From Intake to Discharge: A Discussion on Effective Treatment Planning

Transcription

1 From Intake to Discharge: A Discussion on Effective Treatment Planning Created by: Lynda Darling LMHC, ACADC, NCC & Lori Hancock-Muck LMHC, CADC Date: July 17, 2008

2 The What, Who, When & How of Treatment Planning Magellan Health Services, Inc. 2

3 Sample Treatment Plan Problem: Goal: Objective: Problem: Goal: Objectives: Problem: Goal: Objectives: Low self-esteem Increase self-esteem Complete self-esteem packet Legal Problems No further legal problems Comply with probation Client is in denial Sobriety First step packet What s wrong with this plan???? Magellan Health Services, Inc. 3

4 Overview: Treatment Plan What is a treatment plan? Agreement between the client and therapist on how to best help client address needs. What is an intervention? What the therapist does listen, guide, direct, educate, support. Magellan Health Services, Inc. 4

5 What does the client want? Client Clinical Assessment Treatment Plan What does the client want? What does client need? What is the plan? Why now? Level of commitment? How will she get there? Why? What reasons are revealed by the assessment? How will you get her to accept the plan? Is it linked to what the client wants? Does she buy into the plan? Where will she do this? When will this happen? How quickly? Where is the setting for treatment? What placement criteria When? How soon? What are the realistic expectations? Referral to level of care What is the degree of urgency? What is the process? David Lee-Mee, MD (2008) Magellan Health Services, Inc. 5

6 Where to Begin Begin with Assessment = picture of individual needs and diagnosis Motivation = what does the client want? Stage of change = starting point Tools: ASAM Stages of Change Agreement Possible Evaluations Initial Plan = Engagement - Starts with a relationship based on trust, honesty and commitment. An introduction to treatment/education/support Magellan Health Services, Inc. 6

7 How Does Assessment Guide the Treatment Planning? Components of a good assessment Thorough documentation All areas completed Appropriate recommendations for level of care Complete review of ASAM six dimensions 1. Acute Intoxication and/or Withdrawal Potential 2. Biomedical Conditions and Complications 3. Emotional, Behavioral, Cognitive Conditions/Complications 4. Readiness to Change 5. Relapse Continued Use or Continued Problem Potential 6. Recovery/Living Environment Magellan Health Services, Inc. 7

8 Example Questions What Client goal How Plan of action When Time frame How will I know? Measurement And then What? Discharge plan Magellan Health Services, Inc. 8

9 Easy Planning that Meets Requirements Individualized - Is the goal based on client diagnosis and needs? Short Term When do you evaluate and update? Weekly Monthly Measurable How and when do you know the goals are being met? Achievable Is the goal within the client s ability? Related Does it relate back to the diagnosis or identified problem? Baby steps Phases Time Limited How long will it take to achieve the goal? What happens next? Example: Time frame: Client will attend individual sessions for 6 weeks and then reassess. Magellan Health Services, Inc. 9

10 Transtheoretical Model: Stages of Change Action Maintenance Precontemplation Contemplation Preparation Magellan Health Services, Inc. 10

11 I don t have a problem. Maybe I have a problem. Pre-Contemplation Contemplation I ve got to do something. I m ready to start. Preparation Action Magellan Health Services, Inc. 11

12 Maintenance Relapse How do I keep going? What went wrong? Now What?... Magellan Health Services, Inc. 12

13 DSM IV Diagnosis Axis I: Primary Presenting Problem Axis II: Personality Disorder or Mentally Challenged Axis III: Medical Diagnosis Axis IV: Stressors Axis V: Global Assessment of Functioning Magellan Health Services, Inc. 13

14 Components in a treatment plan Problem Statements Goal Statements Objectives/Interventions Magellan Health Services, Inc. 14

15 Identifying Problem Statements Magellan Health Services, Inc. 15

16 Tips on Writing Problem Statements Non-judgmental Client is in denial. No jargon statements Client is co-dependent. Use complete sentence structure Depression Appropriate to the diagnosis (addiction and/or mental health) Should arise from a biopsychosocial assessment Ask yourself What made me say that? The answer will be your problem statement. Magellan Health Services, Inc. 16

17 Tips on Writing Goal Statements Client clearly understands the goal (Avoid clinical jargon) Be clearly stated Measurable and attainable Is agreeable to both client and staff Use complete sentence structure Use of short-term goals and long-term goals Magellan Health Services, Inc. 17

18 Objectives/Interventions Objectives/Interventions are the specific steps to achieve the goals. Other common terms: Action steps Treatment strategies Method Tasks Magellan Health Services, Inc. 18

19 Timeframe Example Diagnosis: Dysthymia Goal: Client will process through the loss of her father. Action Step: Client will attend weekly therapy sessions to address grief and loss of father. Action Step: Client will complete a goodbye letter and process with her group session in two weeks. Magellan Health Services, Inc. 19

20 Examples - Measurements Ability to Evidenced by Consistent with Compliant with Involved and participating in Completion of Percent of the time Length of time (e.g., 4-6 weeks) Measurement scale (e.g., 1 10) Period of time (e.g., 6 months of sobriety) Magellan Health Services, Inc. 20

21 Measurement Example Diagnosis: Major Depression Disorder Goal: Client will use healthy coping skills to manage depression Action Step: Therapist will monitor depression by administering the Zung Depression screening every two weeks. Discharge Plan: Once client decreases 3 points on the Zung Depression screen, is compliant with medications, and reports a return to baseline daily activities, client will transition to a support group. Magellan Health Services, Inc. 21

22 Discharge Planning Magellan Health Services, Inc. 22

23 Discharge Planning Discharge Planning is a process in agreement with the client/team. What happens next? What is the crisis/safety plan? How will I know when the client is ready for discharge? What additional services will be needed for client posttreatment? Magellan Health Services, Inc. 23

24 Discharge Planning Begins at Admission Discharge Plan may be for maintenance. Discharge Plan may be for support. Discharge Plan may be continued medication management with therapy goals completed. Discharge Plan may be transition to a lower level of service Magellan Health Services, Inc. 24

25 Tools - What are Clinical Tools? Tools used to enhance treatment. Evaluations for mental health Beck Depression Screens ASAM Dimensions Mental health screens Substance screens Cage, Mast, TIP 42 STEPPS Program Continuum of Care Treatment Planner Web sites: American Psychiatric Association Web MD - for medical information Magellan Web site for Best Practices SAMHSA Magellan Health Services, Inc. 25

26 Magellan s QI Reviewers Mental Health Western Iowa Lynda Darling ( ) Central Iowa Myles DeJager ( ) Eastern Iowa Kim Hauser ( ) Substance Abuse Lori Hancock-Muck ( ) Magellan Health Services, Inc. 26