School-Based Service Note (Art Therapy)

Student: [name and school ID]

Date: [encounter date]

Time: [start time – end time, total minutes]

Service Type: [individual / group / consultation]

Setting: [location]

Provider: [name, credentials]

Attendance: [present and participated / present but refused / partial session / absent / canceled]

Program: [IEP / 504 / MTSS / general education support]

Goals Addressed: [goal/objective identifiers from IEP/504]

Session Focus & Educational Linkage

[Target skill or behavior, school function it supports, and IEP/504 objectives addressed] (1–3 sentences connecting the session to the educational plan. If no skilled therapeutic service was provided, state that clearly and skip to Plan.)

Intervention

Art Directive: [activity title or description and materials used]

Therapeutic Approach: [skilled methods used—e.g., co-regulation prompts, emotion labeling, graded choice-making, social skills rehearsal, sensory supports]

Accommodations: [modifications used] (Omit if none.)

Goal Linkage: [one sentence stating how this directive supports the target skill to improve school functioning]

Observations & Progress

Participation: [engagement level with observable anchors—e.g., independent / minimal prompts / moderate prompts / maximum prompts, with brief example]

Behavioral Data: [measurable observations tied to goals—frequency counts, duration, percent accuracy, prompt levels, or specific behaviors]

Art Process Notes: [objective description of salient artwork or process features; student-stated meaning with attribution; artwork disposition] (Include only if clinically relevant.)

Progress Interpretation:

• [Objective identifier]: [today's data]; [improving / stable / regressing / insufficient data]; [brief statement linking change to school participation]
• (Repeat for each objective addressed. If data not collected, state reason and plan.)

Plan

• [Next session focus aligned to goals]
• [Carryover recommendations for classroom or home] (Only if coordinated with team.)
• [Service logistics changes: make-up session, schedule adjustment] (Only if applicable.)

Team Communication: [with whom, method, date/time, content summary tied to educational function] (Include only if communication occurred related to this session.)

Safety Concerns: [observable facts, immediate actions, notifications, disposition; reference separate incident documentation per district policy] (Include only if safety concerns arose.)

(Use neutral, objective, behaviorally anchored language. Omit optional elements if not applicable. For required fields without information, state "Not assessed" or "Not obtained" with brief reason. Do not include other students' identifying information in group notes.)

Provider Signature: [signature, credentials, date/time]

Supervisor Co-sign: [signature, credentials, date/time] (Include only if supervision required.)