sk-claudecode 1.0.0

package/skills/scientific/treatment-plans/assets/mental_health_treatment_plan.tex

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+% Mental Health Treatment Plan Template
+% For psychiatric and behavioral health treatment
+% Last updated: 2025
+
+\documentclass[11pt,letterpaper]{article}
+
+% Packages
+\usepackage[top=1in,bottom=1in,left=1in,right=1in]{geometry}
+\usepackage{amsmath,amssymb}
+\usepackage[utf8]{inputenc}
+\usepackage{graphicx}
+\usepackage{array}
+\usepackage{longtable}
+\usepackage{booktabs}
+\usepackage{enumitem}
+\usepackage{xcolor}
+\usepackage{fancyhdr}
+\usepackage{lastpage}
+\usepackage{tabularx}
+\usepackage[most]{tcolorbox}
+
+% Header and footer
+\pagestyle{fancy}
+\fancyhf{}
+\lhead{Mental Health Treatment Plan}
+\rhead{Page \thepage\ of \pageref{LastPage}}
+\lfoot{Date Created: \today}
+\rfoot{Confidential Patient Information}
+
+% Title formatting
+\usepackage{titlesec}
+\titleformat{\section}{\large\bfseries}{\thesection}{1em}{}
+\titleformat{\subsection}{\normalsize\bfseries}{\thesubsection}{1em}{}
+
+\begin{document}
+
+% Title
+\begin{center}
+{\Large\bfseries MENTAL HEALTH TREATMENT PLAN}\\[0.5em]
+{\large Psychiatric \& Behavioral Health Services}\\[0.5em]
+\rule{\textwidth}{1pt}
+\end{center}
+
+\vspace{1em}
+
+% ===== TREATMENT PLAN HIGHLIGHTS (Foundation Medicine Model) =====
+\begin{tcolorbox}[colback=purple!5!white,colframe=purple!75!black,title=\textbf{TREATMENT PLAN HIGHLIGHTS},fonttitle=\bfseries\large]
+
+\textbf{Key Diagnosis:} [Primary psychiatric diagnosis - e.g., Major Depressive Disorder, moderate (DSM-5 296.32)]
+
+\vspace{0.3em}
+\textbf{Primary Treatment Goals:}
+\begin{itemize}[leftmargin=*,itemsep=0pt]
+    \item [Goal 1 - e.g., Reduce PHQ-9 score from 18 to $<$10 within 12 weeks]
+    \item [Goal 2 - e.g., Return to work full-time within 3 months]
+    \item [Goal 3 - e.g., Develop 3 effective coping strategies for stress management]
+\end{itemize}
+
+\vspace{0.3em}
+\textbf{Main Interventions:}
+\begin{itemize}[leftmargin=*,itemsep=0pt]
+    \item \textit{Psychotherapy:} [Modality - e.g., Cognitive Behavioral Therapy (CBT) weekly for 16 sessions]
+    \item \textit{Medication:} [Key medications - e.g., Sertraline 50mg daily, titrate to 100mg]
+    \item \textit{Safety:} [Crisis plan in place, emergency contacts established]
+\end{itemize}
+
+\vspace{0.3em}
+\textbf{Timeline:} [Duration - e.g., Acute treatment (12 weeks), Continuation (4-6 months), Maintenance (ongoing)]
+
+\end{tcolorbox}
+
+\vspace{1em}
+
+% ===== SECTION 1: PATIENT INFORMATION =====
+\section*{1. Patient Information}
+
+\textbf{HIPAA Notice}: De-identify all protected health information per Safe Harbor method before sharing.
+
+\vspace{0.5em}
+
+\begin{tabularx}{\textwidth}{|l|X|}
+\hline
+\textbf{Patient ID} & [De-identified code, e.g., MH-001] \\ \hline
+\textbf{Age Range} & [e.g., 30-35 years] \\ \hline
+\textbf{Sex} & [Male/Female/Other] \\ \hline
+\textbf{Gender Identity} & [If relevant and disclosed] \\ \hline
+\textbf{Pronouns} & [Patient's preferred pronouns] \\ \hline
+\textbf{Date of Plan} & [Month/Year only] \\ \hline
+\textbf{Treating Provider} & [Psychiatrist/Psychologist/LCSW/NP Name, Credentials] \\ \hline
+\textbf{Treatment Setting} & [Outpatient/IOP/PHP/Inpatient] \\ \hline
+\textbf{Facility} & [Mental health center/clinic name] \\ \hline
+\end{tabularx}
+
+\vspace{1em}
+
+\subsection*{Presenting Problem}
+
+\textbf{Chief Complaint}: [Patient's own words, e.g., "I've been feeling really down and can't get motivated to do anything"]
+
+\textbf{History of Present Illness}:
+[Detailed description of current symptoms, onset, duration, severity, precipitating factors, impact on functioning. Example: Patient reports depressed mood, anhedonia, fatigue, and difficulty concentrating for past 3 months, following job loss. Symptoms have progressively worsened, now affecting ability to complete daily tasks and maintain social relationships.]
+
+\subsection*{Psychiatric History}
+
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Previous Psychiatric Diagnoses}: [e.g., Major Depressive Disorder, diagnosed 5 years ago]
+    \item \textbf{Previous Treatment}:
+    \begin{itemize}
+        \item Psychotherapy: [e.g., CBT for 6 months in 2020, helpful]
+        \item Medications: [e.g., Sertraline 100mg 2020-2021, discontinued due to side effects]
+        \item Hospitalizations: [e.g., One psychiatric hospitalization in 2019 for suicidal ideation]
+    \end{itemize}
+    \item \textbf{Family Psychiatric History}: [e.g., Mother with depression, paternal uncle with bipolar disorder]
+\end{itemize}
+
+\subsection*{Substance Use History}
+
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Alcohol}: [e.g., Social use, 2-3 drinks per week, denies binge drinking]
+    \item \textbf{Tobacco}: [e.g., Non-smoker]
+    \item \textbf{Cannabis}: [e.g., Previously daily use, quit 6 months ago]
+    \item \textbf{Other Substances}: [e.g., Denies other illicit drug use]
+    \item \textbf{Substance Use Disorder}: [e.g., Cannabis use disorder, in remission]
+\end{itemize}
+
+\subsection*{Medical History}
+
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Chronic Medical Conditions}: [e.g., Hypothyroidism, well-controlled on levothyroxine]
+    \item \textbf{Current Medications}: [e.g., Levothyroxine 100mcg daily]
+    \item \textbf{Allergies}: [NKDA or list medication allergies and reactions]
+\end{itemize}
+
+\subsection*{Social History and Support}
+
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Living Situation}: [e.g., Lives alone in apartment, safe housing]
+    \item \textbf{Employment}: [e.g., Recently unemployed (3 months), previously worked as accountant]
+    \item \textbf{Education}: [e.g., Bachelor's degree in accounting]
+    \item \textbf{Marital/Relationship Status}: [e.g., Single, not in relationship]
+    \item \textbf{Social Support}: [e.g., Close relationship with sister, few friends, isolated recently]
+    \item \textbf{Financial Stressors}: [e.g., Unemployment causing financial strain]
+    \item \textbf{Legal Issues}: [e.g., None]
+    \item \textbf{Trauma History}: [e.g., Reports childhood emotional abuse, no recent trauma]
+\end{itemize}
+
+% ===== SECTION 2: PSYCHIATRIC ASSESSMENT =====
+\section*{2. Psychiatric Assessment and Diagnosis}
+
+\subsection*{Mental Status Examination}
+
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Appearance}: [e.g., Casually dressed, fair grooming, appropriate for season]
+    \item \textbf{Behavior}: [e.g., Cooperative, fair eye contact, psychomotor retardation noted]
+    \item \textbf{Speech}: [e.g., Soft volume, slow rate, decreased spontaneity]
+    \item \textbf{Mood}: [e.g., "Depressed and hopeless" - patient's own words]
+    \item \textbf{Affect}: [e.g., Constricted, dysphoric, congruent with mood]
+    \item \textbf{Thought Process}: [e.g., Linear, goal-directed, no tangentiality or loose associations]
+    \item \textbf{Thought Content}:
+    \begin{itemize}
+        \item Suicidal ideation: [e.g., Passive SI present ("wish I wouldn't wake up"), denies active SI/plan/intent]
+        \item Homicidal ideation: [e.g., Denied]
+        \item Delusions: [e.g., None identified]
+        \item Obsessions/compulsions: [e.g., None]
+    \end{itemize}
+    \item \textbf{Perceptions}: [e.g., No hallucinations (auditory, visual, tactile) reported or observed]
+    \item \textbf{Cognition}:
+    \begin{itemize}
+        \item Orientation: [e.g., Oriented to person, place, time, situation]
+        \item Memory: [e.g., Intact for recent and remote events]
+        \item Concentration: [e.g., Impaired, difficulty with serial 7s]
+        \item Insight: [e.g., Fair - recognizes need for treatment]
+        \item Judgment: [e.g., Fair to good - makes reasonable decisions]
+    \end{itemize}
+\end{itemize}
+
+\subsection*{Diagnostic Assessment}
+
+\textbf{Primary Diagnosis}: [e.g., Major Depressive Disorder, Recurrent Episode, Moderate]\\
+\textbf{DSM-5 Code}: [e.g., F33.1]
+
+\textbf{DSM-5 Criteria Met}:
+\begin{itemize}[leftmargin=*]
+    \item Depressed mood most of the day, nearly every day (patient report, observed affect)
+    \item Markedly diminished interest or pleasure in activities (anhedonia)
+    \item Significant weight loss (10 lbs in 2 months)
+    \item Insomnia nearly every night (difficulty falling and staying asleep)
+    \item Fatigue and loss of energy nearly every day
+    \item Feelings of worthlessness and guilt
+    \item Diminished ability to think and concentrate
+    \item Duration: 3 months
+    \item Significant distress and impairment in occupational and social functioning
+\end{itemize}
+
+\textbf{Secondary Diagnoses}:
+\begin{itemize}[leftmargin=*]
+    \item [e.g., Cannabis Use Disorder, Mild, In Sustained Remission] (DSM-5: F12.11)
+    \item [e.g., Unspecified Anxiety Disorder] (DSM-5: F41.9)
+\end{itemize}
+
+\subsection*{Symptom Severity Assessment}
+
+\begin{tabularx}{\textwidth}{|l|c|c|X|}
+\hline
+\textbf{Assessment Tool} & \textbf{Score} & \textbf{Interpretation} & \textbf{Notes} \\ \hline
+PHQ-9 (Depression) & 18/27 & Moderately severe depression & Target $<$10 for remission \\ \hline
+GAD-7 (Anxiety) & 12/21 & Moderate anxiety & Target $<$5 \\ \hline
+PCL-5 (PTSD) & N/A & Not administered & Consider if trauma symptoms emerge \\ \hline
+C-SSRS (Suicide Risk) & Level 3 & Passive SI, no intent/plan & Requires safety planning \\ \hline
+AUDIT (Alcohol) & 3/40 & Low risk & No current concern \\ \hline
+\end{tabularx}
+
+\subsection*{Functional Impairment}
+
+\textbf{Impact on Daily Functioning}:
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Occupational}: Unable to work currently, difficulty with job search due to lack of motivation
+    \item \textbf{Social}: Withdrawn from friends, decreased social activities, isolating at home
+    \item \textbf{Self-Care}: Difficulty maintaining hygiene, skipping meals, irregular sleep
+    \item \textbf{Relationships}: Strained relationships due to irritability and withdrawal
+    \item \textbf{Physical Health}: Decreased exercise, poor nutrition
+\end{itemize}
+
+\subsection*{Risk Assessment}
+
+\textbf{Suicide Risk}: [e.g., Low to Moderate]
+\begin{itemize}[leftmargin=*]
+    \item \textit{Risk Factors}: Depression, unemployment, social isolation, passive SI, previous suicide attempt (2019)
+    \item \textit{Protective Factors}: Engaged in treatment, close relationship with sister, denies current intent/plan, future-oriented (wants to get better)
+    \item \textit{Current Status}: Passive SI only, no active ideation, plan, or intent. Contracts for safety.
+\end{itemize}
+
+\textbf{Homicide/Violence Risk}: [e.g., Low] - No homicidal ideation, no history of violence
+
+% ===== SECTION 3: TREATMENT GOALS =====
+\section*{3. Treatment Goals (SMART Format)}
+
+\subsection*{3.1 Short-Term Goals (4-8 weeks)}
+
+\textbf{Symptom Reduction Goals}:
+\begin{enumerate}[leftmargin=*]
+    \item \textbf{Depression}: Reduce PHQ-9 score from 18 to $<$10 (minimal depression) within 8 weeks through medication and psychotherapy.
+    \begin{itemize}
+        \item \textit{Measurable}: PHQ-9 assessment every 2 weeks
+        \item \textit{Achievable}: With SSRI and weekly CBT
+        \item \textit{Time-bound}: 8 weeks
+    \end{itemize}
+    
+    \item \textbf{Sleep}: Improve sleep to 6-7 hours nightly with no more than 1 awakening within 4 weeks through sleep hygiene and possible medication adjustment.
+    
+    \item \textbf{Anxiety}: Reduce GAD-7 score from 12 to $<$8 within 6 weeks using CBT anxiety management techniques.
+    
+    \item \textbf{Suicide Risk}: Eliminate passive suicidal ideation, maintain safety contract, implement crisis plan within 2 weeks.
+\end{enumerate}
+
+\textbf{Functional Goals}:
+\begin{enumerate}[leftmargin=*]
+    \item \textbf{Self-Care}: Establish daily self-care routine (shower, meals, sleep schedule) with 80\% compliance within 3 weeks.
+    
+    \item \textbf{Social Engagement}: Re-engage in 1-2 social activities per week (phone calls with friends, sister visits) within 4 weeks.
+    
+    \item \textbf{Coping Skills}: Learn and practice 3 new coping skills for managing depressive symptoms within 4 weeks.
+\end{enumerate}
+
+\subsection*{3.2 Long-Term Goals (3-6 months)}
+
+\textbf{Recovery-Oriented Goals}:
+\begin{enumerate}[leftmargin=*]
+    \item \textbf{Remission}: Achieve depression remission with PHQ-9 score $<$5 and sustained improved mood within 12-16 weeks.
+    
+    \item \textbf{Return to Work}: Develop job search plan, practice interview skills, secure employment or engage in meaningful volunteer work within 3-4 months.
+    
+    \item \textbf{Relationship Building}: Rebuild and strengthen social connections, increase social support network by adding 2-3 regular social contacts within 3 months.
+    
+    \item \textbf{Quality of Life}: Re-engage in previously enjoyed activities (hobbies, exercise, leisure) at least 3x per week within 3 months.
+    
+    \item \textbf{Resilience}: Develop sustainable wellness routine including regular sleep, exercise, healthy diet, and stress management practices within 4 months.
+    
+    \item \textbf{Relapse Prevention}: Identify early warning signs of depression, develop relapse prevention plan, maintain treatment gains within 6 months.
+\end{enumerate}
+
+\subsection*{3.3 Patient-Identified Goals}
+
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Priority 1}: "I want to feel like myself again and have energy to do things"
+    \item \textbf{Priority 2}: "I want to find a new job and feel confident in interviews"
+    \item \textbf{Priority 3}: "I want to stop feeling guilty all the time"
+    \item \textbf{Priority 4}: "I want to enjoy spending time with my friends and family again"
+\end{itemize}
+
+% ===== SECTION 4: TREATMENT INTERVENTIONS =====
+\section*{4. Treatment Interventions}
+
+\subsection*{4.1 Psychopharmacology}
+
+\textbf{Medication Plan}:
+
+\begin{longtable}{|p{3cm}|p{2cm}|p{2cm}|p{6.5cm}|}
+\hline
+\textbf{Medication} & \textbf{Dose} & \textbf{Frequency} & \textbf{Rationale \& Instructions} \\ \hline
+\endfirsthead
+\hline
+\textbf{Medication} & \textbf{Dose} & \textbf{Frequency} & \textbf{Rationale \& Instructions} \\ \hline
+\endhead
+
+Escitalopram (Lexapro) & 10mg & Daily (morning) & \textbf{Rationale}: First-line SSRI for major depression. \textbf{Start}: 10mg daily. \textbf{Titration}: May increase to 20mg after 4 weeks if partial response. \textbf{Expected}: 2-4 weeks for initial response, 6-8 weeks for full effect. \textbf{Monitor}: Mood, anxiety, suicidal ideation, side effects. \\ \hline
+
+Trazodone & 50mg & QHS PRN & \textbf{Rationale}: For insomnia, sedating antidepressant. \textbf{Start}: 50mg at bedtime as needed. \textbf{Titration}: May increase to 100mg if ineffective. \textbf{Instructions}: Take 30 min before bed. May cause morning grogginess - reduce dose if bothersome. \\ \hline
+
+[Continue current medications] & & & \\ \hline
+Levothyroxine & 100mcg & Daily & \textbf{Continue}: Hypothyroidism management. Monitor TSH every 6-12 months. \\ \hline
+\end{longtable}
+
+\textbf{Medication Safety and Monitoring}:
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Common Side Effects}: Nausea (take with food), headache, insomnia or drowsiness, sexual dysfunction (discuss if bothersome)
+    \item \textbf{Serious Side Effects} (rare): Serotonin syndrome (agitation, confusion, rapid heart rate, high fever - seek emergency care), increased suicidal thoughts (especially first 1-2 weeks - monitor closely)
+    \item \textbf{Drug Interactions}: Avoid other serotonergic agents, NSAIDs (increased bleeding risk)
+    \item \textbf{Adherence Plan}: Set daily reminder alarm, use pill box, refill prescriptions on time
+    \item \textbf{Follow-up}: Psychiatry visit week 2 (phone), week 4 (in-person), week 8, then monthly
+\end{itemize}
+
+\textbf{Response Timeline}:
+\begin{itemize}[leftmargin=*]
+    \item Week 1-2: May notice side effects before benefits, monitor suicide risk closely
+    \item Week 2-4: Early improvement in sleep, appetite, energy possible
+    \item Week 4-6: Mood improvement, decreased anxiety expected
+    \item Week 6-8: Full therapeutic effect, reassess dose if partial response
+    \item Week 12+: Continued improvement, consider maintenance therapy
+\end{itemize}
+
+\subsection*{4.2 Psychotherapy}
+
+\textbf{Therapy Modality}: Cognitive Behavioral Therapy (CBT) for Depression
+
+\textbf{Frequency}: Weekly 50-minute sessions for 12-16 weeks, then biweekly as symptoms improve
+
+\textbf{Treatment Framework}:
+
+\textbf{Weeks 1-4: Assessment and Behavioral Activation}
+\begin{itemize}[leftmargin=*]
+    \item Establish therapeutic alliance and treatment goals
+    \item Psychoeducation: Depression, treatment options, CBT model
+    \item Activity monitoring and identifying mood-behavior connections
+    \item Behavioral activation: Schedule pleasant and meaningful activities
+    \item Develop daily structure and routine
+    \item Suicide risk assessment and safety planning
+\end{itemize}
+
+\textbf{Weeks 5-8: Cognitive Restructuring}
+\begin{itemize}[leftmargin=*]
+    \item Identify automatic negative thoughts
+    \item Challenge cognitive distortions (all-or-nothing thinking, overgeneralization, catastrophizing)
+    \item Develop balanced, realistic thoughts
+    \item Address guilt and worthlessness cognitions
+    \item Problem-solving skills training
+\end{itemize}
+
+\textbf{Weeks 9-12: Skill Building and Application}
+\begin{itemize}[leftmargin=*]
+    \item Assertiveness and communication skills
+    \item Interpersonal effectiveness
+    \item Stress management and relaxation techniques
+    \item Values clarification and goal-setting (career, relationships)
+    \item Address employment/job search anxiety
+\end{itemize}
+
+\textbf{Weeks 13-16: Relapse Prevention and Maintenance}
+\begin{itemize}[leftmargin=*]
+    \item Identify early warning signs of depression
+    \item Develop personalized relapse prevention plan
+    \item Review and consolidate skills learned
+    \item Plan for ongoing self-care and wellness
+    \item Discuss transition to maintenance phase or termination
+\end{itemize}
+
+\textbf{Specific CBT Techniques}:
+\begin{itemize}[leftmargin=*]
+    \item Thought records (identify situations, thoughts, emotions, behaviors)
+    \item Behavioral experiments (test negative predictions)
+    \item Activity scheduling (increase rewarding activities)
+    \item Graded task assignment (break large tasks into manageable steps)
+    \item Cognitive continuum (evaluate black-and-white thinking)
+    \item Core belief work (address underlying schemas)
+\end{itemize}
+
+\textbf{Homework Assignments}:
+\begin{itemize}[leftmargin=*]
+    \item Weekly mood and activity logs
+    \item Thought records (3-column or 7-column)
+    \item Behavioral activation: Complete 2-3 scheduled activities
+    \item Reading: CBT self-help materials (e.g., "Feeling Good" by David Burns)
+    \item Skills practice between sessions
+\end{itemize}
+
+\subsection*{4.3 Adjunctive Interventions}
+
+\textbf{Case Management}:
+\begin{itemize}[leftmargin=*]
+    \item Assist with unemployment benefits and financial resources
+    \item Connect with vocational rehabilitation services
+    \item Coordinate care with primary care provider
+    \item Insurance and medication assistance navigation
+\end{itemize}
+
+\textbf{Lifestyle Interventions}:
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Exercise}: Goal of 30 minutes moderate exercise 5x/week (walking, yoga, biking)
+    \item \textbf{Sleep Hygiene}: Consistent sleep schedule (11 PM - 7 AM), limit screen time 1 hour before bed, avoid caffeine after 2 PM, bedroom for sleep only
+    \item \textbf{Nutrition}: Regular balanced meals, minimize processed foods, stay hydrated
+    \item \textbf{Substance Use}: Continue cannabis abstinence, limit alcohol to 1-2 drinks/week max
+    \item \textbf{Light Exposure}: Morning sunlight or light box 30 min daily (if seasonal pattern)
+\end{itemize}
+
+\textbf{Social Support Enhancement}:
+\begin{itemize}[leftmargin=*]
+    \item Increase contact with sister (supportive relationship)
+    \item Consider depression support group (online or in-person)
+    \item Re-engage with friend group gradually
+    \item Volunteer opportunities for meaningful engagement
+\end{itemize}
+
+\textbf{Family/Collateral Sessions}:
+\begin{itemize}[leftmargin=*]
+    \item Offer to include sister in 1-2 sessions (with patient consent) for psychoeducation and support
+    \item Educate family on depression, how to help, what to avoid (enabling, criticism)
+\end{itemize}
+
+% ===== SECTION 5: TREATMENT SCHEDULE =====
+\section*{5. Treatment Schedule and Timeline}
+
+\subsection*{Treatment Phases}
+
+\begin{tabularx}{\textwidth}{|l|l|X|}
+\hline
+\textbf{Phase} & \textbf{Duration} & \textbf{Focus} \\ \hline
+Acute Treatment & Weeks 1-8 & Symptom reduction, medication titration, behavioral activation, safety \\ \hline
+Continuation & Weeks 9-16 & Cognitive restructuring, skill building, functional recovery \\ \hline
+Maintenance & Months 4-12 & Relapse prevention, sustained wellness, reduce visit frequency \\ \hline
+\end{tabularx}
+
+\subsection*{Appointment Schedule}
+
+\begin{tabularx}{\textwidth}{|l|l|X|}
+\hline
+\textbf{Provider} & \textbf{Frequency} & \textbf{Notes} \\ \hline
+Psychiatry & Week 2 (phone), 4, 8, then monthly & Medication management, side effect monitoring \\ \hline
+Psychotherapy (CBT) & Weekly weeks 1-12, biweekly weeks 13-16 & 50-minute sessions \\ \hline
+PHQ-9/GAD-7 Assessment & Every 2 weeks & Track symptom severity \\ \hline
+Case Management & As needed & Resources, benefits, vocational support \\ \hline
+\end{tabularx}
+
+\subsection*{Milestones and Reassessment}
+
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Week 2}: Medication tolerance check, safety assessment, initial behavioral activation
+    \item \textbf{Week 4}: PHQ-9 reassessment, medication dose adjustment if needed, CBT engagement
+    \item \textbf{Week 8}: Comprehensive reassessment, PHQ-9 target $<$10, functional improvement expected
+    \item \textbf{Week 12}: PHQ-9 target $<$5, relapse prevention planning initiated
+    \item \textbf{Week 16}: Treatment goal review, transition to maintenance or taper frequency
+\end{itemize}
+
+% ===== SECTION 6: MONITORING AND OUTCOMES =====
+\section*{6. Monitoring Parameters and Outcomes}
+
+\subsection*{Symptom Tracking}
+
+\begin{longtable}{|p{4cm}|p{2.5cm}|p{2.5cm}|p{4.5cm}|}
+\hline
+\textbf{Measure} & \textbf{Baseline} & \textbf{Target} & \textbf{Frequency} \\ \hline
+\endfirsthead
+\hline
+\textbf{Measure} & \textbf{Baseline} & \textbf{Target} & \textbf{Frequency} \\ \hline
+\endhead
+PHQ-9 (Depression) & 18/27 & $<$5 (remission) & Every 2 weeks \\ \hline
+GAD-7 (Anxiety) & 12/21 & $<$5 & Every 2 weeks \\ \hline
+C-SSRS (Suicide Risk) & Level 3 (passive SI) & Level 0 (no SI) & Each session initially, then monthly \\ \hline
+Sleep Quality & 4-5 hrs, fragmented & 6-7 hrs, consolidated & Weekly self-report \\ \hline
+Social Activities & 0-1/week & 3-4/week & Weekly log \\ \hline
+Exercise & 0 days/week & 5 days/week & Weekly log \\ \hline
+Therapy Homework & -- & 80\% completion & Each session \\ \hline
+Medication Adherence & -- & $>$90\% & Each psychiatry visit \\ \hline
+\end{longtable}
+
+\subsection*{Functional Outcome Tracking}
+
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Self-Care}: Daily routine checklist (shower, meals, sleep, medications)
+    \item \textbf{Social Functioning}: Number of social interactions per week
+    \item \textbf{Occupational}: Job applications submitted, interviews attended, volunteer hours
+    \item \textbf{Quality of Life}: Engagement in hobbies, pleasurable activities
+    \item \textbf{Overall Functioning}: GAF or WHODAS score at baseline, 8 weeks, discharge
+\end{itemize}
+
+\subsection*{Safety Monitoring}
+
+\begin{itemize}[leftmargin=*]
+    \item Suicidal ideation assessment at every contact (especially weeks 1-4)
+    \item Medication side effects and tolerability
+    \item Substance use (alcohol, cannabis) - weekly check-ins
+    \item Worsening symptoms or breakthrough depression
+    \item Medication adherence
+\end{itemize}
+
+% ===== SECTION 7: CRISIS AND SAFETY PLANNING =====
+\section*{7. Crisis Management and Safety Planning}
+
+\subsection*{Safety Plan (Based on Stanley-Brown Model)}
+
+\textbf{Step 1: Warning Signs}
+\begin{itemize}[leftmargin=*]
+    \item Thoughts: "I'm worthless," "Things will never get better," "I'm a burden"
+    \item Feelings: Hopelessness, overwhelming sadness, numbness
+    \item Behaviors: Isolating for days, not eating, excessive sleeping
+    \item Situations: Financial stress, rejection, conflict with family
+\end{itemize}
+
+\textbf{Step 2: Internal Coping Strategies} (things I can do on my own)
+\begin{itemize}[leftmargin=*]
+    \item Go for a walk outside
+    \item Listen to favorite music playlist
+    \item Take a warm shower
+    \item Deep breathing exercises (5-10 minutes)
+    \item Read CBT thought records
+    \item Write in journal
+\end{itemize}
+
+\textbf{Step 3: Social Contacts for Distraction}
+\begin{itemize}[leftmargin=*]
+    \item Sister: [phone number]
+    \item Close friend: [phone number]
+    \item Former coworker: [phone number]
+\end{itemize}
+
+\textbf{Step 4: People I Can Ask for Help}
+\begin{itemize}[leftmargin=*]
+    \item Sister: [phone number] - can talk about feelings, will listen without judgment
+    \item Therapist: [phone number] - call for emergency appointment
+    \item Psychiatrist: [phone number] - after-hours answering service
+\end{itemize}
+
+\textbf{Step 5: Professionals and Agencies to Contact}
+\begin{itemize}[leftmargin=*]
+    \item Therapist: [clinic phone]
+    \item Psychiatrist on-call: [after-hours number]
+    \item Crisis Line: 988 Suicide \& Crisis Lifeline (call or text 988)
+    \item Crisis Text Line: Text HOME to 741741
+    \item Local crisis center: [local crisis services phone]
+\end{itemize}
+
+\textbf{Step 6: Reduce Access to Lethal Means}
+\begin{itemize}[leftmargin=*]
+    \item No firearms in home
+    \item Medications: Sister holds extra medication supply, patient has only 1-week supply at home
+    \item Remove other potential means from immediate environment
+\end{itemize}
+
+\textbf{One Thing That Is Most Important to Me}:
+\begin{itemize}[leftmargin=*]
+    \item [e.g., "My relationship with my sister - I don't want to hurt her"]
+\end{itemize}
+
+\subsection*{Emergency Procedures}
+
+\textbf{Patient to seek immediate care (Emergency Department or call 911) if}:
+\begin{itemize}[leftmargin=*]
+    \item Active suicidal ideation with plan and intent
+    \item Unable to maintain safety despite using crisis plan
+    \item Acute psychosis (hallucinations, delusions, disorganized behavior)
+    \item Severe agitation or aggression toward others
+    \item Substance intoxication/overdose
+\end{itemize}
+
+\textbf{Provider to intervene if}:
+\begin{itemize}[leftmargin=*]
+    \item Increased suicide risk (passive → active SI, plan development)
+    \item Significant worsening of depression or emergence of psychotic symptoms
+    \item Non-adherence with safety plan
+    \item Relapse in substance use
+    \item Actions: Increase visit frequency, consider higher level of care (IOP/PHP/inpatient), medication adjustment, collateral contact with family
+\end{itemize}
+
+% ===== SECTION 8: PATIENT EDUCATION =====
+\section*{8. Patient Education and Psychoeducation}
+
+\subsection*{Understanding Depression}
+
+Education provided on:
+\begin{itemize}[leftmargin=*]
+    \item \textbf{What is Depression}: Biological illness, not weakness or character flaw
+    \item \textbf{Neurobiology}: Serotonin, norepinephrine, brain circuits involved
+    \item \textbf{Course}: Episodic illness, high recurrence rate, importance of treatment adherence
+    \item \textbf{Treatment}: Evidence for medication + therapy combination
+\end{itemize}
+
+\subsection*{Medication Education}
+
+\begin{itemize}[leftmargin=*]
+    \item How SSRIs work (increase serotonin availability)
+    \item Timeline for response (2-4 weeks initial, 6-8 weeks full effect)
+    \item Common side effects and management
+    \item Importance of daily adherence (not "as needed")
+    \item Not addictive, but need to taper when discontinuing
+    \item Maintenance treatment (continue 6-12 months after remission)
+\end{itemize}
+
+\subsection*{Therapy Skills and Homework}
+
+\begin{itemize}[leftmargin=*]
+    \item CBT model: Thoughts → Feelings → Behaviors (interconnected)
+    \item Behavioral activation: Activity improves mood (not the reverse)
+    \item Cognitive distortions: Common thinking errors in depression
+    \item Thought challenging: Evidence for/against, alternative perspectives
+    \item Skills practice between sessions is essential
+\end{itemize}
+
+\subsection*{Self-Management Strategies}
+
+\begin{itemize}[leftmargin=*]
+    \item Recognize early warning signs of depression
+    \item When to call provider (worsening symptoms, suicidal thoughts)
+    \item Lifestyle factors: sleep, exercise, nutrition, substance use
+    \item Stress management and self-care
+    \item Building and maintaining social connections
+\end{itemize}
+
+\subsection*{Resources Provided}
+
+\begin{itemize}[leftmargin=*]
+    \item Crisis hotline numbers (988, Crisis Text Line)
+    \item CBT self-help books: "Feeling Good" by David Burns, "Mind Over Mood"
+    \item Meditation apps: Headspace, Calm, Insight Timer
+    \item Exercise resources: Local trails, gyms, online yoga
+    \item NAMI (National Alliance on Mental Illness) support groups
+    \item Depression and Bipolar Support Alliance (DBSA)
+\end{itemize}
+
+% ===== SECTION 9: FOLLOW-UP AND DISCHARGE =====
+\section*{9. Follow-Up and Discharge Planning}
+
+\subsection*{Continuation and Maintenance Treatment}
+
+\textbf{After Acute Treatment (if goals achieved)}:
+\begin{itemize}[leftmargin=*]
+    \item Continue medication for 6-12 months minimum after remission
+    \item Taper therapy to biweekly, then monthly "booster" sessions
+    \item Regular symptom monitoring (monthly PHQ-9)
+    \item Psychiatry visits every 2-3 months for medication management
+\end{itemize}
+
+\subsection*{Relapse Prevention}
+
+\begin{itemize}[leftmargin=*]
+    \item \textbf{Early Warning Signs}: [Patient-specific list from treatment]
+    \item \textbf{Action Plan}: If warning signs emerge, resume weekly therapy, contact psychiatrist
+    \item \textbf{Protective Factors}: Maintain exercise, sleep, social connections, continue medication
+    \item \textbf{Ongoing Skills Practice}: Continue thought records, behavioral activation as needed
+\end{itemize}
+
+\subsection*{Discharge Criteria}
+
+Ready for discharge when:
+\begin{itemize}[leftmargin=*]
+    \item PHQ-9 $<$5 sustained for 4+ weeks
+    \item No suicidal ideation
+    \item Functional recovery (working or engaged in meaningful activities, social connections restored)
+    \item Mastery of CBT skills and relapse prevention plan
+    \item Stable on medication regimen
+    \item Patient and provider agree discharge is appropriate
+\end{itemize}
+
+\subsection*{Discharge Recommendations}
+
+\begin{itemize}[leftmargin=*]
+    \item Continue antidepressant for 6-12 months, then discuss tapering with psychiatrist
+    \item Monthly "check-in" sessions available if needed
+    \item Return to treatment if early warning signs emerge
+    \item Continue healthy lifestyle practices
+    \item Stay connected with support system
+    \item Annual depression screening with primary care provider
+\end{itemize}
+
+% ===== SECTION 10: INFORMED CONSENT =====
+\section*{10. Informed Consent and Collaboration}
+
+\subsection*{Treatment Consent}
+
+The following have been discussed with the patient:
+\begin{itemize}[leftmargin=*]
+    \item Diagnosis, symptoms, and prognosis
+    \item Treatment options (medication, therapy, combination, no treatment)
+    \item Risks and benefits of recommended treatment
+    \item Expected timeline for improvement
+    \item Potential side effects of medication
+    \item Alternatives to proposed treatment
+    \item Importance of adherence and therapy homework
+    \item Right to refuse or discontinue treatment
+    \item Limits of confidentiality (harm to self/others, abuse)
+\end{itemize}
+
+Patient demonstrates understanding and agrees to treatment plan. Questions answered satisfactorily. Patient has opportunity for shared decision-making and treatment preferences incorporated.
+
+\subsection*{Collaborative Treatment Agreement}
+
+\textbf{Provider Responsibilities}:
+\begin{itemize}[leftmargin=*]
+    \item Provide evidence-based treatment
+    \item Monitor progress and adjust treatment as needed
+    \item Maintain availability for emergencies (or provide backup coverage)
+    \item Respect patient autonomy and preferences
+\end{itemize}
+
+\textbf{Patient Responsibilities}:
+\begin{itemize}[leftmargin=*]
+    \item Attend scheduled appointments
+    \item Take medications as prescribed
+    \item Complete therapy homework
+    \item Communicate openly about symptoms and concerns
+    \item Contact provider if symptoms worsen or suicidal thoughts emerge
+    \item Follow safety plan
+\end{itemize}
+
+% ===== SECTION 11: SIGNATURES =====
+\vspace{2em}
+
+\section*{11. Provider Signature and Attestation}
+
+I have reviewed this treatment plan with the patient. The patient demonstrates understanding of the diagnosis, treatment recommendations, risks and benefits, and alternatives. The patient has been involved in shared decision-making. Safety planning has been completed. The patient agrees to this treatment plan.
+
+\vspace{1em}
+
+\begin{tabular}{ll}
+Provider Signature: & \rule{7cm}{0.5pt} \\[1em]
+Provider Name/Credentials: & \rule{7cm}{0.5pt} \\[1em]
+Date: & \rule{4cm}{0.5pt} \\[2em]
+\end{tabular}
+
+\subsection*{Patient Acknowledgment}
+
+I have reviewed this treatment plan with my mental health provider. I understand my diagnosis, treatment goals, and the recommended interventions. My questions have been answered. I agree to participate in this treatment plan and will contact my provider if I have concerns or my symptoms worsen.
+
+\vspace{1em}
+
+\begin{tabular}{ll}
+Patient Signature: & \rule{7cm}{0.5pt} \\[1em]
+Date: & \rule{4cm}{0.5pt} \\
+\end{tabular}
+
+\vspace{2em}
+\begin{center}
+\rule{\textwidth}{1pt}\\
+\textbf{End of Mental Health Treatment Plan}\\
+This document contains confidential patient information protected by HIPAA and 42 CFR Part 2.
+\end{center}
+
+\end{document}
+
+% ========== NOTES FOR USERS ==========
+%
+% CUSTOMIZATION:
+% - Replace all bracketed placeholders with patient-specific information
+% - Adjust CBT framework based on presenting problem (can use DBT, ACT, IPT instead)
+% - Modify safety plan collaboratively with patient
+% - Select appropriate medications based on diagnosis and patient factors
+%
+% IMPORTANT:
+% - Complete thorough suicide risk assessment
+% - Document safety planning
+% - Ensure crisis resources are accurate and accessible
+% - Maintain 42 CFR Part 2 confidentiality for substance use information
+%
+% COMPILATION:
+% pdflatex mental_health_treatment_plan.tex
+