Mental Health Treatment Plan



Mental Health Treatment Plan

|Area of Need: |

|Present Level: |

|Measurable Long-Term Goal: |

|Parents will be informed of progress |Periodic Review Dates |Progress Toward Goal |Sufficient Progress to Meet Goal |

|Quarterly ( Trimester |1. ________________ |1. ___________________________ |( Yes ( No ___________________ |

|Semester ( Other:_________ |2. ________________ |2. ___________________________ |( Yes ( No ___________________ |

|How? |3. ________________ |3. ___________________________ |( Yes ( No ___________________ |

|Annotated Goals/Objectives |4. ________________ |4. ___________________________ |( Yes ( No ___________________ |

|( Other: ____________________ | | | |

|Benchmark/Short-Term Objective: |Date: |

| | |

| |( Achieved |

| | |

| |( Reviewed |

|Person(s) Responsible: | |

|Benchmark/Short-Term Objective: |Date: |

| | |

| |( Achieved |

| | |

| |( Reviewed |

|Person(s) Responsible: | |

|Area of Need: |

|Present Level: |

|Measurable Long-Term Goal: |

|Parents will be informed of progress |Periodic Review Dates |Progress Toward Goal |Sufficient Progress to Meet Goal |

|Quarterly ( Trimester |1. ________________ |1. ___________________________ |( Yes ( No ___________________ |

|Semester ( Other:___________ |2. ________________ |2. ___________________________ |( Yes ( No ___________________ |

|How? |3. ________________ |3. ___________________________ |( Yes ( No ___________________ |

|Annotated Goals/Objectives |4. ________________ |4. ___________________________ |( Yes ( No ___________________ |

|( Other: _____________________ | | | |

|Benchmark/Short-Term Objective: |Date: |

| | |

| |( Achieved |

| | |

| |( Reviewed |

|Person(s) Responsible: | |

|Benchmark/Short-Term Objective: |Date: |

| | |

| |( Achieved |

| | |

| |( Reviewed |

|Person(s) Responsible: | |

| |

|______________________________________ ______________ ______________________________________ ______________ |

|Student Signature Date Signature of Parent Date |

|__________________________________________ ______________ |

|Signature of Mental Health Services Representative Date |

Date: Student: Type of Service: Start Date: Duration:

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