Program Plan Template

Describe the problem/concern as

evidenced by
EXAMPLE: Luke has repetitive
temper tantrums as evidenced by his
excessive crying, screaming and noncompliance several times a day.
Problem/Concern #1:
Everyday plenty of high school/
junior high students are being bullied.
Often times they have no one to relate
to and have no idea how to stop the
issue either.

Goal outcome
EXAMPLE: decrease conflict in
the home
Objective measurable, time
frame, what the client will do.
EXAMPLE: clients will utilize
I messages in each interaction
for 1 week
Goal #1:
The team has created a website
filled with useful information to
help victims and let them know
they are not alone. The website is
available for not only victims, but
anyone who may benefit.
Objective 1.1: help victims find
someone or something to relate to.
Objective 1.2: help victims as
well as parents find help
Objective 1.3: leave an
empowering message on the
impacts of bullying and how
kindness is a greater weapon.

Interventions/Methods (what you

the social worker/team will do help
client to reach each objective)
EXAMPLE: SW will role-play with
client practicing the use of I
messages

We will reach these goals through

our web site as well as counseling to
anyone who has felt like a victim.