School-Based DMT Session Note

Student Name/ID: [Student name and ID]

DOB/Grade: [DOB] / [Grade]

School: [School name]

Session Date: [Date]

Start/End Time: [Start time]–[End time]

Duration: [Minutes]

Format: [Individual / Group / Classroom-integrated]

Location: [Location/room]

Provider/Credentials: [Provider name, credentials]

Attendance: [Present / Absent / Partial] (Note if tardy or left early.)

Service Authorization: [IEP related service / 504 / MTSS / Other]

Session Focus & Targeted Goals

[Brief session focus statement linking to current functional needs in the school setting]

• [Goal 1]

  • Source: [IEP goal / Behavior plan target / MTSS plan / Other]
  • Domain: [self-regulation / social communication / attention / motor planning / emotional expression / other]
  • Session success criterion: [Observable indicator defining progress for today]
  • Baseline: [Brief baseline reference] (Include only if relevant.)

• [Goal 2] (Include only if addressed this session.)

  • Source: [Goal source]
  • Domain: [Domain]
  • Session success criterion: [Observable indicator]
  • Baseline: [Brief baseline reference] (Include only if relevant.)

Subjective

[Attributed report from student or staff] (Use direct quotes only when exact wording matters clinically—e.g., safety statements, refusals, disclosures. Omit this section entirely if no subjective data was obtained.)

Objective Observations

• Engagement/participation: [Observable participation level without interpretation]
• Regulation/arousal: [Observable signs related to regulation state]
• Movement observations: [Goal-relevant observations—posture, grounding, rhythm matching, spatial boundaries, impulse control, attunement/mirroring as applicable]
• Communication/affect: [Verbal/nonverbal output, facial affect, prosody, gesture, gaze]
• Task performance: [Quantifiable metrics—minutes engaged, prompts required, successful turns, accuracy]
• Contextual factors: [Schedule disruption, space change, peer dynamics] (Include only if relevant to session.)

Interventions

(Document each distinct intervention component; avoid vague terms like "did DMT.")

• [Intervention 1: Name]

  • Purpose: [Therapeutic purpose linked to targeted goal(s)]
  • Duration/repetitions: [Time or count]
  • Therapist actions: [Modeling, mirroring, prompting, co-regulation strategies, cueing]
  • Adaptations: [Sensory accommodations, visual cues, simplified steps, peer pairing, equipment] (Include only if adaptations were made.)
  • Touch: [Type, rationale, and how consent/assent was addressed] (Include only if touch was used.)

• [Intervention 2: Name] (Add components as needed.)

  • Purpose: [Therapeutic purpose]
  • Duration/repetitions: [Time or count]
  • Therapist actions: [Actions taken]
  • Adaptations: [If applicable]
  • Touch: [If applicable]

Assessment & Response

• [Goal 1]: [met / partially met / not met] — [Brief observable evidence]
• [Goal 2]: [met / partially met / not met] — [Brief observable evidence] (Include only if addressed.)

Clinical interpretation: [Brief statement linking observations to targeted goals and functional implications]

Trend: [improving / stable / worsening] relative to baseline — [Basis for trend assessment]

Continued need: [One sentence justifying ongoing DMT services related to educational access/participation]

Safety

(Include this section only if safety concerns arose during the session.)

• Risk concerns: [Self-harm statements, threats, aggression, elopement, severe dysregulation, suspected abuse/neglect indicators]
• De-escalation actions: [Interventions used to address safety concern]
• Notifications: [Crisis team, administration, parent/guardian, mandated report filed]
• Disposition: [Returned to class / Remained with support staff / Sent home / Emergency services contacted]

Plan

• Next session focus: [Linked to goals and today's response]
• Intervention adjustments: [Planned changes based on today's response]
• Progress monitoring targets: [Specific targets for upcoming sessions]
• Team communication: [Who contacted, what shared, recommendations given] (Include only if communication occurred.)
• Follow-up actions: [Referrals, schedule changes, or other actions needed with due dates/responsible parties] (Include only if applicable.)

Provider Signature/Credentials: [Signature and credentials]

Date/Time Signed: [Date and time]

(Documentation guidance: Keep the formal record focused on educational/functional relevance; maintain personal process notes separately per ADTA guidance. Document observations before interpretations. Use minimum necessary detail appropriate for educational team access.)