Family Enrichment Behavioral Health Services Inc.

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3829 Hollywood Blvd. Suite D. Hollywood, FL 33021
P: (954) 367-3600 F: (954) 367-3601
info@febhs.org

Guillermo Garcia

Individualized Treatment Plan

Staff Name *

Service Date *

YYYY

Service Shift *

Service Location *

Office

Home

School

Other:

Following Instructions (verbal) *

Guillermo will follow verbal directions and complete requested task, assignment, preparation procedure etc., in a timely manner and with cooperation. Independently. 20% of trials for 3 consecutive months.

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Trial 1

Trial 2

Trial 3

Trial 4

Trial 5

Social Compliance (Non-preferred task) *

Guillermo will follow instruction to complete a non-preferred task cooperatively with at least 1 other individual, with verbal prompts 90% of trials in three consecutive months.

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Trial 1

Trial 2

Trial 3

Trial 4

Trial 5

Social Skills (Preferred Task) *

Guillermo will follow instruction to complete a preferred task cooperatively/collaboratively with at least 1 other individual, independently 40% of trials in three consecutive months.

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Trial 1

Trial 2

Trial 3

Trial 4

Trial 5

Self Management Skills *

Guillermo will identify different coin sums as presented by his therapist, with verbal prompts 40% of trials in three consecutive months

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Trial 1

Trial 2

Trial 3

Trial 4

Trial 5

Request Attention *

Guillermo will access attention by calling his therapist, parent(s), teacher or respective adult by name, or saying "excuse me", and waiting for acknowledgement before speaking; with Demonstrative Prompts. 60% of trials for 3 consecutive months.

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Trial 1

Trial 2

Trial 3

Trial 4

Trial 5

Appropriate Interaction (Social Skills) *

Guillermo will follow his acquisition skill training to increase his social skills: maintain social distance, introduce self, look at speaker’s, talk appropriately, and wait while others speak with verbal prompts 20% of trials in three consecutive months.

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Trial 1

Trial 2

Trial 3

Trial 4

Trial 5

Expressive Skills *

Guillermo will discuss a short story or recent event and provide accurate responses to simple questions asked by his staff with demonstrative prompts 60% of trials in three consecutive months.

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Trial 1

Trial 2

Trial 3

Trial 4

Trial 5

Social Safety Skills *

Guillermo will follow his plan daily in order to differentiate a stranger, friend, and family with no more than two modelling (demonstrative) prompts 60% of trials in three consecutive months. Scenarios will be presented by the therapist accompanied by pictures (such as fireman, policeman etc). The therapist will then question Guillermo and record his responses.

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Trial 1

Trial 2

Trial 3

Trial 4

Trial 5

Receptive Skills *

After being told a distinct phrase from his therapist, Guillermo will be able to answer one question about the phrase with demonstrative prompts, 40% of trials in 3 consecutive months

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Trial 1

Trial 2

Trial 3

Trial 4

Trial 5

Garbage *

Guillermo will take out trash following the steps below, with Demonstrative Prompts. 60% of the trials for 3 consecutive months.

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Walk towards trash can

Remove the trash can lid

Lift trash bag out fo the trash can

Tie the top of the trash bag in a knot

Walk the trash bag to the waste disposal area

Take a new trash bag and replace it into the emptied trash can

Put the lid back onto the trash can

Wash or sanitize hands

Independent

Verbal Prompt

Demonstration

Partial Physical Guidance

Full Physical Guidance

Refused without Problem Behavior

Refused with Problem Behavior

Scheduled - Not Available

Trial Not Executed

Walk towards trash can

Remove the trash can lid

Lift trash bag out fo the trash can

Tie the top of the trash bag in a knot

Walk the trash bag to the waste disposal area

Take a new trash bag and replace it into the emptied trash can

Put the lid back onto the trash can

Wash or sanitize hands

Occurrence(s) of Physical Aggression *

Either observed directly or reported by valid stakeholders for this service date

Occurrence(s) Property Destruction *

Either observed directly or reported by valid stakeholders for this service date

Occurrence(s) Non-Compliance *

Either observed directly or reported by valid stakeholders for this service date

Comments:

Confirm Submission *

I declare that the above information is true to the best of my knowledge. I am aware that this information may be used for the purpose of assessing and treating clients at FEBHS and will be a part of my service record. I agree that my typed name in combination statement constitutes the signing of this document.

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