Family Enrichment Behavioral Health Services Inc.
3829 Hollywood Blvd. Suite D. Hollywood, FL 33021
P: (954) 367-3600  F: (954) 367-3601
info@febhs.org
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Adrian Olsen
Individualized Treatment Plan
Staff Name *
Service Date *
MM
/
DD
/
YYYY
Service Shift *
Service Location *
Call By Name (Receptive Skills) *
Adrian will come to his therapist within 15 seconds of being called by his name, with Verbal Prompts. 20% 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
Trial 1
Trial 2
Trial 3
Trial 4
Trial 5
Social Skills *
Adrian will engage in a cooperative activity while imitating at least one other individual, with Demonstrative Prompts. 20% 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
Trial 1
Trial 2
Trial 3
Trial 4
Trial 5
Wash Hands (Self Management) *
Adrian will wash his hands following the steps below, with Physical Prompt. 90% 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
Turn on water
Put soap on hands
Rub hands together
Rinse hands
Dry hads
Throw paper towel into garbage
Group Activity (Leisure Skills) *
Adrian will participate in a group activity with a preferred toy, 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
Visual Orientation *
Adrian will complete a simple Puzzle (12 piece maximum), with Demonstrative Prompts; 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
Clean Work Area *
Adrian will clean and pick up items after finishing an activity or session, with Verbal Prompts. 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
Complete a Task *
Adrian will complete a non-preferred task at the table, with Demonstrative Prompts. 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
Match Items: Teaching Steps & Strategies      
Materials required:  Plastic forks and spoons (11 each) freezer bags. Tokens – back up reinforcers.
Steps and strategies
Note on the training grid that F and S are both alternated in capitalization. The capitalized letter indicates the required response and its location left or right. S – f for instance indicates the correct response is to put the spoon in the bag to the left (each session will start with the match item in a bag). F – s indicates the correct response is putting a fork in the bag with forks on the left.  “s”—F indicates correct response is fork on the right. “f” – S indicates correct response Spoon to the right.
Present the bag with one fork in it and the bag with one spoon in it. Show Adrian that the forks go with the bag with the fork in it and the spoons go with the bag with the spoon in it. Check the data sheet or tablet for the location of the fork and spoon – capital letter indicated the item and position that is to be requested/correct.
Provide the least amount of assistance to have him place the item in the correct bag. If he does it independently after you present the item and say “where does this (name the item) go?” provide enthusiastic praise and token, score independent. If he makes an incorrect response – guide him to place it correctly while saying where it goes, such as “Adrian the spoon goes over here with the other spoons in the bag.” Score Model cue.
If he needs physical assist – use least amount – score based on touch prompts (partial physical) or hand over hand (full physical).
He may vocally protest – keep the session going – ignore the protest – but praise him when he works with you – more praise if he is not vocalizing… =-)
At the end of the session exchange the tokens he has earned for an item from the store he likes (might be best to have a portable store).  

Match Items *
Adrian will match items to like items, with Demonstrative Prompts 80% of trials for 2 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
F - s
F - s
f - S
f - S
S - f
S - f
s - F
s - F
f - S
f - S
F - s
F - s
Occurrence(s) of Tantrum *
Either observed directly or reported to you by a valid stakeholder for the service date
Occurrence(s) of Stereotypy *
Either observed directly or reported to you by a valid stakeholder for the service date
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