treatment planning

Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC

Treatment PlanningDr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC


What is treatment planning?

•The process in which the counselor and client: ▫ identify and rank problems needing resolution▫establish agreed upon immediate and long-term goals▫decide on the treatment methods ▫ identify necessary resources


Treatment plans…

•Guide the course of treatment for identified problems or issues.

•Are dynamic and address a client’s current functioning and needs.

•Evaluate the client’s progress in meeting specified goals and objectives.


Treatment Plan Foundation

•Biopsychosocial assessment ▫Current stressors▫Coping skills▫Self-esteem▫Mental health▫Substance abuse▫Social network▫Physical health


Treatment Plan Development

•The individualized treatment plan is: ▫ structured▫goal-oriented ▫a schedule of services ▫developed jointly with the client▫a written document with treatment-related goals and

measurable objectives• Interventions are grounded in the client’s learning style


Learning •3 parts to the learning process:

1. Cognition How people acquire knowledge

seeing, hearing or doing2. Conceptualization

How people process information abstract, specific, memory pathways

3. Affective People’s motivation, decision-making styles, values and

emotional preferences how much does this information matter


Knowledge: Understanding Learning Styles

• Active/Reflective ▫When you process information

• Auditory/hearing, visual/seeing, or kinesthetic/doing▫Methods for receiving information

• Attitudinal or Emotional▫How you conceptualize information

• Sensing vs. Intuitive ▫What you pay attention to

• Global vs. Specific ▫Parts to whole or vice versa


Active/Reflective Learner Tips•Reflective learners ▫think it through first ▫prefer working alone

•Active learners ▫have difficulty sitting quietly through lectures▫ like group work ▫need discussion or problem-solving activities

• Action without reflection can get you into trouble, while if you spend too much time reflecting you may never get anything done.


Auditory, Visual, Kinesthetic

• Kinesthetic learners▫mentally or physically work with the material

• Auditory learners▫need to hear the material

• Visual learners▫need to see the material

• In order to meet different learning needs, present material: ▫visually (notes, graphs)▫verbally (talk about it)▫manipulatively (questions, group activities)


Attitudinal/Emotional

•Thinkers vs. Feelers•Present compelling information in a way that appeals

to people’s emotions▫Ex: Statistics on child abuse with pictures of kids


Sensing vs. Intuitive

•Big picture vs. details•Find a balance•Present the big picture and the basics then let

participants ask questions


Global vs. Sequential

•Bottom Up or Top Down▫Think puzzles: Box or no box?▫Think DVDs: Read the back or no?

•Present a general overview•Provide an outline/agenda for direction•Answer the question---▫“Why do I care?”


Learning Style Summary

•Create an emotionally and objectively meaningful and positive goal (Emotional, Attitudinal, Global)

•Create steps to that goal (Sequential)•Write the sub-goals in a positive KSA format•For each sub-goal, provide written information,

discuss it then apply it•Regularly address how each goal builds on the last


Where to now?

•What we know▫Who they are▫Their issues▫Their learning style

•What we still need to know▫What they are motivated to change


Steps of Treatment Plan Development

•Step One: Problem Selection•Step Two: Goal Development•Step Three: Problem Definition•Step Four: Objectives•Step Five: Interventions


Problem Selection: Motivation

•Changeable•Variable•Components▫Emotional▫Cognitive▫Social▫Physical▫Situational


Problem Selection: Meaningful

•The reward must be worth the effort•Create mutually beneficial goals if needed•Help the client identify motivations and

corresponding goals•Use the miracle question

Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLCPrioritizing Goals

Biological/Physiological

Safety & Security

Love & Belonging

Self-esteem

Self-actualization

1

2

3

4

5


PHYSIOLOGICALBiological/Physiological

•Substance Use

•Physical Health Management

•Medication Adherence Issues

Physical Needs


Safety & Security

•Mental health management

•Functional impairments

•Legal issues

Safety & Security


Love & Belonging

•Social & interpersonal skills

•Need for affiliation

•Family relationships

Love & Belonging Needs


Self-Esteem

•Achievement and mastery

•Independence/status

•Prestige

Self-Esteem


Self-Actualization

Self-Actualization

• Seeking personal potential

• Self-fulfillment

• Personal growth


Writing the Plan

• Individualized•Use positive language•Address the reasons for

not changing

•Goals are:▫Meaningful to the

patient▫Observable▫Measurable▫Incremental▫Realistic▫Supported by sub-goals▫Use the KSA progression


Goal Development

•What is the broad goal for resolution of the problem?

•What is the absence of the problem?


Problem Definition

•How is the problem evidenced in the client?•How is the problem affecting the client’s overall

functioning?•What is the client’s perception of the problem?•What are the client’s strengths?


Objectives•Objectives are steps toward the goal•S.M.A.R.T▫Specific

Rome was not built in a day Frequent reinforcement Logical sub-goals KSAs

▫Measurable (duration, frequency, intensity)▫Attainable▫Realistic▫Time-limited


Pitfalls

•Failing to consider why you currently do (or do not) engage in certain behaviors

• Setting goals that are too big • Setting goals that are too hard • Setting too many goals • Setting goals without sufficient rewards • Setting goals that are too specific


Common Issues


Anxiety: Differential Diagnosis•General Medical▫Thyroid problems▫Hormone imbalance▫Medication (Methadone, decongestants, etc.)▫Diabetes▫Substance intoxication or withdrawal

•Other▫Domestic violence▫Low self-esteem/external validation▫Diet—caffeine, low blood sugar


Anxiety• Statement▫ “Sally will be calmer resulting in improved

concentration/focus, increased energy, improved sleep and reduced headaches.”

• Identify sub-goals (SMART)▫ “What would it be like if you were not anxious anymore?”

• Knowledge/Skills▫Educate Sally about anxiety causes, short and long term

effects▫What skills does Sally have?▫What skills does sally need to learn?

• Teach, discuss, role play, practice, report


Depression•General Medical▫Thyroid problems▫Hormone imbalance▫Medication (Opiates, antipsychotics etc.)▫Diabetes▫Substance intoxication or withdrawal

•Other▫Domestic violence▫Low self-esteem/external validation▫Diet—insufficient carbohydrates


Depression cont…• Statement▫ “Sally will be happier resulting in improved

concentration/focus, increased energy, improved sleep and increased enjoyment of daily activities.”

• Identify sub-goals▫ “What would it be like if you were not depressed anymore?”

• Knowledge/Skills▫Educate Sally about depression causes; short and long term

effects▫What skills does Sally have?▫What skills does sally need to learn?

• Teach, discuss, role play, practice, report


Substance Use•Statement▫“Sally will stay clean resulting in improved

relationships, energy, health and happiness.”• Identify sub-goals▫“What would it be like if you did not feel the need to

use anymore?”•Knowledge/Skills▫Educate Sally about addiction causes, short and long

term effects▫What skills does Sally have?▫What skills does sally need to learn?

•Teach, discuss, role play, practice, report


Psychosocial Issues•Statement▫“Sally will _________ resulting in _________.”

• Identify sub-goals▫What would it be like if you (had this need met)?

•Knowledge/Skills▫Educate Sally about the need and available resources▫What skills/resources does Sally have?▫What skills/resources does sally need?

•Teach, discuss, role play, practice, report


Case A : Jan

27 year old, single Caucasian female

3 children under age 7

No childcare readily available

Social companions using drugs/alcohol

Unemployed

No high school/GED

2 arrests for possession of meth & cannabis + 1 probation violation


Case B: Dan36 year old, married African-American male

2 children

2 arrests and 1 conviction for DUI

Arrest BAC .25

Employed

Rates high severity - family problems


Problem Statement

• “Alcohol Dependence”

▫Not individualized

▫Not a complete sentence

▫Doesn’t provide enough information

▫A diagnosis is not a complete problem statement

▫Is a negative statement


Goal Statement

• “Will refrain from all substance use now and in the future”

▫Not specific for Jan or Dan

▫Not helpful for treatment planning

▫Cannot be accomplished by program discharge

▫Still negative


Objective Statement

• “Will participate in outpatient program”

▫Again, not specific for Jan or Dan

▫A level of care is not an objective


Changing Language: Problem Statements

1. Client has low self-esteem.

2. Client is in denial.

3. Client is alcohol dependent.

4. Client is promiscuous.

5. Client is resistant to treatment.

6. Client is on probation because he is a bad

alcoholic.


Changing Language

• Think about how you might change the language for 2 of the preceding problem statements.

• Rewrite those statements using non-judgmental and jargon-free language.


Changing Language - Examples

1. Client has low self-esteem.▫ Client averages 10 negative self-statements daily.

2. Client is in denial.▫ Client reports two DWIs in past year but states

that alcohol use is not a problem.3. Client is alcohol dependent.▫ Client experiences tolerance, withdrawal, loss of

control and negative life consequences due to alcohol use.


Changing Language - Examples

4. Client is promiscuous.▫ Client participates in unprotected sex four times a

week.5. Client is resistant to treatment.▫ In past 12 months, client has dropped out of 3

treatment programs prior to completion.6. Client is on probation because he is a bad alcoholic.▫ Client has legal consequences because of alcohol-

related behavior.


Summary

•By working with your clients to develop goals, they will determine:▫How they learn the best▫How to identify appropriate sub-goals▫How to create an effective change plan

treatment planning

Health & Medicine