Name of SMT: ________________________ Facility: __________________________

Personal Goal Self Evaluation (write 1 page)

Pre-internship Goal setting: Final:
Date
Class number mm/dd/year mm/dd/year

1. Goal
Objectives (eg. musical, clinical, or behavioral) Reason for setting the objective
Objective 1

Objective 2

Objective 3

2) Execution and Measurement (Record at least once a month)

Tracking Records
Date Date Date Date
Objective1 ( / ) ( / ) ( / ) ( / )

Date Date Date Date

Objective2 ( / ) ( / ) ( / ) ( / )

Date Date Date Date

( / ) ( / ) ( / ) ( / )
Objective3

3) Results:
⦁Describe results (Describe strengths, weaknesses, complementation strategy)
Name of SMT: ________________________ Facility: __________________________

Client Resource Guide & Assessment

Client’s name /group Pre internship class

Period of Assessment Supervisor
Submission date Instructor

Ⅰ. Clinical information
1) Diagnosis of the client/Client’s age
For group session, list all diagnosis, numbers of the clients, gender, and clients’ age range
2) General characteristics of the diagnosis
Find materials from the literature

Ⅱ. General therapeutic and educational approaches of the diagnosis

Use at least 2-3 sources, at least 2 should be from journal articles.

Ⅲ. Music therapy approaches in the literatures of the diagnosis

Find at least 2-3 sources, at least 2 should be from journal articles.

Ⅳ. Assessment
1) Background of the client(s)
Family history, relationship with music, previous music experiences, spiritual or religious values
and beliefs, cultural background

2) Main symptoms and characteristics of the client(s)

3) Assessment categories
a. Cognitive
-Reality orientation, attention span, short/long term memory, perception of academic skills
(numbers, colors, reading, writing, and so on)
b. Motor/Physical
-Gross motor: Body awareness, reaction speed/agility, balance, laterality, directionality,
coordination
-Fine motor: Grasp and release, finger strength and dexterity, wrist movement
-Range of motion, muscular strength
Name of SMT: ________________________ Facility: __________________________

c. Language/Communication
-Vocalization, breath and muscle control, verbalization, receptive/expressive language, speech
rhythm and inflection, articulation, communication with people
d. Social/Emotional
-Social: Individual play, parallel play, cooperative play, competitive play, interaction, problem
management
-Emotional: emotional status (external, internal), psychological issues, self-esteem, self-efficacy

e. Musical

4) Client(s)’s Strength & Needs

a. Strength (3-5)

b. Needs (3-5)

Ⅴ. Treatment Plan (1 or 2 goals per client)

1) Music Therapy Goal setting: 1 goal, 1 or 2 objectives for 1 setting (example)

Goal Increase attention span

Given a preferred song, client will sing 3 phrases of the song in a row for 3
Music Objective
consecutive sessions
Client will have a conversation with MT that lasts for 3 exchanges for 3
Non-Music Objective
consecutive sessions.

Goal Decrease anxiety

Given a music making (singing, active listening, or percussion) intervention,
Music Objective
client will engage for 3 consecutive songs during the session.
Client’s extraneous verbalizations will decrease by 50% during the music
Non-Music Objective
therapy session.

Goal Increase vocalization

Given a phonics song and pictures, client will sing the letter sounds 3x a
Music Objective
session for 3 consecutive sessions.
Non-Music Objective Given 5 different pictures held up by the therapist, the client will vocalize the
Name of SMT: ________________________ Facility: __________________________

sound that corresponds to at least 4 of the 5 pictured.

Musical Objectives include

● Condition: Start the sentence come from “Given”, “During” or “When”
● Behavior: One behavior that is observable and measurable
● Criterion: How long or how many times the behavior is to be performed
● Client: The viewpoint of what one(and only one) individuals will do

Rational for the goal and objective

References (Find more than 3 journal articles out of more than 5 references)
Name of SMT: ________________________ Facility: __________________________

Music Therapy Session Plan

Pre internship
Client’s name /group
class
Diagnosis/ age Supervisor
Session number Session date

Goal and Objective

Goal

Objective

AP #1: Type of Intervention

Objective of the Intervention

Data collection method (if applicable)

Preparation
1) Structure of the setting:

2) Musical materials:

3) Non-Musical materials:

Procedure
1) SMT will
2) SMT demonstrates
3) SMT will
4) SMT..

Extension of the intervention (+)

Application of the intervention (-)

AP #2: Type of Intervention

AP #3: Type of Intervention

Name of SMT: ________________________ Facility: __________________________

AP #4: Type of Intervention

Write At least AP#4 in 1 session

Name of SMT: ________________________ Facility: __________________________

Progress Note
Pre internship
Client’s name /group
class
Diagnosis/ age Supervisor
Session number Session date

Goal and Objective

Goal

Objective

2. Summary of the Intervention

3. Data collection
1) Objective

2) Results

Objective behavior/Date 3/3 3/10 3/17 3/24 3/31 4/7 4/14 4/28 5/12
Number of SMT prompts 8 7 n/a 8
Number of Client responses 3 3 n/a 4
Result ( eg. %) 37.5 42.0 n/a 50.0

4. Observation of client(s)

5. SMT’s Reflection and recommendation

Name of SMT: ________________________ Facility: __________________________

Final Client Progress Report

Client’s name /group Pre internship class

Diagnosis/ age Supervisor

Session numbers Session period mm/dd/year~

mm/dd/year

Ⅰ. Client Description
1. General information
2. Evaluation of client(s)’s changes

Ⅱ. Goal & Objectives

Goal

Objective

III. Music Therapy approach

1. Summary of the Interventions:

2. Music Therapy techniques used:

IV. Data analysis

1. Data changes (Use Table)

2. Describe the data in the table

3. Additional observations of client(s)

V. Music therapy final evaluation statement:

VI. Future Recommendation

Name of SMT: ________________________ Facility: __________________________