Write BIRP Notes Fast & Effectively: 4 Practical Examples

published:	7 Jan 2021
updated:	13 Apr 2021

In therapy, counseling, and medicine, clear and informative progress notes can avoid clinical errors and misunderstandings. Many different templates can help facilitate communication between busy providers, yield valuable insight, and streamline continuity of care – among them, BIRP Notes are one of the best-known formats.

This article will show you how to write effective, efficient BIRP notes using a variety of templates. Use these samples and illustrative applications to guide you in creating high-caliber progress notes and deliver even better, more professional therapy for those you help.

How To Write Quick and Effective BIRP Notes

The BIRP format in itself is a handy outline that streamlines documentation by dividing a Progress Note into four sections:

Behavior: Or a client’s presenting problem(s)
Intervention: The techniques and methods applied, as well as the broader intervention categories that they fall into
Response: How a patient or client responds to the therapy as a whole, and the specific approaches used, and
Plan: A framework for their treatment, addressing key goals and outcome objectives.

Following this format, which this article outlines in more detail, can greatly speed up the otherwise arduous documentation typically associated with clean, concise, and informative Progress Notes.

BIRP Notes Best Practice Checklist

When creating BIRP Notes manually or using clinical software, it’s useful to keep a few pointers in mind. Using industry best practice is a good way to ensure they serve their intended purpose as a communication tool between providers and that no important information is overlooked.

For example:

BIRP Notes should link to a client’s personalized treatment plan, including their unique ID and name
Regarding their therapeutic goals, their notes should consider a patient’s unique strengths and limitations
As professional documents, they should be clearly written or typed, dated, and signed by the practitioner, and
They should include standardized, consistent, and specialty-specific abbreviations where appropriate.

Using essential fields and drop-down menus, many therapy apps take care of these important details for practitioners – allowing them to focus on the content at hand. In a busy surgery or telehealth setting, the right software can sometimes be key to standardizing and streamlining BIRP notes within patient files.

BIRP notes are versatile and can be used for variety of applications and interventions. They can also be used at many stages of a patient’s treatment.

2 Useful Templates and Formats

Whether you’re a physical therapist, mental health coach, or online counselor, BIRP notes will likely have crossed your desk at some point. The BIRP format has a versatility that lends itself well to various applications and interventions and can be used at many stages of a patient’s treatment.

They may be used for:

Management – e.g., Outlining different strategies and coping techniques in a pain management plan
Skills-Building Interventions – In this context, they are commonly found in coaching interventions
Evaluation – To assess and conclude a treatment’s efficacy, or
Supporting documentation – Accompanying an insurance claim or in medical billing.

These templates all follow the standard Behavior, Intervention, Response, and Plan framework to demonstrate some of its many applications in practice.

In the next few sections, we’ll take a closer peek at the content of a BIRP note and what it should entail.

Standard BIRP Format

This standard BIRP format template can be used as a checklist for your progress notes. Each section details the key elements required for clear and exhaustive but concise documentation.[1]

BIRP Format Heading	Details
Behavior	Subjective information regarding the client or patient: What do they report about their thoughts, experiences, or observations? Objective patient data: As a practitioner, what do you observe about their mood, presentation, or behavior?
Intervention	Session objectives: What were the goals of the therapy? Problem: What is your professional understanding of the client’s diagnosis, condition, and/or challenge(s)? Session content: What happened during the session? How did it unfold? Methods and techniques: What approaches were introduced, implemented?
Response	How did the client receive the intervention? How did they react to their perceived progress? What response did they have to the treatment plan as a whole?
Plan	Treatment Plan: What elements need to be adapted, removed, or introduced? Next steps: What actions come next?

BIRP Template for Counseling

In counseling, BIRP notes help maintain consistency when multiple organizations and providers collaborate as part of societal or community mental health programs.

California’s Solano County Mental Healthcare Network, for example, outlines a standardized BIRP template for behavioral health specialists such as clinicians and psychologists:[2]

Behavior/Presenting Problem: Identifies long-term presenting problems and the patient’s current presentation that day to justify the medical necessity of the provided service. Here, the type of therapy and location of a session is also documented.
Interventions: Capture specific interventions and their encompassing therapeutic modalities, such as supportive counseling or CBT. As with many other templates, clinicians are encouraged to use verbs to communicate actions to achieve a patient’s treatment goals.
Response: For each intervention outlined, a response is included in this section. Under these sub-headings, responses from a patient or their support person can be detailed.
Plan: Includes clear and specific goals that will comprise the next appointment’s foci. An outline for the follow-up session can be detailed here.

BIRP Notes Samples: 2 Practical Examples

Building on the Solano Mental Healthcare example, we can formulate a few practical examples.

Counseling Sample

In a counseling context, a BIRP notes sample for a patient with Generalized Anxiety Disorder might look as follows:

BIRP Format Heading	Details
Behavior	Visited patient at the Sunshine Community Clinic. Based on today’s psychological assessment, the patient has moderate symptoms of anxiety. Most recently, he demonstrated negative affect, and her movements were tense and shaky. He reported feeling frightened and exhausted all week and seemed aggravated while talking. Patient reports that she has stopped taking the prescribed SSRIs.
Intervention	Applying cognitive restructuring techniques, the practitioner reframed the patient’s concerns and modeled mental coping strategies for trigger events. The therapist also supported the patient through talk therapy, coaching him to rationalize his ‘worst case’ thinking patterns. Discussed client’s decision to cease medication and encouraged him to renew his prescription. Recommended that patient schedule a meeting with GP this week to discuss changing dosage. Recommended that the client meets with her Psychiatrist as soon as possible to discuss his (patient’s) concerns about medication.
Response	When confronted about SSRI cessation, patient responded by describing reluctance to refill prescription in person. Patient described fears about being judged by others at the clinic concerning requiring mental health treatment. When the appointment finished, the patient agreed to meet with his GP on Tuesday.
Plan	Follow-up session scheduled on October 3rd. Goals include: Evaluate client medication compliance and Continue assessing anxiety-related symptoms.

BIRP Notes Sample: ICANNotes Software

As many blended care professionals know, various great practice management systems offer BIRP note templates to speed up the process further.

ICANotes, for example, will integrate pre-written patient data into the Behavior, Intervention, Response, and Plan template along with ICD-10, DSM, or ICD codes.

As the sample below illustrates, it is easier for therapists, counselors, and behavioral health specialists to take brief in-session notes before centralizing them as a single patient file.

Watch the full ICANotes BIRP notes example here on Youtube.

5 Interventions To Consider For Your Notes

In counseling, BIRP notes help maintain consistency when multiple organizations and providers collaborate as part of societal or community mental health programs.

As mentioned earlier, the BIRP format is versatile. These standard and long-established progress notes lend themselves well to a range of general and mental health treatments in virtual, conventional, and blended care.

As such, they are frequently found in treatment plans that encompass interventions such as:

Cognitive Behavioral Therapy (CBT) – e.g., in the mental health treatment of trauma, depression, phobias, or anxiety
Speech Therapy – both in adult care and pediatric treatments
Psychiatry – to consolidate medication-related and therapeutic treatments
Occupational Therapy – such as in recovery from injury, and
Physical Therapy – where they may include details of physical exercises and data from medical assessments.

Final Thoughts

If you’re working in a multi-provider practice, or regularly collaborate with other practitioners, BIRP notes can be a handy tool. But what works for one organization may not for another – and so it’s good to have more than one framework to refer to.

Elsewhere on this site, you’ll find valuable information on how to write great SOAP Notes, and on the best all-around private practice software with in-built Progress Note-taking features. If you’ve found a great blended care solution for your practice needs, leave a comment, and share it with your peers.