Treatment Team | HOFYRSTAFF

Treatment Team Form

Date:

Resident:

DOB:

Behavior

Current Points:

Level:

Behaviors to Note:

Behavioral/Treatment Goals

Goals:

Select Treatment Goals:

Adolescent Psychiatric Diagnoses

Select Psychiatric Diagnoses:

Case Plan

Case Plan:
Adoptions
Reunification
Non-relative Placement
Relative Placement

Higher Level of Care Recommendation: Yes No

CPA: Yes No

School

School:

Grade:

ESSA Staffing:

Grade Level:

Grades:

IEP:

Discipline:

Legal

DJJ History:

Cell Phone/Electronic:

Primary Goal:

History of Case:

Medical

72-hr Wellness Check:

Medical:

Optical:

Dental:

Med Management:

Medications:

Clinical

Weekly Counseling/Groups:
Family Counseling:
Individual Counseling:
Anger Management Group:
Substance Abuse Group:
Lifeskills Group:
Equine Therapy:

Staff Signatures

Clinical Director (Print and Signature):

Therapist (Print and Signature):

Direct Care (Print and Signature):

Direct Care (Print and Signature):

Case Manager (Print and Signature):

Other (Print and Signature):

Improve Communication Skills
Enhance Self-Esteem
Reduce Impulsivity
Increase Coping Mechanisms
Manage Anxiety
Decrease Aggressive Behaviors
Develop Social Skills
Promote Positive Relationships
Enhance Problem-Solving Skills
Manage Stress Effectively
Increase Independence in Activities
Develop Healthy Habits
Promote Emotional Regulation
Establish Routines
Reduce Risk-Taking Behaviors
Improve Concentration and Attention
Establish Boundaries
Develop Time Management Skills
Enhance Anger Management Skills
Increase Self-Awareness

Anxiety Disorder
Major Depressive Disorder
Bipolar Disorder
Oppositional Defiant Disorder
Attention Deficit Hyperactivity Disorder (ADHD)
Post-Traumatic Stress Disorder (PTSD)
Obsessive-Compulsive Disorder (OCD)
Generalized Anxiety Disorder
Panic Disorder
Social Anxiety Disorder
Conduct Disorder
Reactive Attachment Disorder
Eating Disorders (e.g., Anorexia, Bulimia)
Schizophrenia
Disruptive Mood Dysregulation Disorder
Autism Spectrum Disorder
Adjustment Disorder
Specific Phobias
Substance Use Disorder
Sleep Disorder