Treatment Plan (Art Therapy)

Patient Name: [Patient full name] DOB: [MM/DD/YYYY] MRN: [Medical Record Number] Date of Plan: [MM/DD/YYYY] Anticipated Review Date: [MM/DD/YYYY] Clinician: [Name, Credentials] Service Setting: [inpatient / outpatient / partial hospital / residential / school-based / community] Service Format: [individual / group / family]; [primary / adjunct]

Reason for Referral

[Referral narrative including referral source, indication for art therapy, presenting concerns, functional limitations, and patient's stated goals in their own words] (2–4 sentences. If patient cannot articulate goals, note proxy input and label as such. If referral reason is unclear, state: "Referral reason not specified; clarification pending.")

Clinical Summary

Diagnoses: [Behavioral health and/or medical diagnoses justifying services] (If uncertain, label as working diagnosis and note what is pending.)

Baseline Functioning: [Summary of current status in emotion regulation, coping skills, interpersonal functioning, symptom presentation, treatment engagement, and distress tolerance] (Keep concise and behaviorally descriptive.)

Strengths:

• [Personal interests, values, and creative strengths]
• [Supportive relationships and resources]
• [Motivation and prior effective coping strategies]

Barriers:

• [Cognitive limitations, dissociation, avoidance patterns]
• [Language barriers, sensory sensitivities, communication needs]

Preferences:

• [Preferred and avoided materials/media]
• [Topics to avoid, pacing preferences, sensory accommodations]
• [Cultural/spiritual considerations]

(If any element is not yet assessed, document: "Not yet assessed; will assess by [timeframe].")

Risk and Safety Considerations

(Include this section when risk is relevant to treatment planning. If risk is documented elsewhere with no art-therapy-specific considerations, replace with: "Risk assessment documented in [location]; no art-therapy-specific safety considerations.")

• Risk Screening Summary: [Findings for suicidality/self-harm, violence risk, abuse/neglect concerns] (If low risk, note basis. Reference existing safety plan by date if applicable.)
• Materials Safety: [Restrictions for sharps, toxic media, choking/ligature hazards]
• Trigger Planning: [Known trauma triggers, dissociation risk, grounding strategies, permission to pause or stop]

Treatment Goals

(Organize by problem in order of clinical priority. Include 1–3 problem areas. Goals and objectives must be individualized with patient-specific baselines, timeframes, and measurement methods. Do not state artwork interpretations as fact; attribute as "Patient described..." or "Clinician hypothesized...")

Problem Area 1

Problem Statement: [Behaviorally anchored description of the issue with functional impact]

Long-Term Goal: Patient will [broad functional change] by [timeframe], as evidenced by [indicator aligned with patient's stated goals when possible].

Short-Term Objectives:

• Within [number] sessions, patient will [specific behavior/skill] in [X]% of sessions, under [conditions], as documented by [self-report / clinician observation / standardized measure].
• Within [number] sessions, patient will [specific behavior/skill] when [trigger/context], achieving [criterion], as measured by [method].

Planned Interventions:

• Directive types/themes: [safe place image / container drawing / timeline collage / emotion mapping / values exploration / coping skills rehearsal / strengths-based portrait / other]
• Structure level: [highly directive / semi-structured / open studio]
• Processing approach: [verbal reflection / narrative construction / mindfulness-based / somatic awareness / solution-focused]
• Adaptations: [sensory accommodations / simplified instructions / visual supports / interpreter / pacing adjustments] (Include if applicable.)

Problem Area 2

(Include if applicable.)

Problem Statement: [Behaviorally anchored description with functional impact]

Long-Term Goal: Patient will [broad functional change] by [timeframe], as evidenced by [indicator].

Short-Term Objectives:

• Within [number] sessions, patient will [specific behavior] in [X]% of sessions, under [conditions], as documented by [measurement method].
• Within [number] sessions, patient will [specific behavior/skill] with [criterion], as measured by [method].

Planned Interventions: [Directive types, structure level, processing approach, and adaptations as above]

Problem Area 3

(Include if applicable.)

Problem Statement: [Behaviorally anchored description with functional impact]

Long-Term Goal: Patient will [broad functional change] by [timeframe], as evidenced by [indicator].

Short-Term Objectives:

• Within [number] sessions, patient will [specific behavior] in [X]% of sessions, under [conditions], as documented by [measurement method].
• Within [number] sessions, patient will [specific behavior/skill] with [criterion], as measured by [method].

Planned Interventions: [Directive types, structure level, processing approach, and adaptations as above]

Service Parameters

Frequency: [e.g., 1x/week] Session Length: [e.g., 50 minutes] Planned Duration: [e.g., 12 sessions over 12 weeks] Format: [individual / group / family] (If group, specify type and target population. If pending scheduling, note: "Provisional; pending confirmation.")

Care Coordination

Team Involvement: [Interdisciplinary team members/roles involved in broader care and art therapy's role in coordinated treatment]

Communication Plan: [Who receives updates, format, and frequency]

ROI Status: [On file for (list parties) / Requested / Declined / Not applicable]

Parent/Guardian Involvement: [Expectations for minors] (Include for minor patients.)

(If art therapy is the sole service, note: "Patient not currently engaged in other services" or "Coordination not applicable.")

Review and Discharge Planning

Review Schedule: [Every X days or every X sessions] (Include triggers for earlier review: safety event, level-of-care change, lack of progress.)

Progress Determination: [Objective attainment status (Met / Partially Met / Not Met), quantitative changes on measures, qualitative observations]

Discharge Criteria:

• Clinical: [Goals met and maintained / symptoms manageable / skills generalized / patient can self-direct coping]
• Administrative: [Patient declines / non-attendance per policy / transfer / authorization change]

Artwork Disposition: [return to patient / photograph per consent / store per policy / dispose per policy]

Consent Status

Art Therapy Consent: [On file / Obtained today / Verbal / Pending] Artwork Photography/Sharing Consent: [On file / Declined / Not yet obtained] ROI for Coordination: [On file for (list parties) / Requested / Declined / Not applicable]

Signature

Clinician Signature: _____________________ Date: [MM/DD/YYYY] Credentials: [Credentials]