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Treatment Planning

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NBCC, NAADAC, CAADAC, and California Board of Behavioral Sciences approved Mental Health continuing education and addictions counselor training series. Narrated versions and CEUs available at http://www.allceus.com

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Treatment Planning

  1. 1. Treatment Planning Dr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC
  2. 2. Copyright 2008-2012 AllCEUs.com, a subsidiary of CDS Ventures, LLC What are Treatment Plans • Opportunities for us to teach clients ▫ Problem solving skills ▫ How to identify and use personal strengths • Dynamic documents that ▫ Address a client’s current functioning and needs. ▫ Evaluate the client’s progress in meeting specified goals and objectives ▫ Guide the course of treatment for identified problems or issues ▫ Enhance multidisciplinary team communication
  3. 3. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  4. 4. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Treatment Plan Foundation • Biopsychosocial assessment ▫ Current stressors ▫ Coping skills ▫ Self-esteem ▫ Mental health ▫ Substance abuse ▫ Social network ▫ Physical health
  5. 5. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  6. 6. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Learning • 3 parts to the learning process: 1. Cognition  How people acquire knowledge  seeing, hearing or doing 2. 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
  7. 7. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  8. 8. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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.
  9. 9. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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)
  10. 10. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  11. 11. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Sensing vs. Intuitive • Big picture vs. details • Find a balance • Present the big picture and the basics then let participants ask questions
  12. 12. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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?”
  13. 13. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  14. 14. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  15. 15. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Steps of Treatment Plan Development • Step One: Problem Selection • Step Two: Goal Development • Step Three: Problem Definition • Step Four: Objectives • Step Five: Interventions
  16. 16. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Problem Selection: Motivation • Changeable • Variable • Components ▫ Emotional ▫ Cognitive ▫ Social ▫ Physical ▫ Situational
  17. 17. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  18. 18. Prioritizing Goals Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 5 Self-actualization 4 Self-esteem 3 Love & Belonging 2 Safety & Security 1 Biological/Physiological
  19. 19. Physical Needs Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC •Substance Use •Physical Health Management •Medication Adherence Issues Biological/Physiological PHYSIOLOGICAL
  20. 20. Safety & Security Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC •Mental health management •Functional impairments •Legal issues Safety & Security
  21. 21. Love & Belonging Needs Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Love & Belonging •Social & interpersonal skills •Need for affiliation •Family relationships
  22. 22. Self-Esteem Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Self-Esteem •Achievement and mastery •Independence/status •Prestige
  23. 23. Self-Actualization Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Self-Actualization • Seeking personal potential • Self-fulfillment • Personal growth
  24. 24. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Writing the Plan • Individualized • Goals are: • Use positive language ▫ Meaningful to the • Address the reasons for patient not changing ▫ Observable ▫ Measurable ▫ Incremental ▫ Realistic ▫ Supported by sub-goals ▫ Use the KSA progression
  25. 25. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Goal Development • What is the broad goal for resolution of the problem? • What is the absence of the problem?
  26. 26. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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?
  27. 27. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  28. 28. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  29. 29. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Common Issues
  30. 30. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  31. 31. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  32. 32. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  33. 33. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  34. 34. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  35. 35. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  36. 36. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  37. 37. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Case B: Dan 36 year old, married African-American male 2 children 2 arrests and 1 conviction for DUI Arrest BAC .25 Employed Rates high severity - family problems
  38. 38. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  39. 39. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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
  40. 40. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC Objective Statement • “Will participate in outpatient program” ▫ Again, not specific for Jan or Dan ▫ A level of care is not an objective
  41. 41. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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.
  42. 42. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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.
  43. 43. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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.
  44. 44. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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.
  45. 45. Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC 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

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