Music Therapy Treatment Plan (Plan of Care)

Patient Name: [Patient full name]

MRN/DOB: [MRN] / [DOB]

Date of Plan: [Plan date]

Effective Period: [Start date] through [End date or next review date]

Next Review Date: [Next review date]

Setting/Service Line: [Care setting or service line]

Visit Type: [individual / group / co-treatment]

Music Therapist: [Therapist name, credentials]

Referral Source: [Referring clinician or service]

Clinical Summary and Basis for Plan

[Brief narrative synopsis: reason for referral, relevant diagnoses or conditions being addressed, key assessment findings including baseline symptoms and functional limitations, musical responsiveness and preferences, patient strengths and protective factors, and barriers or constraints affecting intervention] (2-4 sentences. If assessment data is incomplete, state what is known, what remains unknown, and when missing information will be obtained rather than inferring.)

Safety Precautions and Risk Controls

[No music-therapy-relevant precautions identified beyond standard care.] (Replace with specific precautions if applicable.)

• Medical precautions: [Lines, tubes, cardiac or respiratory restrictions, seizure risk, activity tolerance, positioning needs]
• Infection control: [Isolation status, instrument cleaning protocol, single-patient items, PPE requirements]
• Sensory and hearing safety: [Volume limits, sound sensitivity, tinnitus accommodations, headphone use parameters]
• Behavioral safety: [Agitation or elopement risk, trauma-informed content considerations, triggers to monitor]
• Medication timing: [Medications influencing participation and optimal session timing]
• Escalation plan: [Stop criteria for distress or physiologic intolerance, who to notify]

Problem List

(Number problems in priority order with highest acuity or impact first. Use functional or behavioral problem statements describing observable limitations, not diagnosis labels alone.)

1. Problem 1: [Functional or behavioral problem statement in observable terms]

   • Contributing factors: [Contributing factors if known]
   • Baseline measure: [Metric or scale, baseline value, date, measurement conditions]
   • Associated diagnosis: [Associated diagnosis or condition]

2. Problem 2: [Functional or behavioral problem statement in observable terms]

   • Contributing factors: [Contributing factors if known]
   • Baseline measure: [Metric or scale, baseline value, date, measurement conditions]
   • Associated diagnosis: [Associated diagnosis or condition]

(Add additional problems as needed.)

Goals, Objectives, and Interventions

(Organize by problem to maintain traceability. Each intervention must map to a specific objective; each goal must map to a documented problem with baseline.)

Problem 1: [Restate problem]

Patient-Centered Goal: [Patient's stated goal in their own words, then translate to measurable form below]

Long-Term Goal: By [date], patient will [functional outcome] as evidenced by [measure and threshold] with [level of assistance] in [context].

Short-Term Objectives:

1. [Condition or context], patient will [behavior] to [criterion and consistency] by [timeframe].

   • Measurement: [Tool or structured count]
   • Baseline: [Value and date] (If unknown, first objective is to establish baseline by [date].)

2. [Condition or context], patient will [behavior] to [criterion and consistency] by [timeframe].

   • Measurement: [Tool or structured count]
   • Baseline: [Value and date]

Interventions:

• For Objective 1: [Intervention modality] targeting [clinical mechanism]

  • Parameters: [Tempo range, volume limit, session structure, group size, instrumentation, environment setup as applicable]
  • Content considerations: [Music style and preferences, themes to avoid for trauma-informed care]
  • Progression plan: [How intensity, complexity, or support will be graded over time]
  • Education or home program: [Patient or caregiver education, home practice guidance] (Include only if applicable.)
  • Non-response plan: [Modifications if no progress or worsening occurs]

• For Objective 2: [Intervention modality] targeting [clinical mechanism]

  • Parameters: [Tempo range, volume limit, session structure, group size, instrumentation, environment setup as applicable]
  • Progression plan: [How intensity, complexity, or support will be graded over time]
  • Non-response plan: [Modifications if no progress or worsening occurs]

Problem 2: [Restate problem]

Patient-Centered Goal: [Patient's stated goal in their own words]

Long-Term Goal: By [date], patient will [functional outcome] as evidenced by [measure and threshold] with [level of assistance] in [context].

Short-Term Objectives:

1. [Condition or context], patient will [behavior] to [criterion and consistency] by [timeframe].

   • Measurement: [Tool or structured count]
   • Baseline: [Value and date]

Interventions:

• For Objective 1: [Intervention modality] targeting [clinical mechanism]

  • Parameters: [Tempo range, volume limit, session structure, group size, instrumentation as applicable]
  • Progression plan: [How intensity, complexity, or support will be graded over time]
  • Non-response plan: [Modifications if no progress or worsening occurs]

(Repeat this structure for additional problems.)

Frequency, Duration, and Scheduling

Frequency: [Sessions per week]

Session Length: [Minutes per session]

Plan Duration: [Number of weeks or total sessions in plan period]

Anticipated Start Date: [Start date]

Scheduling Constraints: [Coordination with other treatments, preferred or blocked times, location or transport needs]

Outcome Measures and Data Collection

1. Problem 1: [Problem short label]

   • Primary outcome measure: [Validated tool or structured rating with scale anchors]
   • Data collection schedule: [every session / weekly / at review]
   • Responder definition: [Threshold for meaningful improvement]
   • Documentation location: [Where data are recorded]

2. Problem 2: [Problem short label]

   • Primary outcome measure: [Validated tool or structured rating]
   • Data collection schedule: [every session / weekly / at review]
   • Responder definition: [Threshold for meaningful improvement]
   • Documentation location: [Where data are recorded]

(Add outcome sets for each problem.)

Review Schedule and Discharge Criteria

Review Interval: [Every X days or every Y sessions or per facility standard]

Criteria for Plan Modification: [Goal achieved, plateau in progress, change in medical or psychiatric status, new precautions, patient preference change]

Discharge Criteria: [Goals met, no further benefit from skilled intervention, patient declines services, discharge from facility, transition to community resources]

Transition Plan: [Maintenance strategies, caregiver coaching, referrals, recommended follow-up]

Signatures

Music Therapist Signature: [Name, credentials, date]