WK2BTAssignment

Behavior Plan Template

Version 2

Material

Behavior Plan Template

Use this template to create behavioral plans for assignments in Weeks Two and Three. Fill in each section and provide additional information as needed.

Client Identifying Information List all pertinent and known identifying information.
Name				Age
Gender				Religion
History Describe all pertinent and known history.
Medical
Family
Substance Abuse
Developmental and Social
Course of Treatment List two target behaviors and two interventions.
Target Behaviors
Frequency and Duration of Target Behaviors
Severity and Number of Relapses
Interventions
Goals and Objectives List two long-term goals, two short-term goals, and one objective to work towards each goal.
Long-Term Goal
Short-Term Goal
Objectives
Discharge and Termination Plans Describe the discharge and termination plan for the client.
Discharge Plan
Termination Plan