Model Treatment or Service Plan
Lynette89
cf_treatment_plan_template.docASI Treatment Plan Template
(ASI/DENS Format)
Client/Organization Name: Counselor Name:
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Problem Statement |
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Goals |
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D/C Criteria |
Objectives What will the client say or do? Under what circumstances? How often will he/she say or do this? |
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Interventions What will the counselor/staff do to assist client? Under what circumstances? |
Service Codes |
Target Date |
Resolution Date |
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Participation in Treatment Planning Process |
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Participation by Others in the Treatment Planning Process |
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Note: All participants may not have participated in every area.
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Client Signature/Date
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Counselor Signature/Date
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Service Codes
I=Individual G=Group F=Family C=Couples P=Psychoeducational H=Homework
R=Reading M=Media V=Videotape A=Audiotape R=Referral
Treatment Planning M.A.T.R.S.:
Utilizing the Addiction Severity Index (ASI) to Make Required Data Collection Useful
