How to use the Impact of Event Scale (IES-R) assessment
Learn more about the IES-R assessment and how you can incorporate it into your practice.
Learn about how to write SOAP notes, DAP notes, BIRP notes, and more therapy notes.
In addition to providing quality care to your clients, an important part of being a therapist is writing progress notes. As a mental healthcare provider who works with insurance, you need to document your clients’ sessions and improvements. Making this a natural part of your treatment and workflow, rather than an added stressor, is the key to staying on top of progress notes.
To help with writing them, many therapists use specific templates. Formats like SOAP notes, DAP notes, BIRP notes, and others can make writing progress notes easier and more efficient. Ahead, learn about five types of progress note templates you can use in your practice.
SOAP notes are a popular format for writing progress notes as a behavioral health clinician. Because SOAP notes are widely recognized and used in many different healthcare settings, other care providers can easily recognize and review your mental healthcare records to provide continuity of care for your clients.
SOAP notes contain four primary sections, represented by its acronym:
Learn more about SOAP notes and see an example here.
DAP notes provide a very simple through line that helps you reflect on your progress with a client. You might choose to use the DAP note format if you prefer to take a more straightforward and efficient approach to documentation.
DAP notes contain three primary sections, represented by its acronym:
Learn more about DAP notes and see an example here.
The BIRP note template might be a fit for your practice if you work with behavioral frameworks, due to the template’s focus on how the client appears to think and feel before and after your therapeutic intervention.
BIRP notes contain four primary sections, represented by its acronym:
Learn more about BIRP notes and see an example here.
A DARP note is a templated four-part strategy for documenting therapy sessions and other client interactions. DARP notes contain an extra section compared to DAP notes, so they may take a little longer to complete for some providers.
DARP notes contain four primary sections, represented by its acronym:
Learn more about DARP notes and see an example here.
SIRP notes cover both the present session and plans for future ones, providing a useful way to not only track patient progress, but also keep a treatment plan evolving and improving.
SIRP notes contain four primary sections, represented by its acronym:
Learn more about SIRP notes and see an example here.
Therapists tend to use the format they were trained on, and whichever one feels most authentic to their style and modality. Any of these templates can be insurance compliant. Which one you use is generally a matter of personal preference.
While there are many options for documentation, Headway's in-product templates are designed to make note-taking fast and efficient, all while helping to take out the guesswork.
Plus, our templates are included at no additional cost for Headway providers.
Learn more about the IES-R assessment and how you can incorporate it into your practice.
Here are some precise language examples and effective techniques for improving therapy progress notes and documentation.
Learn about CMS health documentation requirements and how mental health providers can stay on top of billing private insurance.