# Treatment Planning

> Use when developing treatment plans, writing SMART goals, determining appropriate level of care, implementing measurement-based care protocols, or adapting treatment based on patient progress. Provides SMART goals framework, ASAM/LOCUS criteria guidance, and treatment monitoring strategies.

- Skill: `majiayu000/treatment-planning` (Agent Skill, multi-file: 2 files)
- Install (CLI): `npx skillmds@latest add majiayu000/treatment-planning`
- Raw SKILL.md: https://api.skillmd.com/api/skills/majiayu000/treatment-planning/raw
- Safety review: pending (external: skill-scanner PASS, skillspector PASS)
- Works with: Claude Code, Claude.ai, OpenAI Codex
- Category: Coding & Dev Tools
- Author: majiayu000 (https://skillmd.com/u/majiayu000)
- Updated: 2026-09-09
- Page: https://skillmd.com/skills/majiayu000/treatment-planning

---


# Treatment Planning

## Description

This skill provides frameworks and tools for developing evidence-based, collaborative treatment plans. Includes SMART goals methodology, level of care guidance, and measurement-based care approaches.

**Clinical Context:** Effective treatment planning translates assessment findings into actionable, measurable interventions. These frameworks support collaborative goal-setting and progress monitoring while maintaining clinical flexibility.

## Available Frameworks

| Framework | Purpose | Key Components |
|-----------|---------|----------------|
| **SMART Goals** | Behavioral health goal setting | Specific, Measurable, Achievable, Relevant, Time-bound |
| **Level of Care Guidance** | Matching symptoms to treatment intensity | Criteria for outpatient, IOP, PHP, residential, inpatient |
| **Measurement-Based Care** | Using assessments to track progress | Baseline, regular monitoring, treatment adjustment |

## Response Style

- Start with the Quick Reference table below.
- Ask if the user wants the detailed guidance and examples.

## Quick Reference

| Step | Action | Tools |
|------|--------|-------|
| 1 | Review assessment results and severity | PHQ-9, GAD-7, PCL-5, AUDIT-C/DAST-10 |
| 2 | Select level of care | OP, IOP, PHP, residential, inpatient |
| 3 | Write SMART goals and monitoring plan | SMART + outcome tracking |

## Interactive Mode (Lightweight)

Use this mode when the clinician asks to build a plan step-by-step.

1. Confirm readiness, target problems, and recent assessment results.
2. Ask one domain at a time (goals, objectives, interventions, timeframe).
3. Propose SMART goals and check for clinician approval.
4. Identify level of care considerations and monitoring plan.
5. Summarize the plan and offer documentation-ready bullets.

## Usage

This skill can be invoked when you need to:
- Develop treatment goals with patients
- Determine appropriate level of care
- Create measurement-based care plans
- Write treatment plan documentation
- Monitor and adjust treatment based on outcomes

**Example requests:**
- "Help me write SMART goals for this patient"
- "What level of care does this patient need?"
- "How do I implement measurement-based care?"
- "Guide me through treatment planning"

## Framework Details

### SMART Goals Framework

**Purpose:** Structure goals to be clear, achievable, and measurable for behavioral health treatment.

**SMART Criteria:**
- **S - Specific:** Clear, concrete behaviors or outcomes
- **M - Measurable:** Quantifiable progress indicators
- **A - Achievable:** Realistic given patient's current functioning and resources
- **R - Relevant:** Aligned with patient's values and treatment needs
- **T - Time-bound:** Specific timeframe for achievement

**Examples:**
**Well-Formed vs. Poorly-Formed Goals:**
- Poor: "Feel less depressed."
  Good: "Reduce PHQ-9 from 16 to <10 within 8 weeks through weekly CBT and activity scheduling."
- Poor: "Stop having panic attacks."
  Good: "Complete 3 interoceptive exposure exercises per week and reduce GAD-7 by 4 points in 6 weeks."
- Poor: "Sleep better."
  Good: "Average 7 hours of sleep on 5 nights/week within 6 weeks, tracked with sleep diary."

**Common Goal Areas:**
- Symptom reduction
- Functional improvement
- Coping skills development
- Relationship enhancement
- Recovery maintenance

**Goal-Writing Guide (Detailed):**
1. **Start with baseline data** (PHQ-9, GAD-7, PCL-5, AUDIT-C/DAST-10).
2. **Name the target behavior/outcome** in observable terms.
3. **Set a time frame** that matches acuity and resources.
4. **Define measurement** (score change, frequency, duration, or functional milestone).
5. **Use patient language** and confirm buy-in.

**Examples by Domain:**
- **Depression:** "Increase daily activity to 5 days/week; PHQ-9 decrease by ~5 points in 4-6 weeks."
- **Anxiety:** "Practice 10 minutes of relaxation daily; GAD-7 decrease by ~4 points in 4-6 weeks."
- **Trauma:** "Complete grounding skills plan; PCL-5 decrease by 10-20 points over 8-12 weeks."
- **Substance Use:** "Reduce drinking days to 1/week; AUDIT-C moves from hazardous to low range in 8 weeks."

### Level of Care Guidance

**Purpose:** Match symptom severity and functional impairment to appropriate treatment intensity.

**Level of Care Continuum:**

1. **Outpatient (OP):**
   - 1-2 sessions per week
   - Stable, lower acuity symptoms
   - Adequate social support
   - No acute safety concerns

2. **Intensive Outpatient (IOP):**
   - 9+ hours per week, multiple days
   - Moderate symptoms affecting functioning
   - Needs structure but can maintain community living
   - Some safety concerns manageable with increased support

3. **Partial Hospitalization (PHP):**
   - 20+ hours per week, weekdays
   - Significant symptom severity
   - Marked functional impairment
   - Needs daily clinical monitoring
   - Alternative to inpatient or step-down

4. **Residential Treatment:**
   - 24-hour structured environment
   - Severe, persistent symptoms
   - Unable to maintain community living safely
   - Needs constant supervision, not acute medical

5. **Inpatient Psychiatric:**
   - 24-hour medical management
   - Acute safety risk (suicide, homicide, grave disability)
   - Severe symptoms requiring medical monitoring
   - Brief stabilization focused

**Decision Factors:**
- Symptom severity and acuity
- Suicide/violence risk
- Functional impairment
- Social support availability
- Previous treatment response
- Co-occurring conditions
- Patient preference (when safe)

**Decision Tree (Quick Guide):**
1. **Imminent risk** or inability to care for self -> **Inpatient**
2. **Severe symptoms** with unsafe home environment -> **Residential or PHP**
3. **Moderate impairment** needing structure -> **IOP**
4. **Mild to moderate symptoms** with stable supports -> **Outpatient**

**Additional Indicators for Higher Level of Care:**
- Recent suicide attempt or escalating self-harm
- Severe functional impairment or inability to complete ADLs
- Psychosis or severe substance withdrawal risk
- Failure to improve with appropriate outpatient treatment

### Measurement-Based Care

**Purpose:** Systematically use assessment data to guide treatment decisions and track outcomes.

**Key Principles:**
1. **Baseline Assessment:** Establish starting point with validated measures
2. **Regular Monitoring:** Consistent re-assessment (weekly, monthly)
3. **Collaborative Review:** Share results with patient
4. **Treatment Adjustment:** Modify interventions based on progress
5. **Outcome Tracking:** Document change over time

**Common Measures:**
- PHQ-9 (depression)
- GAD-7 (anxiety)
- PCL-5 (PTSD)
- Functioning scales
- Quality of life measures

**Implementation Steps:**
1. Select appropriate measures for presenting problems
2. Administer at baseline
3. Set review schedule (e.g., every 4 sessions)
4. Graph progress with patient
5. Discuss results and adjust treatment
6. Document in clinical notes

**Using Measurement to Guide Treatment:**
- Reliable change indices
- Clinically significant change
- When to intensify treatment
- When to step down care
- When to change approaches

**Implementation Guide (Detailed):**
- **Select measures** aligned with primary problems (1-3 tools max).
- **Baseline** at intake and **repeat every 2-4 weeks** or every 4 sessions.
- **Share results** with the patient and document clinical interpretation.
- **Adjust treatment** if no meaningful improvement after 4-6 sessions.
- **Escalate level of care** if scores worsen, risk increases, or function declines.

## Clinical Interpretation

**Translating Assessment to Plan (Examples):**
- **Mild severity:** Low-intensity interventions, psychoeducation, brief therapy.
- **Moderate severity:** Structured therapy (CBT/DBT), weekly visits, consider meds.
- **Severe or complex:** Combined treatment, close monitoring, consider higher level of care.
- **Positive safety screens:** Immediate safety plan and risk-focused interventions.

**Treatment Plan Development Process:**
1. Review assessment findings
2. Identify primary problems/diagnoses
3. Discuss patient's goals and priorities
4. Determine appropriate level of care
5. Develop SMART goals collaboratively
6. Select evidence-based interventions
7. Establish progress monitoring plan
8. Set review timeline

**Matching Interventions to Goals:**
- Evidence-based practices for specific diagnoses
- Patient preferences and values
- Cultural considerations
- Available resources
- Therapist competencies

## Safety Protocols

**Treatment planning must address safety:**
- Document suicide/violence risk assessment
- Include crisis plan in treatment plan
- Identify early warning signs
- Specify emergency contacts and procedures
- Plan for means restriction if indicated
- Schedule more frequent contact if needed

**When to revise treatment plan:**
- Emergence of safety concerns
- Significant symptom worsening
- Major life changes or stressors
- Lack of progress over reasonable timeframe
- Patient request or preference change

**Safety Protocols (Expanded):**
- Use ASQ or C-SSRS for any positive PHQ-9 Item 9 or clinical concern.
- Document intent, plan, means, protective factors, and prior behaviors.
- Include a written safety plan for any elevated risk.
- Arrange same-day evaluation for moderate to high risk.
- For imminent risk, activate emergency services and do not leave patient alone.

## Limitations & Considerations

**These are support frameworks, not rigid requirements:**
- Treatment plans are collaborative documents
- Patient autonomy and choice essential
- Cultural factors shape goal priorities
- Social determinants affect achievability
- Flexibility within structure
- Clinical judgment guides application

**Cultural Considerations:**
- Individualism vs. collectivism in goal-setting
- Family involvement expectations
- Traditional healing integration
- Language and communication style
- Structural barriers to care access
- Cultural concepts of distress and recovery

**Common Challenges:**
- Patient and clinician goals may differ
- Insurance limitations on level of care
- Limited availability of appropriate services
- Social determinants limiting goal achievement
- Balancing structure with flexibility

**Additional Limitations and Considerations:**
- Resource constraints may limit ideal level-of-care placement.
- Insurance authorization may require justification and measurable goals.
- Patient readiness and preference affect pacing and intervention selection.
- Cultural factors influence goal relevance and engagement.

## References

**SMART Goals:**
- Doran GT. There's a S.M.A.R.T. way to write management's goals and objectives. Manage Rev. 1981;70(11):35-36.
- Bovend'Eerdt TJ, Botell RE, Wade DT. Writing SMART rehabilitation goals and achieving goal attainment scaling: a practical guide. Clin Rehabil. 2009;23(4):352-361.

**Level of Care:**
- American Society of Addiction Medicine (ASAM) Criteria
- LOCUS (Level of Care Utilization System) for psychiatric services
- Mee-Lee D, ed. The ASAM Criteria: Treatment Criteria for Addictive, Substance-Related, and Co-Occurring Conditions. 3rd ed. Carson City, NV: The Change Companies; 2013.

**Measurement-Based Care:**
- Scott K, Lewis CC. Using measurement-based care to enhance any treatment. Cogn Behav Pract. 2015;22(1):49-59.
- Fortney JC, Unützer J, Wrenn G, et al. A tipping point for measurement-based care. Psychiatr Serv. 2017;68(2):179-188.

**Additional References:**
- Bovend'Eerdt et al. SMART goals in rehab (PubMed): https://pubmed.ncbi.nlm.nih.gov/19666905/
- Measurement-based care overview (PMC): https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5250470/
- Measurement-based care tipping point (PubMed): https://pubmed.ncbi.nlm.nih.gov/28199986/
- LOCUS overview (AACP): https://www.communitypsychiatry.org/what-we-do/locus
- VA/DoD CPG for Suicide Risk (2024): https://www.healthquality.va.gov/guidelines/MH/srb/VADOD-CPG-Suicide-Risk-Full-CPG-2024_Final_508.pdf

---

**Status:** ✅ Implemented
**Priority:** MEDIUM - Phase 3
**Last Updated:** 2026-02-03