Residential Rehabilitation Plan-Group Home
Reason(s) for Recovery Plan completion:
| |Initial Plan | |90 day review and Update | |Goal/Objective attainment or change |
| |
|Progress Review Summary Update: |
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| |
|Goal #1: (Long Term, in person’s own words): |
|Client Strengths & Supports, including Natural Community Supports: |Barriers/ skills development needed, i.e., what specific /needs from assessment(s) will be addressed to achieve this |
| |goal |
| | |
| | |
| | |
|Goal 1 |Objectives: (a, b, c, etc.) Using action words, describe the specific changes expected in measurable and behavioral terms, and include target date. Consider stage of change/readiness in developing |
|Obj. a |objective and setting target date. |
| | |
|Stage of Change: Pre-contemplation Contemplation Preparation Action Maintenance |
|Interventions/Action Steps |
|Include detailed descriptions of rehabilitation interventions to be provided: 1:1 prompting, cuing, coaching, demonstrating, step by step written and/or verbal directions, visual and verbal directions. |
|Client Strengths & Supports including Natural Community Supports: |Barriers/ skills development needed, i.e., what specific /needs from assessment(s) will be addressed to achieve this goal|
| | |
| | |
| | |
|Goal 2 |Objectives: (a, b, c, etc.) Using action words, describe the specific changes expected in measurable and behavioral terms, and include target date. Consider stage of change/readiness in developing |
|Obj. a |objective and setting target date. |
| | |
| | |
|Stage of Change: Pre-contemplation Contemplation Preparation Action Maintenance |
|Interventions/Action Steps |
|Include detailed descriptions of rehabilitation interventions to be provided: 1:1 prompting, cuing, coaching, demonstrating, step by step written and/or verbal directions, visual and verbal directions. If TCM-CLAMP |
|language. |
|Client Strengths & Supports or Natural Community Supports: |Barriers/ skills development needed, i.e., what specific /needs from assessment(s) will be addressed to achieve this goal |
| | |
| | |
| | |
|Goal 3 |Objectives: (a, b, c, etc.) Using action words, describe the specific changes expected in measurable and behavioral terms, and include target date. Consider stage of change/readiness in developing |
|Obj. a |objective and setting target date. |
| | |
|Stage of Change: Pre-contemplation Contemplation Preparation Action Maintenance |
|Interventions/Action Steps |
| |
|Include detailed descriptions of rehabilitation interventions to be provided: 1:1 prompting, cuing, coaching, demonstrating, step by step written and/or verbal directions, visual and verbal directions. If TCM-CLAMP |
|language. |
| |
Diagnoses:
|Axis | | |Dx Code | |Diagnosis |
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| | | | | | |
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Axis IV:
| |Primary Support Group | | |Housing | | |Occupational | |
| |Social Environment | | |Economic | | |Legal | |
| |Educational | | |Health Care Services | | |Other: | |
| | | |
|Axis V: Current mGAF | |Highest mGAF in the past 12 months |
| |This check mark signifies that all diagnoses have been evaluated for accuracy and necessary changes are reflected in this document. |
|Client Signature: |Date: |Client provided copy of TX Plan? ( Yes ( No If no, please explain: |
|Provider Signature: |Date: |Supervisor Signature/Credentials: |Date: |
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