Number

/

Problem

/ Date ID /

Goals and Objectives

/ Projected Achieved Date / Date
Actually
Achieved /

Clinical Interventions

Approaches, Modality, Provider, & Frequency

Poor Impulse Control

Related to:
 history of mental illness
 self-destructive behavior
 medication
noncompliance
 psychotic symptoms
 overwhelming
situational stressors
 other: ______
______
As evidenced by:
 mood swings
 anger outbursts
 verbal/physical threats
 irritability/agitation
 assaultive behavior
 sexually inappropriate behavior
 self-harming behavior
 binge-eating
 other: ______
______
ÿ other: ______
______/ Long-Term Goals:
 1. Patient will become more responsible for his/her behavior and maintain behavior within acceptable limits.
 2. Other: ______
______
Short-Term Goals/Objectives:
ÿ a. Patient will decrease the level of resistance to accepting feedback on behavior from significant others.
ÿ b. Patient will verbalize the causes for the anxiety or frustration that accompany the impulsive behavior.
ÿ c. Patient will comply with prescribed medications and report any side effects.
ÿ d. Patient will consistently follow PHP/IOP rules for _____ consecutive days.
ÿ e. Patient will no longer exhibit physical aggression or acting out behavior for _____ consecutive days.
ÿ f. Patient will verbalize and demonstrate ______% improvement in impulse control and problem solving skills.
ÿ g. Patient will develop and implement specific coping strategies to resist impulsive urges.
ÿ h. Other:______
______
______
ÿ i. Other: ______
______
______
/ 1. Group Psychotherapy ____x/day, ____ days/week, for one hour each. Therapist
2. Educational Group ____x/day, ____days/week, for one hour each. Nurse/Therapist
3. Prescribe and adjust psychotropic meds. MD
4. Monitor patient’s response to psychotropic
medications ongoing. MD, Nurse
5. Build trust and establish therapeutic rapport
with patient. All staff
6. Other: ______
Revised Goals/Objectives
______
______
______
______
______
______
______
______
______
______
______
______
______
______

MULTIDISCIPLINARY INTEGRATED TREATMENT PLAN

*Status Key Denotes: A=Achieved, D=Deferred, E=Extended, and R=Revised.

June 2006