Treatment Planning. The Key to Effective Client Documentation. Adapted from OFMQ s 2002 provider training.

Transcription

1 Treatment Planning The Key to Effective Client Documentation Adapted from OFMQ s 2002 provider training. 1

2 Models Medical Model Diagnosis Psych Eval Problems Symptoms Psycho/Social/Behavioral Model Diagnosis Risk Assessment Problems Risk Factors: Characteristics, Behavior Patterns, Relationships, etc, associated with greater likelihood of re-offending 2

3 Process Diagnosis Problems Goals Objectives Interventions Services with frequencies Clinician and credentials 3

4 Components (RBMS) Treatment Goals Treatment Objectives for each goal Treatment Intervention for each identified objective, including a theoretical approach for individual therapy objectives An identified treatment service for each treatment objective Treatment frequency for each identified treatment service Name of the clinician providing the treatment service and their credentials (degree/license) 4

5 Treatment Plan GOAL = General outcome statement of what the client will ultimately attain through treatment that is important to the client; focuses on the positive; is realistic, achievable; and is perceived as worthwhile by the client. A positive statement which, if met, should directly effects one or more of the symptoms of the diagnosis. 5

6 Goals for Conduct Disorder Decrease the frequency and severity of anger outbursts by identifying, describing and discussing feelings. Reduce conflicts with authority figures by processing objections. Improve compliance with rules and expectations. Express anger in controlled, respectful manner. Improve impulse control 6

7 Treatment Plan OBJECTIVE = A short-term step the client will take toward attaining the longterm treatment goal that can be realistically achieved within the authorization period. The objective is to identify what the client and/or family will do while in session and is to be stated in client s language and in measurable terms, with identified target dates. 7

8 Objectives for Conduct Disorder Identify and verbalize how feelings are connected to misbehavior. Express anger through appropriate verbalizations and healthy physical outlets. Identify feelings associated with past neglect, abuse, separation, or abandonment. Discuss how current acting-out and aggressive behaviors are associated with past neglect, abuse, separation, or abandonment. Increase participation in positive peer group activities. 8

9 Treatment Plan INTERVENTION = What the clinician will do to assist the client in achieving the objective, including the theoretical approach for individual therapy objectives (i.e., cognitive, behavioral, reality, person-centered, REBT, solution-focused, etc.) TREATMENT SERVICE = The type of service identified to treat client symptoms. Treatment services can include: Individual counseling, family counseling, group counseling, social skills redevelopment, living skills redevelopment, etc. TREATMENT FREQUENCY = The number of hours per week or month that client will be seen for the identified treatment service. 9

10 Interventions for Conduct Disorder Help client develop thorough list of all targets of and causes for anger. Direct client to keep daily journal documenting people, events, and situations that evoke anger response. Help client identify and correct irrational thoughts and beliefs that contribute to the anger response. Provide prompts and feedback regarding anger control. 10

11 Example: Conduct Disorder DIAGNOSIS: Conduct Disorder PROBLEM: Client displays consistent failure to accept responsibility for misbehavior, accompanied by a pattern of blaming others. GOAL: Increase honesty, sensitivity to the rights and feelings of others, and accept responsibility for his behavior. Objective A: Client will learn 3 statements that reflect the acceptance of responsibility. TARGET DATE: 11/01 INTERVENTION A: Clinician will teach client responsibility statements, and help client develop list of situations in which to use the statements. Objective B: Client will decrease the frequency of verbalizations that project the blame for problems onto others. TARGET DATE: 11/01 INTERVENTION B: Clinician will confront statements in which the client blames others for his misbehavior, and will explore and process the factors contributing to the client s blaming pattern. 11

12 Process Diagnosis Risk Assessment Problems Risk Factors Goals Objectives Interventions Placement Considerations 12

13 YLSI Risk Factors What are the Characteristics, Behavior Patterns, Relationships, etc, associated with greater likelihood of re-offending? Offenses Attitudes/Orientation Personality & Behavior Peer Relations The Big Four 13

14 YLSI Risk Factors What are the Characteristics, Behavior Patterns, Relationships, etc, associated with greater likelihood of re-offending? Substance Abuse Family Education/Employment Leisure/Recreation Health Mental Health 14

15 YLSI Risk Factors Offenses Three or more prior adjudications Two or more failures to comply Prior probation Prior detention Three or more current adjudications Low=0; Mod=1-2; High=3-5 15

16 YLSI Risk Factors Attitudes/Orientation Antisocial/procriminal attitudes Not seeking help Actively rejecting help Defies authority Callous, little concern for others Low=0; Mod=1-3; High=4-5 16

17 YLSI Risk Factors Personality & Behavior Inflated self-image Physically aggressive Tantrums Short attention span Poor frustration tolerance Inadequate guilt feelings Verbally aggressive, impudent Low=0; Mod=1-4; High=5-7 17

18 YLSI Risk Factors Peer Relations Some delinquent acquaintances Some delinquent friends No or few positive acquaintances No or few positive friends Low=0-1; Mod=2-3; High=4 18

19 YLSI Risk Factors Substance Abuse Occasional drug use Chronic drug use Chronic alcohol use Substance abuse interferes with life Substance use linked to offense(s) Low=0; Mod=1-2; High=3-5 19

20 YLSI Risk Factors Family Circumstances and Parenting Inadequate supervision Difficulty in controlling behavior Inappropriate discipline Inconsistent parenting Poor relations/father-child Poor relations/mother-child Low=0-2; Mod=3-4; High=5-6 20

21 YLSI Risk Factors Education/Employment Disruptive classroom behavior Disruptive behavior on school property Low achievement Problems with peers Problems with teachers Truancy Unemployed/not seeking employment Low=0; Mod=1-3; High=4-7 21

22 YLSI Risk Factors Leisure/Recreation Limited organized activities Could make better use of time No personal interests Low=0; Mod=1-2; High=3 22

23 YLSI Risk Factors Offenses Three or more prior adjudications Two or more failures to comply Prior probation Prior detention Three or more current adjudications Low=0; Mod=1-2; High=3-5 GOAL: Develop and demonstrate a sense of respect for others by honoring personal and property boundaries 23

24 YLSI Risk Factors Attitudes/Orientation Antisocial/procriminal attitudes Not seeking help Actively rejecting help Defies authority Callous, little concern for others Low=0; Mod=1-3; High=4-5 GOAL: Develop and demonstrate skills in listening and responding empathetically to the thoughts, feelings, and needs of others 24

25 YLSI Risk Factors Personality & Behavior Inflated self-image Physically aggressive Tantrums Short attention span Poor frustration tolerance Inadequate guilt feelings Verbally aggressive, impudent Low=0; Mod=1-4; High=5-7 GOAL: Develop and practice positive coping mechanisms and conflict resolution skills to stop escalation of anger and control aggressive impulses 25

26 YLSI Risk Factors Peer Relations Some delinquent acquaintances Some delinquent friends No or few positive acquaintances No or few positive friends Low=0-1; Mod=2-3; High=4 GOAL: Develop and practice refusal skills to resist invitations, threats, intimidation, or coercion by negative peers to engage in illegal behavior 26

27 YLSI Risk Factors Substance Abuse Occasional drug use Chronic drug use Chronic alcohol use Substance abuse interferes with life Substance use linked to offense(s) Low=0; Mod=1-2; High=3-5 GOAL: Eliminate the use of mood-altering substances, and improve coping skills and relationships to support and enhance recovery and sobriety 27

28 YLSI Risk Factors Family Circumstances and Parenting Inadequate supervision Difficulty in controlling behavior Inappropriate discipline Inconsistent parenting Poor relations/father-child Poor relations/mother-child Low=0-2; Mod=3-4; High=5-6 GOAL: Identify and resolve family conflicts and develop skills that contribute to consistent, positive parent-child relationship 28

29 YLSI Risk Factors Education/Employment Disruptive classroom behavior Disruptive behavior on school property Low achievement Problems with peers Problems with teachers Truancy Unemployed/not seeking employment Low=0; Mod=1-3; High=4-7 GOAL: Attend, participate, and complete school and homework assignments consistently 29

30 YLSI Risk Factors Leisure/Recreation Limited organized activities Could make better use of time No personal interests Low=0; Mod=1-2; High=3 GOAL: Identify interests and develop and practice new leisure and recreational skills 30

31 TREATMENT SERVICES 31

32 Individual Therapy A method of treating mental health and alcohol and other drug disorder using face to face, one on one interaction between a MHP and a patient to promote emotional or psychological change to alleviate disorders. Individual therapy typically includes exploring/processing client s thoughts and feelings, and requires client insight. 32

33 Treatment Plan IT Example DIAGNOSIS: Bereavement PROBLEM: Grief/loss related to death of parent. GOAL: Begin the process of acceptance of the loss. OBJECTIVE A: Identify and process 3 ways the loss has affected life. TARGET DATE: 11/01 Validation/Reminiscent Therapy OBJECTIVE B: Identify and process 3 memories. TARGET DATE: 11/01 Cognitive and Solution Focused Therapy 33

34 Treatment Plan IT Example DIAGNOSIS: Post Traumatic Stress Disorder PROBLEM: Recurring, traumatic memories GOAL: Be able to go to sleep, stop nightmares. OBJECTIVE A: Talk about one scary thing to help me not be so scared. TARGET DATE: 11/01 Cognitive and Solution Focused Therapy OBJECTIVE B: Talk about 2 safe places in the neighborhood/community where a kid can go and not be hurt, and find a place like it at my home and school. TARGET DATE: 11/01 Cognitive and Solution Focused Therapy 34

35 Family Therapy A face to face interaction between MHP and family to facilitate emotional, psychological or behavioral changes and promote successful communication and understanding. Family therapy objectives should reflect family participation- the measurable step that the family needs to accomplish during session. Note: When the objective reflects what the client needs to accomplish, even when family members are present, this is content for individual therapy. 35

36 FT Example DIAGNOSIS: Adjustment Disorder with Depressed Mood PROBLEM: Client experiencing depressive symptoms in response to parents divorce GOAL: Process acceptance of parents divorce and decrease depression Objective A: Client/Family will identify and process 3 feelings related to change in family system. TARGET DATE:11/01 INTERVENTION A: Clinician will facilitate family discussion of feelings regarding divorce. Objective B: Client/Family will identify and process 3 ways to maintain effective communication even though family members do not all live in the same home. TARGET DATE: 11/01 INTERVENTION B: Clinician will facilitate family discussion regarding maintaining family communication/contact. 36

37 Group Therapy A method of treating mental health disorders using the interaction between an MHP and two or more patients to promote positive emotional or behavioral change. Group therapy is similar to individual therapy in that it also typically entails exploring/processing thoughts and feelings, and requires client insight. However, group therapy is utilized when it is felt that client would benefit from processing feelings and thoughts within a group of individuals with similar issues. 37

38 GT Example DIAGNOSIS: Oppositional Defiant Disorder PROBLEM: Often defies or refuses to comply with requests and rules even when they are reasonable. GOAL: Increase compliance with rules and respectfully accept direction from authority figures Objective A: Client will describe perception of his behavior and feelings toward rules and authority figures, and process with the group. TARGET DATE : 11/01 INTERVENTION A: Will direct group discussion to assist client with accurate perception of feelings and behavior. Objective B: Client will verbalize the connection between feelings and behavior and practice constructive responses to feelings. TARGET DATE: 11/01 INTERVENTION B: Will direct group discussion to assist client with constructive responses to feelings. 38

39 GT Example DIAGNOSIS: Adjustment Disorder with Depressed Mood PROBLEM: Client experiencing depressive symptoms in response to parents divorce GOAL: Process acceptance of parents divorce and decrease depression Objective A: Client will identify and process with group 3 feelings related to parents divorce. TARGET DATE: 11/01 INTERVENTION A: Clinician will facilitate group discussion of feelings regarding divorce. Objective B: Client will identify and process with group 3 changes in family routine since parents divorce. TARGET DATE: 11/01 INTERVENTION B: Clinician will facilitate group discussion regarding changes in family routine due to divorce. 39

40 Social/Living Skills 40

41 Social/Living Skills Each service must have a purpose that is related directly to the individual treatment plan and diagnosis Social/Living Skill Objectives should reflect (in measurable terms) what the client is to LEARN and/or PRACTICE. Please note that social/living skills training objectives should not require client insight or any processing of thoughts or feelings, which is content for therapy. 41

42 Social/Living Skills Examples DIAGNOSIS: ADHD PROBLEM: Disruptive, aggressive, negative attentionseeking behaviors. GOAL: Develop positive, respectful, constructive behaviors that gain attention and recognition. Objective A: Client will learn 3 constructive behaviors to gain attention. TARGET DATE: 11/01 INTERVENTION A: Clinician will teach client constructive attention seeking behaviors. Objective B: Client will practice 1 behavior each rehab session, utilizing the behaviors learned in Objective A. TARGET DATE: 11/01 INTERVENTION B: Clinician will prompt client practice each session as needed, and provide necessary feedback. 42

43 Social/Living Skills Examples DIAGNOSIS: Oppositional Defiant Disorder PROBLEM: Client argues frequently with adults GOAL: Decrease arguments and increase positive communication Objective A: Client will learn and practice 3 ways to effectively handle a disagreement. TARGET DATE: 11/01 INTERVENTION A: Clinician will teach client ways to effectively handle a disagreement and will facilitate practice. Objective B: Client will learn and practice 3 ways to positively present an idea and/or a request. TARGET DATE: 11/01 INTERVENTION B: Clinician will teach client ways to positively present an idea/request and will facilitate practice. 43

44 Social/Living Skills Examples DIAGNOSIS: Posttraumatic Stress Disorder PROBLEM: Poor Hygiene Due To Marked Distrust of Others GOAL: Improve Hygiene Objective A: Client will learn 3 ways poor hygiene can negatively impact his life. TARGET DATE: 11/01 INTERVENTION A: Clinician will teach client the negative effects of poor hygiene. Objective B: Client will learn 3 ways to improve hygiene. TARGET DATE: 11/01 INTERVENTION B: Clinician will teach client how to improve hygiene. 44

45 Examples of Goals and Objectives for Conduct Disordered Youth 45

46 Diagnosis: Conduct Disorder Problem: Repeated angry outbursts including cursing, verbal abuse, and threats Goal: Reduce the intensity and frequency of anger outbursts. Objectives: Identify and process people, events, and situations that stimulate fear, anxiety, and/or hurt feelings. Develop and practice alternative responses to the identified people events, and situations. 46

47 Finis 47