorite Food:
My Favorite Color:
My Favorite Animal:
My Favorite Hobby:
My Favorite Subject in School:
My Favorite TV Show or Movie:
My Favorite Song:
2. Things I Dislike
Food I Don’t Like:
Activity I Don’t Like:
Animal I Don’t Like:
3. About My Family and Friends
Who’s in My Family (Parents, Siblings, etc.)?
Who’s My Best Friend?
What’s My Favorite Memory with Family or Friends?
4. How I Feel
What Makes Me Happy?
What Makes Me Sad?
What Makes Me Angry?
5. My Dreams & Goals
What Do I Want to Be When I Grow Up?
What’s a Goal I Want to Achieve Soon?
What’s One Thing I Hope Will Happen This Year?
Resident 1-30 day
1-30 Day Therapeutic Initial Treatment Plan
Heart of Florida Youth Ranch: 1-30 Day Therapeutic Initial Treatment Plan
Client Name:
Date of Birth:
Date of Admission:
Therapist Name:
Date of Plan:
2. Short-Term Goals (Days 6-15)
Goal 1:
Increase Emotional Regulation
Reduce Anxiety Levels
Improve Communication Skills
Enhance Social Interaction
Improve Coping Mechanisms
Increase Problem-Solving Skills
Develop Positive Self-Esteem
Reduce Aggressive Behavior
Establish Healthy Boundaries
Improve Attention and Focus
Objective:
Identify 3 coping strategies for anxiety
Practice emotional labeling daily
Increase positive peer interactions by 50%
Develop problem-solving skills through role-play
Identify and manage triggers for anger
Interventions:
Cognitive Behavioral Therapy (CBT)
Mindfulness and Relaxation Exercises
Daily Journaling
Group Therapy Sessions
Individual Therapy
Outcome Measure:
Reduction in anxiety episodes by 50%
Improved emotional labeling by 75%
Reduction in aggressive behavior incidents
Increase in social engagement by 30%
Increased resilience during stress
Goal 2:
Increase Emotional Regulation
Reduce Anxiety Levels
Improve Communication Skills
Enhance Social Interaction
Signatures
Therapist Signature:
Clinical Director Signature:
Monthly Progress Note
Progress Note Form
Heart of Florida Youth Ranch Monthly Progress Note
Client Name:
Date:
Client Status
On Time
Late
No Show
Late Cancel
Mode of Treatment
Individual
Couple
Family
Topics / Issues Discussed
Anger
Trauma
Conflict Resolution
Peer Relationships
Alcohol/Drug Problem
Self-Harm Behaviors
Social Skills
Self-esteem
Grief & Loss
Depression/Anxiety
Treatments / Interventions / Techniques
Insight Development
Behavior Modification
Cognitive Therapy
Psycho-Education
Skill Development
Goal Development
Supportive Counseling
Play Therapy
Homework Assignment
Positive Psychology
Notes:
Assessments
Mood
Normal
Anxious
Depressed
Angry
Euphoric
Affect
Appropriate
Intense
Blunted
Incongruent
Labile
Mental Status
Normal
Memory Difficulty
Concentration Difficulty
Disoriented
Suicide / Homicide Risk Assessment
Yes
No
Safety Plan on File
Yes
No
Response to Treatment
Cooperative
Responsive
Good Prognosis
Passive
Guarded
Defensive
Resistant
Suspicious
Lacks Insight
Referrals:
Next Appointment:
Time:
Additional Notes:
Submit Monthly Progress Note
Master Treatment Plan
90-Day Master Treatment Plan - Heart of Florida Youth Ranch
Resident Information
Resident Name:
Date of Birth:
Case Number:
Date:
Presenting Problems
Anxiety
Depression
Substance Abuse
Trauma/PTSD
Behavioral Issues
Family Conflict
Anger Management
Other
Diagnosis
Primary Diagnosis:
Secondary Diagnosis:
Tertiary Diagnosis:
Treatment Goals
Decrease Anxiety/Depression Symptoms
Improve Family Relationships
Establish Coping Skills
Improve Social Skills
Achieve Abstinence from Substance Use
Resolve Past Trauma
Other
Objectives
Attend Weekly Therapy Sessions
Develop Triggers/Coping List
Improve Communication Skills
Develop Relapse Prevention Plan
Engage in Family Counseling
Maintain Mood Journal
Other
Interventions
Cognitive Behavioral Therapy (CBT)
Dialectical Behavior Therapy (DBT)
Family Therapy
Motivational Interviewing
Trauma-Informed Therapy
Medication Management
Mindfulness Techniques
Group Therapy
Other
Frequency of Treatment
Weekly Individual Sessions
Weekly Family Sessions
Group Sessions
Monthly Psychiatric Reviews
Progress Monitoring
Monthly Goal Review
Weekly Progress Notes
Client Self-Report
Family Report
Potential Barriers to Treatment
Non-compliance with Medication
Family Conflict
Substance Use
Lack of Transportation
Financial Issues
Other
Discharge Criteria
Symptoms Significantly Reduced
Family Relationships Improved
Achieved Abstinence
Completed All Treatment Goals
Independent Use of Coping Skills
Submit Treatment Plan