1.4 Effective Treatment Planning
Effective Treatment planning starts with the Human Service Professional. YOU! With every client you see, you bring your strengths, interpersonal skills, compassion, attitudes and behaviors that can enhance the outcomes of effective treatment planning, you hold the key! Yes, you and I have areas we need to “enhance” (areas that you believe may by weakness). With empathy and HOPE we can be a small part in making a difference in the life of another person. In order to start this process, effective treatment planning, you must embrace three broad areas: Interviewing stage and Skills, Diagnostic Skills and Documentation Skills.
Interviewing Skills
The interview starts with establishing a collaborative relationship with your client, consumer or student. This relationship starts at the very first contact either by phone or in person. You set the tone with your first greeting; did you extend your hand? What tone of voice did you use? Did you establish an atmosphere in your office that is safe, comfortable and welcoming? A therapeutic relationship based on respect, care, embracing unconditional positive regard and trust. Question, why should any client or anyone you meet immediately trust you or me? Trust must be earned, by how we choose to interact with our clients, the language we use, building on their strengthen while accepting their differences
You the “interviewer” must be able to use a balance of open and closed ended questions. This occurs by creating “a conversational partnership,” with your client. To fully understand what is occurring in that person’s life, we must truly LISTEN. Listen with our eyes, see the other person, their facial and non-verbal expressions, we must listen with our ears, truly hear what’s being sharing, we use our HEART, to be compassionate and our willingness to be present with a person, that no one is more important to you at that moment, than the person sitting in front of you. In addition to the usage of open and closed ended questions, utilizing paraphrasing and summarization are necessary to accurately listen and understand the client from their perspective. Other skills that are beneficial are restatements or reflection of content while reviewing the information gathered, to ascertain if additional information is needed to fill in or provided a more detail description of the client’s life.
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Activity
There are several purposes for this initial interview; to establish a rapport, to start of the therapeutic alliance, collecting information while starting the assessment. The assessment leads to an effective treatment planning.
Diagnostic Skills
A good clinical diagnosis is best obtained by integrating several types of clinical information, so gather information from at least six different sources, including but not limited; the clinical interview (intake), clinical observations, records from other sources (school, employment, other agencies etc.) Testing (PLEASE KNOW, diagnoses are based on individuals’ behaviors and criteria, whereas testing is based on statistical averages of behavior of larger groups of people. They do NOT account for individual differences, environment, history, background or culture. Biographical information and collateral informants (parents, coaches, teachers etc.) During this process it’s important to assess the “gaps” in information. Be mindful of “resistance” from our clients. Resistance can present itself in many forms: being late for appointments, checking the clock, poor eye contact, increase responses of “I don’t know” intentionally leaves out information, contradictions (information not matching previous information shared), changing the subject, exaggerations (bragging about their accomplishments or covering up their story due to shame, rejection). Please know, before we say “a client is resistant to treatment” let’s look at ourselves which includes our attitude towards the client, or their presenting problem, we can create a cold environment that those we serve don’t feel comfortable and or safe. As a final note, R. Sommer-Flannagan & J. Sommers-Flannagan (XXXX) stressed four types of self-awareness in conducting clinical interviews: 1). Physical Self Awareness- being aware of your own attributes, gender, tone of voice, projection, inflection and body language. 2). Psycho-social Self-Awareness, must be aware and mindful of your own “isms.” Which includes your own personal biases, stereotypes and assumptions. 3). Developmental Self-Awareness, being conscious of how’s one personal development may affect your perception and finally 4). Cultural Self-Awareness, being cognizant that one’s culture may have different norms or expectations. We have a responsibility to enhance our Cultural Skills, through reading, attending conferences, self-reflections or any other means to “uncover” lack of information or blind spots. As a final note we as Human Service Professionals must be mindful of Transference and Countertransference
Assessment
There are a variety of assessments one can use during the initial phase of the intake which can include a structured interview, unstructured, criteria focused interview. Remember there are six general questions that can assist you in a systematic inquiry almost with any problem, they include: who is involved? What is the presenting problem? When did/does it occur? Where did/does it occur? How do you(client) respond or behave in the situation? What finally brought you to treatment? In addition, in the Diagnostic and Statistical Manual of Mental Disorder published by the American Psychiatric Association has both a hard copy in their manual along with several online assessment tools several online assessment tools.
Documentation skills
We can not remember every detail someone shares with us. You may ask for permission from your client to take notes. Asking for permission will ease the client’s anxiety about “why you are taking note and what you plan to do with the notes.” Informed consent from the client must be obtained BEFORE you start taking notes, informed consent is an ongoing process throughout this therapeutic relationship. We will discuss in later chapter who to document case note and diagnoses.
These three areas (Interviewing Skills, Diagnostic Skills and Documentation skills) are interconnected. The primary purpose of the diagnostic interview is to make sound “therapeutic judgement,” that will assist in creating strong treatment plans focused on enhancing the clients coping mechanisms, feel better themselves and their lives while focusing on their goals to enhance the quality of their life.
Note:
This statement is Pennsylvania specific, there are five major entities within each county that are important partners in providing services to our children, adults and families. They include:
Mental Health (County Office of Behavioral Health)
Children and Youth Services
Education
Department of Health
Drug and Alcohol.
In addition to the major entities there are Auxiliary/Adjunct services that are vital in providing treatment to those you serve. We must remember, we can not address every concern a client may be experiencing. We must be able to establish professional relationships with other providers. It’s not a mental health kid or a CYS kid. It’s a child, family in our county that many need multiple services.
Activity: Please identify five auxiliary services in your county. Once identify please write a one-page summary of the agency, services provided, who is eligible for services, Include, address, website and contact information. Activity, please search the area in which you live, services that you could refer individuals to.
Within the counties in Pennsylvania there is a Levels of Care, starting with least restrictive to most restrictive.
Outpatient
School Based Mental
Community Based Mental Health Services (Family Based Mental Health, School Based Mental Health, Behavioral Health Services)
Partial Hospitalization Programs (Children, adolescents and Adults)
Residential Programs
Inpatient
Drop in Centers
Please review the attached document that includes a list of Fayette County Acronym Glossary
When providing services there are a variety of clinical modalities we could use, they include:
Individual, family, couples and group (therapeutic and psycho educational)
There are numerous interventions to use, sand therapy, HTP, art, music, dance, journaling , sentence completion, talk therapy, story telling, puppets just to name a few.