Treatment Plan #1

72-Month Reassessment and Treatment Plan
Assessment and Treatment Plan
BEHAVIOR ASSESSMENT WORKSHEET
CLIENT NAME: _ Alexander Jauregui-Orozco_________

DOB: _6/28/10_____
DATE OF ASSESSMENT (DATE COMPLETED WITH CONSUMER): __3/4/2022_____
BEHAVIOR ASSESSMENT TYPE:

VBMAPP ____ ABLLS __X __ AFLLS _____ PEAK _____ Social Savvy _____ Other _____
BEHAVIOR ASSESSMENT SCORE: __202___
ASSESSMENT STATUS *Please specify the assessment number* (6 month, 12 months, etc.): _72____
NAME OF CLINICIAN WHO COMPLETED BEHAVIOR ASSESSMENT: __ Betzaida Rivera-Ash__________

CREDENTIALS: ___ MS, QBHP _________________
CLINICIAN PHONE: __ (248) 935-4820______
CLINICIAN EMAIL: __ bash@centriahealthcare.com_____
CLINICIAN’S CLINICAL SUPERVISOR: __ Casey James _____________

CREDENTIALS: __ MA., BCBA, LBA(MI), RCD_______________________
CLINICIAN PHONE: __ (248) 974-6681______________________________
CLINICIAN EMAILS: __ cjames@centriahealthcare.com___________________
SKILL ACQUISITION:
NUMBER OF SKILLS (TARGETS) WORKED ON IN THE LAST 6 MONTHS: __391___
NUMBER OF SKILLS (TARGETS) MASTERED: __340____

CO.RG.010.02
11/2021
Proprietary + Confidential © Page 1 of 22

Client Information
Client Name Alexander Jauregui-Orozco
Funding Source and Member ID F-0000934-WMH
Date of Birth 6/28/10
Age 11 years 8 months
Address 2039 Moran, Lincoln Pk., MI 48146
Phone (313) 721-2397
Parent/Guardian(s) Maria Orozco (Mother)
Jaime Jauregui (Father)
Assessing Clinician Betzaida Rivera-Ash, MS, QBHP
Assessing Clinician NPI Number N/A
Regional Clinical Director Casey James, MA, BCBA, LBA(MI), RCD
Date/Time of Assessment 03/04/2022 9:00 am – 11:00 pm
Date/Time of Treatment Plan 03/06/2022 8:00 am – 10:00 pm

Report
Treatment Team Members TCC
Centria Tax ID 27-1402749
Centria’s NPI Number 1053641498
Centria Admin Contact Information

Betzaida Rivera-Ash (MS, QBHP)
Phone (248) 935-4825
bash@centriahealthcare.com
Telehealth Disclaimer
6 MONTH DISCLAIMER
Unable to perform face to face assessment, due to COVID-19. Telehealth technology was used to complete this assessment
with parent and client. The 6-month assessment captures the last 6-months of client progress, mastery of goals, and creation
of new treatment plan goals.

CO.RG.010.02
11/2021

Statement of Confidentiality
The following may contain confidential and sensitive information.
Its use is intended for Alexander and/or Alexander’s parent/legal guardian and/or treatment team to determine
program placement, therapy-treatment goals, and necessity for medical intervention.
Further disclosure requires written consent of Alexander’s parent/legal guardian.

CO.RG.010.02
11/2021

Reason for Referral
A referral to Centria Healthcare for Applied Behavior Analysis (ABA) services was made for Alexander by the Children’s Center of
Detroit.
Alexander was diagnosed with Autism Spectrum Disorder (ASD299.0/F84.0) by the Children’s Center of Detroit.
Alexander displays difficulties with lack of eye contact and delay in speech. His parents’ main concerns are improving
communication, improving speech sounds, increasing social skills at home and in the community, school success and
performing self-help skills independently.
Recommendation for ABA Therapy
As observed by the evaluator during the initial assessment, Alexander appears to be an appropriate candidate for ABA therapy.
Additionally, Alexander is able to actively participate in ABA therapy.
The below report presents assessment findings as well as recommendations for treatment including 15 hours of direct ABA Therapy
per week with 10% being supervised by a Board Certified Behavior Analyst (BCBA).
Has the client ever been assessed for comorbid diagnoses? ☐ Yes ☒ No ☐ Unsure
Brief History and Pertinent Background Information
The following information was gathered through a review of records as well as through caregiver interviews.
Detailed information pertaining to developmental history, medical evaluations, or academic history can be found in the client
records.
Home Life/Living Arrangements
Alexander lives in Lincoln Pk., MI with both biological parents and a younger brother.
Alexander’s primary language is Spanish and secondary language is English.
Health Information
Alexander is:
Currently prescribed medication ☐yes N/A

☒no
Overall health ☒healthy with adequate hearing and sight
☐not healthy and/or inadequate hearing or sight
Allergies ☐yes N/A
☒no
Family history is significant for ☐yes
developmental/ significant medical ☒no
diagnoses.
Education Information
School/Education
Alexander: ☒ attends school ☐does not attend school.

CO.RG.010.02
11/2021

School Name Lincoln Park Middle School
Attendance ☐ Part time
☒ Full time
Current Schedule 5 days per week from 7:30am to 2:30pm.
Proposed Schedule N/A
Support IEP
Primary Concerns
Betzaida Rivera-Ash reports primary concerns surrounding improving communication, improving speech sounds, increasing
social skills at home and in the community, school success, and performing self-help skills independently.
In addition to stated concerns, Alexander’s parents expressed strengths of Alexander being a gentle and loving boy, and obedient.
Documentation and Assessments
Assessments Completed
☒ Vineland-3
☐ Verbal Behavior Milestone and Placement Program (VBMAPP)
☒ Assessment of Language and Learning Skills (ABLLS)
☐ Assessment of Functional Living Skills (AFLS)
☐ Other: _________________________
☐ Other: _________________________
☐ Other: _________________________
Assessment Results
Direct Clinical Observation
Alexander was observed on March 4, 2022, for a total duration of 2 hours. The evaluator was welcomed into the home via Zoom by
Mrs. Orozco.
The client was observed to greet the evaluator when he was prompted. He kept himself occupied playing videos game and his iPad.
He did not interrupt and followed directions whenever he was asked to do something. Alexander did not exhibit any maladaptive
behaviors during the observation.
Adaptive Behavior Assessment
During this assessment, Betzaida Rivera-Ash administered the Vineland Adaptive Behavior Scales-3.
Vineland-3
Mrs. Orozco (Mother) completed the Vineland-3 Comprehensive Interview Form in order to assess Alexander’s current adaptive
functioning. This interview was conducted using telehealth technology.

CO.RG.010.02
11/2021

The Vineland-3 is a rating scale comprising four domains to assess adaptive functioning: Communication, Daily Living Skills,
Socialization, and Motor Skills. The Communication, Daily Living Skills, and Socialization domains together provide an overall
composite score called the Adaptive Behavior Composite.
Alexander received an Adaptive Behavior Composite standard score of 34, which falls at the <1 percentile and in the low range.

CO.RG.010.02
11/2021

I. ABC
II.
Sub-Domains

CO.RG.010.02
11/2021

Analysis
The Communication domain assesses abilities surrounding Receptive, Expressive, and Written communication. Alexander received a
standard score of 24 within this domain falling at the <1 percentile and in the low range. Alexander’s relative weaknesses are
expressive.
The Daily Living Skills domain assesses Personal, Domestic, and Community skills. These tasks include aspects of self-care, helping in
the home, and functioning in the community. Alexander received a standard score of 50 within this domain falling at the <1
percentile and in the low range. Alexander’s strengths are domestic, and community.
The Socialization domain focuses on skills surrounding Interpersonal Relations, Play and Leisure, and Coping Skills. Alexander
received a standard score of 27 within this domain falling at the <1 percentile and in the low range. Alexander’s strengths are coping
skills and relative weaknesses are interpersonal relationships and play and leisure.
The maladaptive scale assesses areas of concern regarding internalizing and externalizing behaviors. Scores between 1 to 17 are
considered Average, 18 to 20 Elevated, and 21 to 24 Clinically Significant. Alexander received a v-scale score of 15 for Internalizing
and 12 for Externalizing.
Overall, compared to his same-aged peers, Alexander’s adaptive skills across Communication, Socialization, and Daily Living skills are
below normal limits when compared to his same-aged peers. Alexander may require intervention in these areas: Communication,
Socialization, and Daily Living skills. Additionally, continuous monitoring of these skills is recommended to ensure acquisition of
social norms and motor skills. It is believed that the scores derived during this assessment are an accurate depiction of Alexander’s
abilities. Mrs. Orozco was confident in reporting her child’s strengths and weaknesses.
Behavioral Curriculum Assessment
During this assessment, Betzaida Rivera-Ash administered the following
☐Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP)
☐Assessment of Basic Language and Learning Skills (ABLLS-R)
☒Assessment of Functional Living Skills (AFLS)
☐Other: ________________________________________________

CO.RG.010.02
11/2021


CO.RG.010.02
11/2021


CO.RG.010.02
11/2021

Domain Previous Score New Score Possible
Self-Management 16 20 60
Basic Communication 6 12 78
Dressing 11 29 110
Toileting 29 31 98
Grooming 12 13 62
Bathing 0 4 40
Health and First Aid Safety 12 16 106
Nighttime Routines 8 10 34
Basic Mobility 17 21 108
Community Knowledge 1 15 82
Shopping 5 5 114
Eat in Public 2 4 64
Money 1 1 54
Phone 0 0 90
Time 4 17 64
Social Awareness &

Manners 3 4 108
Total 127 202 1,234

CO.RG.010.02
11/2021

Behavior Treatment Plan
6 Month - Cumulative Mastered Graph
Client Treatment Goals
Client Treatment Goal 1: Behavior
Treatment Goal 1: Alexander will interact with others around him without maladaptive behaviors in 90% of opportunities across 5
consecutive sessions.
Program Goals
Program Goal 1 Alexander will engage in 5 helpful behaviors focused on the baby in
90% of opportunities across 5 consecutive sessions.
Setting: ☒ Home
☐ Center
☒ Community
Baseline Date: 5/7/21
Baseline Data: Alexander engages in 5 helpful behaviors focused on the baby in 0% of
opportunities.
Start Date: 03/11/2022
Anticipated Mastery Dates: 09/11/2022
Current Status: ☐ New
☒ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold
Progress Toward Goal: ☐ N/A

CO.RG.010.02
11/2021

☐ Goal has been met
☒ In Progress
ABA Interventions: DTT, Errorless Learning, NET
Generalization Training: Across 2 people or 2 settings
Program Goal 2 Alexander will participate in a community-based activity with an adult

for a minimum of 10 minutes by staying in the area, engaging in the
activity and interacting with the other person without exhibiting
challenging behaviors or attempting to elope from the area for 5
consecutive events.
Setting: ☒ Home
☐ Center
☒ Community
Baseline Data: Alexander is able to respond appropriately to the Behavior Technician
(BT) when he is engaging in activities that he chooses and when the BT
is prompting him.
☒ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold
☒ In Progress
Client Treatment Goal 2: Self-Management
Treatment Goal 2: Alexander will become more independent with daily living skills (appropriately and independently requesting a
break from/help with ongoing tasks and to use a coping strategy to calm down then return to the task within the time limit) in 80%
of opportunities across 5 consecutive sessions.
Program Goals
Program Goal 1 Alexander will be able to ask for a break/help and use calming strategies
when trying to communicate with others in 80% of opportunities across
5 consecutive sessions.
CO.RG.010.02
11/2021

Setting: ☒ Home
☐ Center
☒ Community
Baseline Data: Alexander engages in aggressive behavior when he has difficulty
communicating his wants and needs to others.
☒ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold
☒ In Progress
Client Treatment Goal 3: Basic Communication
Treatment Goal 3: Alexander will follow multi-step directions in routine situations (getting the mail and putting it on the table,
closing the door, locking it, taking off his shoes, and hanging up his coat, etc.) in 80% of opportunities across 5 consecutive sessions.
Program Goals
Program Goal 1 Alexander will be able to follow at least 20 directions to go to locations
or people and retrieve, place, and deliver specific items in 80% of
opportunities across 5 consecutive sessions.
Setting: ☒ Home
☐ Center
☒ Community
Baseline Data: Alexander can follow 20 directions. He delivers specific items
independently in 0% of opportunities.

☒ Ongoing

CO.RG.010.02
11/2021

☐ Discontinued
☐ Mastered
☐ Hold
☒ In Progress
Client Treatment Goal 4: Bathing
Treatment Goal 4: Alexander will shower independently (full routine) in 80% of opportunities across 5 consecutive sessions.
Program Goals
Program Goal 1 Alexander will identify items necessary for bathing or showering, with
80% accuracy across 2 consecutive sessions.
Setting: ☒ Home
☐ Center
☒ Community
Baseline Data: Alexander will independently get in the shower when the shower is
started for him.
☒ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold
☒ In Progress

CO.RG.010.02
11/2021

Client Treatment Goal 5: Health, Safety, and First Aid
Treatment Goal 5: Alexander will adjust water to a safe/appropriate temperature for the task (washing dishes, washing face,
washing hands, brushing teeth, and showering) in 100% of opportunities across 5 consecutive sessions.
Program Goals
Program Goal 1 Alexander will adjust the temperature when brushing teeth and bathing
to an appropriate temperature in 100% of opportunities across 5
Setting: ☒ Home
☐ Center
☒ Community
Baseline Data: Alexander does adjust the faucet when washing hands.

☒ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold
☒ In Progress
Client Treatment Goal 6: Money
Treatment Goal 6: Alexander will receptively and expressively identify coin and bill names and values with 80% accuracy across 5
Program Goals
Program Goal 1 Alexander will identify all values of coins and bills, 80% of the time across
3 consecutive sessions.
Setting: ☒ Home
☐ Center
☒ Community

CO.RG.010.02
11/2021

Baseline Data: Alexander identifies and sorts coins and bills.

☒ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold
☒ In Progress
Client Treatment Goal 7: Phone
Treatment Goal 7: Alexander will locate contacts his phone and make/answer phone calls in 80% of opportunities across 5
Program Goals
Program Goal 1 Alexander will recognize when the phone is ringing in 80% of
Setting: ☒ Home
☐ Center
☒ Community
Baseline Data: Alexander operates a cell phone to watch videos and to play games.

☒ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold

CO.RG.010.02
11/2021

☒ In Progress
Client Treatment Goal 8: Time
Treatment Goal 8: Alexander will use a digital clock to tell time and will set his own morning alarm and wake up in 80% of
Program Goals
Program Goal 1 Alexander will state “before” and “after” for activities in a familiar
picture sequence and/or schedule with 80% accuracy across 3
Setting: ☒ Home
☐ Center
☒ Community
Baseline Data: Alexander follows a visual schedule.
☒ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold
☒ In Progress
Program Goal 2 Alexander will increase the time of waiting for an activity, or an item, or
event for more than 5 minutes in 80% of opportunities across 3
Setting: ☒ Home
☐ Center
☒ Community
CO.RG.010.02
11/2021

Baseline Data: Alexander does not wait more than 5 minutes.
☒ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold
☒ In Progress
Client Treatment Goal 9: Social Awareness and Manners
Treatment Goal 9: Alexander will expressively identify and follow the rules/norms in at least 3 community settings in 80% of
Program Goals
Program Goal 1 Alexander will say, “Excuse me/Can you move please,” to request others
to move, 80% of the time across 3 consecutive sessions.
Setting: ☒ Home
☐ Center
☒ Community
Baseline Data: Alexander returns greetings and says “thank you” appropriately.
☒ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold
☒ In Progress

CO.RG.010.02
11/2021

Family Priorities
Betzaida Rivera -Ash and the parent/guardian discussed short term goals for Alexander to include: Making appropriate vocal mands
of 4-5 word approximations in language that is understood by familiar adults and peers, and Improving Alexander’s independent
living skills (self-help, completing daily routines, household chores).
Long term aspirational goals include: Independently approach and interact with peers, navigate familiar community environments,
and behave appropriately in the community with adult supervision.
Family Engagement Goal
Family Engagement Goal: Socialization

Current Status: ☒ New
☐ Ongoing
☐ Discontinued
☐ Mastered
☐ Hold
Setting: ☒ Home
☐ Center
☒ Community
Treatment Goal: ☒ Overall
☐ Domain
Baseline: Alexander shares appropriately with his brother in 0% of opportunities.
Program Goal: Alexander will appropriately interact and share (especially food) with
his younger brother on 3 occasions per week without maladaptive
behavior, in 2 out of 3 opportunities across a 12 week period.
Progress Toward Goal: N/A
ABA Interventions: Errorless Learning
Generalization Training
The clinical team will plan for generalization at the onset of therapy. Various materials, items and instructions will be used, and
therapy will take place in various environments across different team members. Once skill acquisition goals are met, the clinical
team will generalize and maintain those skills by thinning reinforcement (moving from continuous to intermittent reinforcement
schedules) and fading prompts. As caregivers become more competent in implementing behavioral strategies, the clinical team will
slowly fade out their presence to allow for the parent to independently manage behaviors and take over programming. The result
should be a gradual decrease in direct therapy services and an increase in parent engagement sessions.

CO.RG.010.02
11/2021

Transition, Graduation, and Discharge
The long-term goal for Alexander is to transition to the home and community setting with limited support and function similar to
typically developing same-aged peers. Depending on the response and progress with treatment, Alexander’s ABA therapy hours will
gradually decrease. There will be a focus on generalization of skills and maintenance.
Additionally, collaboration with other services (i.e., school, speech/language therapy, pediatricians) will be implemented to determine
individual transition supports when appropriate. A formal transition plan will be initiated when Alexander has demonstrated
independence and consistent implementation of replacement behaviors across multiple individuals and settings for at least three
consecutive months.
Additionally, the frequency, duration, and/or intensity of Alexander’s challenging behaviors must reduce to no longer jeopardize
individual safety or the safety of others. In addition to reduction of challenging behavior, the clinical team will analyze Alexander’s
progress weekly to ensure skill acquisition targets have been generalized and maintained.
Part of generalization and maintenance includes fading out supports, thinning reinforcement to more natural schedules and
instructional control has been transferred to caregivers. Prior to transition, a meeting will be set with Alexander’s
parent/caregiver(s) and other professionals (e.g., teachers) to discuss progress since the inception of services, timeline of the fade-
out plan as well as recommendations for future support and services. Discharge will be considered when Alexander meets the
following goals for desired outcomes necessary for independent living.
Vineland Discharge Criteria
Alexander’s Vineland-3 score fall within two standard deviations below the means.
Alexander will demonstrate the ability to be independent in the home and community settings.
Overall Expected Outcome
The overall expected outcome includes increased and fluent expressive and receptive communication skills.
Alexander is expected to increase:
• Functional Communication with clearer speech.

• Become more independent with daily living skills.
• To learn how to wait for extended periods of time.
• To share with his younger brother.
Additionally, these acquired skills are expected to provide Alexander with the skills necessary to engage with peers and be an active
member of his social community.
Risks and Benefits
Potential Benefits
ABA therapy will ultimately increase skills used in the home, school, and community. It will provide the necessary intervention for
Alexander to be independent and learn functional daily living skills.
Potential Risks
Specific risk factors related to Alexander:
• Alexander has limited mand repertories. Parents will hold back on items that Alexander wants until a verbal mand is
attempted.
• Alexander Speaks in English and Spanish which limits the ability for others to understand him unless they speak English and
CO.RG.010.02
11/2021

Spanish. Treatment team will reinforce that Spanish is his home language and English is spoken in school.
• Responses are often rote and/or prompt bound. Treatment team will use visual prompts when appropriate and
systematically fade them.
• Alexander engages in parallel play but does not initiate social interaction with peers. Some therapy time will include
interactions with peers (swimming class, yoga, and center social skills group).
• Alexander will engage in repetitive vocalizations, rocking, and inappropriate laughing.
• Alexander can become restrictive in routines. Change to routine will be built into therapy sessions.
• It is not recommended Alexander’s technician receive QBS training.
Dosage/Service Level Recommendations and Medical Necessity
ABA Treatment Strategy and Dosage Recommendation
☐ Comprehensive Treatment Plan (intervention addressing multiple domains)
☒ Focused Treatment Plan (intervention addressing challenging behavior and up to two domains of deficit)
Based on the Treatment Goals and Associated ABA Program Plan as outlined herein, it is medically necessary that Alexander receive
15 hours per week of direct 1:1 ABA Intervention. Services are scheduled to occur for 15 hours per week in Alexander’s home and
community environments.
Based on a shared decision-making review of the Treatment Plan, the parents/guardians disagree with this Service Level
Recommendation
As a result of this determination, this plan will be:
Select one option: ☐ Implemented as written ☒ Modified as outlined below
Treatment Authorization Request
CPT Code Description of Total # of Hours/Units Units Location of Services

Service Hours (per week)
97151 ABA Assessment 6 hours N/A 24 units ☒ Home
☐ Community
☐ Center
97153 Direct 312 hours 12 hours/week 48 ☒ Home
Implementation of units/week ☒ Community
ABA Services ☐ Center
97155 Direct Observation 32.5 hours 1.25 5 ☒ Home
of ABA Services hours/week units/week ☒ Community
☐ Center
97156 Family 6 hours 1 hour/month 4 ☒ Home
Engagement units/month ☒ Community
☐ Center
Alexander’s family is encouraged to participate in home-based sessions and formal family engagement sessions at least once per
month to learn how to analyze and maintain positive behaviors.
The Assessing Clinician has discussed these recommendations with Mrs. Orozco. She would like to start with 12 hours of treatment
programs per week and will look to increasing in the future. Based on the assessment results, Alexander will benefit from and actively
participate in ABA treatment programs.
CO.RG.010.02
11/2021

Approval and Consent
This Report was written by:
________________________________________ _______3/6/22_________
Betzaida Rivera-Ash, MS, QBHP (Supervising Clinician) Date
(248) 935-4820
bash@centriahealthcare.com
This Report was reviewed and approved by:
3/11/2022
Nathaniel Schick, MA, BCBA, LBA (MI, OR) Date
Lead Supervising Clinician
313 694 5385
nschick@centriahealthcare.com

CO.RG.010.02
11/2021

Treatment Plan #1

Uploaded by

Document Information

Original Description:

Original Title

Copyright

Available Formats

Share this document

Share or Embed Document

Sharing Options

Did you find this document useful?

Is this content inappropriate?

Copyright:

Available Formats

Treatment Plan #1

Uploaded by

Copyright:

Available Formats

72-Month Reassessment and Treatment Plan

Assessment and Treatment Plan

BEHAVIOR ASSESSMENT WORKSHEET

CLIENT NAME: _ Alexander Jauregui-Orozco_________

DATE OF ASSESSMENT (DATE COMPLETED WITH CONSUMER): __3/4/2022_____

BEHAVIOR ASSESSMENT TYPE:

BEHAVIOR ASSESSMENT SCORE: __202___

NAME OF CLINICIAN WHO COMPLETED BEHAVIOR ASSESSMENT: __ Betzaida Rivera-Ash__________

CLINICIAN PHONE: __ (248) 935-4820______

CLINICIAN EMAIL: __ bash@centriahealthcare.com_____

CLINICIAN’S CLINICAL SUPERVISOR: __ Casey James _____________

CLINICIAN PHONE: __ (248) 974-6681______________________________

CLINICIAN EMAILS: __ cjames@centriahealthcare.com___________________

Assessment and Treatment Plan

Proprietary + Confidential © Page 1 of 22

Client Name Alexander Jauregui-Orozco

Funding Source and Member ID F-0000934-WMH

Date of Birth 6/28/10

Age 11 years 8 months

Address 2039 Moran, Lincoln Pk., MI 48146

Phone (313) 721-2397

Parent/Guardian(s) Maria Orozco (Mother)

Jaime Jauregui (Father)

Assessing Clinician Betzaida Rivera-Ash, MS, QBHP

Assessing Clinician NPI Number N/A

Regional Clinical Director Casey James, MA, BCBA, LBA(MI), RCD

Date/Time of Assessment 03/04/2022 9:00 am – 11:00 pm

Date/Time of Treatment Plan 03/06/2022 8:00 am – 10:00 pm

Treatment Team Members TCC

Centria Tax ID 27-1402749

Centria’s NPI Number 1053641498

Centria Admin Contact Information

Phone (248) 935-4825

Assessment and Treatment Plan

Proprietary + Confidential © Page 2 of 22

The following may contain confidential and sensitive information.

Further disclosure requires written consent of Alexander’s parent/legal guardian.

Assessment and Treatment Plan

Proprietary + Confidential © Page 3 of 22

Recommendation for ABA Therapy

Brief History and Pertinent Background Information

Home Life/Living Arrangements

Alexander’s primary language is Spanish and secondary language is English.

Currently prescribed medication ☐yes N/A

Alexander: ☒ attends school ☐does not attend school.

Proprietary + Confidential © Page 4 of 22

Documentation and Assessments

☐ Verbal Behavior Milestone and Placement Program (VBMAPP)

☒ Assessment of Language and Learning Skills (ABLLS)

☐ Assessment of Functional Living Skills (AFLS)

Direct Clinical Observation

Adaptive Behavior Assessment

Assessment and Treatment Plan

Proprietary + Confidential © Page 5 of 22

Assessment and Treatment Plan

Proprietary + Confidential © Page 6 of 22

Assessment and Treatment Plan

Proprietary + Confidential © Page 7 of 22

Behavioral Curriculum Assessment

During this assessment, Betzaida Rivera-Ash administered the following

☐Verbal Behavior Milestones Assessment and Placement Program (VB-MAPP)

☐Assessment of Basic Language and Learning Skills (ABLLS-R)

DATE OF ASSESSMENT (DATE COMPLETED WITH CONSUMER): 3/4/2022___

BEHAVIOR ASSESSMENT SCORE: 202_

NAME OF CLINICIAN WHO COMPLETED BEHAVIOR ASSESSMENT: Betzaida Rivera-Ash________

CLINICIAN PHONE: (248) 935-4820____

CLINICIAN EMAIL: bash@centriahealthcare.com___

CLINICIAN’S CLINICAL SUPERVISOR: Casey James ___________

CLINICIAN PHONE: (248) 974-6681____________________________

CLINICIAN EMAILS: cjames@centriahealthcare.com_________________