Treatment Planning Worksheet

GROUP CHARTR - WORKSHEET

When to use the CHARTR Worksheet:  A client is new to the group or clinic, and you need to complete an initial assessment.  The client is new to the group or you but has received therapy at the clinic during previous terms.  You continue with a client for a second term, but there have been significant changes in client status that warrant a new assessment to determine new goals, approach etc.

When NOT to use the CHARTR Worksheet and instead complete a lesson plan:  You continue with the same client for a second term using the same goals and approach(es)

Section I: Background (Completed prior to first group meeting)

Clinician: Supervisor: Term: Group Name: Session Date

Client’s Alphacode: Client’s Alphacode: Client’s DOB: Client’s DOB: Client’s Chronological Age: Client’s Chronological Age: Client’s Gender Client’s Gender:

Client’s Alphacode: Client’s Alphacode: Client’s DOB: Client’s DOB: Client’s Chronological Age: Client’s Chronological Age: Client’s Gender: Client’s Gender:

Case History (general overview of each client using client code)

Provide referral source (if client new to clinic):

Reason(s) for referral or continuation of treatment:

Relevant diagnoses (medical conditions, syndromes, etc):

Significant birth/ developmental history (child):

Significant educational history:

Significant vocational history (adult):

Current living situation:

Other therapies (include names of providers and therapy frequency): Prior Therapy at UOSLHC? Term (You don’t need to go back Intervention Approaches Long-Term Goals further than three terms unless you (please indicate whether they were achieved) feel it’s relevant)

If previous therapy at UOSLHC, are there any new concerns? Are there any new concerns/ issues noted in the file or reported by the client/parent/caregiver? (if so, please explain)

Specify reason(s) for assessment (Check all that apply):

Diagnostic: Programmatic: __Make a (new) diagnosis __Establish (new) goals __Determine whether a diagnosis is still present __Determine (new) intervention approach __Determine (ongoing) eligibility/need for service __Establish a (new) baseline of performance __ Other: __Document progress on current goals __Document progress in areas currently not targeted __Other: Section II: Plan Assessment METHODS for Clinical Questions (Completed prior to first group meeting)

Formulate clinical questions based on your reasons for assessment

Clinical Questions Specific Method(s) Used to Answer Rationale for Choice of Method (What questions do I expect to answer?) Clinical Questions (e.g., standardized test, interview) Section III: Assessment Planning Details (Completed after first group meeting, before assessment)

Preparation Consider disorder/disability-specific information, appropriate treatment approaches, developmental milestones (for peds), etc.

Information I need to successfully conduct this assessment, Where I plan to find this information select a treatment approach, and write relevant goals

Measure Practice: Name of Have you administered this How do you plan What support do you need (if any) to Measure measure before? to prepare? successfully administer this test?

Assessment Agenda: Day Tasks/Activities (in order - Materials needed Estimated Comments (include include “warm-ups,” breaks, all time assistance you need, measures) plans if multiple clinicians participating)

General Preparation: What will be the role of the family member/parent/ caregiver? Where will you and the client/child, parent/family member/caregiver sit? What will the room look like? How will you “control” the testing situation? What is your plan to prevent behavior problems? What is your back-up plan (e.g., when client gets frustrated, fatigues, etc.) What other problems can you anticipate and how will you deal with them? Have you contacted the family to discuss the assessment and obtain any preliminary information? Interview Guide  List resource for selecting interview topics (e.g., validated questionnaire used for this disorder):  Review and insert responses from existing intake forms or telephone conversations so questions are not repeated unless information needs to be validated  Plan for who will be involved in interview: client/child, parent, other family member, caregiver; separate/collaborative?  Review interview tips and strategies

Interview Topic Areas Questions Section IV: Assessment Analysis (Completed after assessment or first session; before group meeting)

Clinical Question Analysis Clinical question Evidence gathered during session Answer to clinical question (from Section II) Section V: Recommendations (Completed after first session)

Therapy Recommendations Your Recommendation Rationale Does this client need therapy or continue to need therapy? What should be the frequency/duration of therapy? What major areas should you focus on in therapy? Other recommendations?

Potential Goals for the upcoming term (make sure to include measurement) Long-Term Goals Short-Term Objectives

Therapy Approach(es) Name and brief description of Rationale How will you implement the approach approach? Discuss any adaptations you will use.

Evidence supporting chosen intervention approach(es) List references and brief annotated summary. Summary paragraphs for each article you review should contain a brief description of the participants, procedures, and results (immediate effects, maintenance effects, generalization to untrained stimuli, and generalization to non-clinical contexts).