Behavior Plan Template

CJHS/400 Version 1

University of Phoenix Material

Behavior Plan Template
Use this template to create behavioral plans for assignments in Weeks Two and Three. Fill in each
section and provide additional information as needed.
Client Identifying Information
List all pertinent and known identifying information.
Name

Violet

Age

20

Gender

Female

Religion

Unkown

History
Describe all pertinent and known history.
Medical

Unknown

Family

Sustained sexual abuse by uncle at age 12. Conflicted relationship with her
mother. Foster care from age 12 to 18.

Substance Abuse

Unknown at this time

Developmental and
Social

Violet has a history of difficult relationships. Violet and her mother have a
conflicted relationship. Violet sustained sexual abuse by her uncle at the age of
12. The uncle paid her and took her out to eat. She believes her relationship with
her uncle was not an incestuous one and believes the twelve year age difference
is not an issue. Violet attended a career college for dental assisting. She obtained
a job as a dental assistant. She has a history of difficult relationship with both men
and women. She says that she needs to have a man to feel safe and secure. She
usually becomes sexual early on in the relationship. She has used self-harm in an
attempt to regulate her emotions.

Course of Treatment
List two target behaviors and two interventions.
Target Behaviors

Decrease obsessive behaviors

Decrease self injurious behaviors

Frequency and
Duration of Target
Behaviors

Violet should refrain from starting

new relationships.

Therapy to work through her childhood

events

Severity and
Number of
Relapses

Has been having sex since 12

and continues to engage in
promiscuous activity.

Has had five other restraining orders before

the most recent one.

Interventions
Goals and Objectives
List two long-term goals, two short-term goals, and one objective to work towards each goal.
Long-Term Goal

Gain self control of sexual activity

Avoid self injurious behaviors

Short-Term Goal

No contact, sexually or any type of communication with men in terms of a

Copyright 2013 by University of Phoenix. All rights reserved.

Behavior Plan Template

CJHS/400 Version 1
relationship.
Attend all therapy sessions,
Objectives
Discharge and Termination Plans
Describe the discharge and termination plan for the client.
Discharge Plan
Termination Plan

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