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Quality Improvement & Outcomes

Tips for Treatment Plan Development

Documentation of Medical Necessity:

The key question(s) an assessment should provide an answer to is:

  • Why does the client need treatment now?
  • What is client’s explicit reason for seeking treatment?
  • What symptoms are making life more difficult than previously?
  • How is a mental health issue impacting day- to-day functioning?

Describe how symptoms of anxiety, depression, etc. are manifested in the client’s behavior. Each person will have a unique expression (e.g., not all depressed people cry; some become angry and irritable)

Client Strengths (skills, abilities, motivation):

People grow from their strengths. Document client past achievements and probe for the strengths that were responsible—these can be used to propel change and improvement in the future.

  • Why particular activities are enjoyable: Do they provide a creative outlet? Do they meet a need for praise? Do they provide competition that the client wins?
  • Focus on strengths and resiliency by exploring past success and tie to expectations for future success. Surviving difficult experiences can provide inner resources such as determination, courage, patience, etc.

Client Identified Opportunities for Improvement and Outcome Measures:

  • What outcomes does the client desire from the time they invest in counseling?
  • Example: Parental expectations are usually clear; however, unless adolescents buy in or invest in the process, therapy will probably not be successful. Sometimes they will buy in sideways, as in "What do I have to do to keep my mother from nagging at me?"

Goals should be stated in the client’s language:

I’ll be able to (positive change or outcome) at the end of treatment, as shown by (indications or criteria measuring change). It is recommended that you include a quote from the member.

Goals include the measurements that show accomplishment:

For example, how will you know when an anxious client is no longer anxious?

SMART Goals:

SMART Goals can be useful tool to formulate measurable goals. SMART stands for:

  • Specific: Are specific activities included? Could the client understand what is expected? Are they stated in the positive?
  • Measurable: Can change or progress toward meeting the objectives and can be documented and evaluated?  Identify baseline measurements? What assessments will be used?
    • CANS (from Magellan of Louisiana website);
    • Burns or Beck Depression and Anxiety Inventories;
    • PHQ-9;
    • Child behaviors checklists;
    • 1-10 scales of self-report of progress.
  • Attainable: Can the client take steps toward meeting the objectives? Goals are aligned to the deficit and active (use action words—suggestions below).
  • Realistic: Can the client meet the objectives given their current situation? Are the objectives challenging and achievable?
  • Time-Limited: Is the time frame specified for the objectives? Has the client’s stage of readiness to change been considered in the objectives and the time frame for completion? How will you and the client adjust to changes in the goals when barriers arise that prevent progress?

Suggested action words: describe, identify, experience, practice, develop, explain, apply, list, name, recognize, select, state, tell, express, report, restate, review, demonstrate, employ, detect, separate, create, detect, manage, organize, plan, prepare, produce, choose, determine, judge, increase understanding…

Recommendations for use of community/peer support:

Community/peer supports are natural resources that can help clients to integrate into the community and increase community tenure for clients. Once a client has reached a baseline status, community resources are the appropriate level of service. Medicaid mental health coverage is only available for treatment of acute psychiatric symptoms that are significantly impairing day to day functioning.

Examples of community supports for adult clients include:

  • Family members and friends
  • Support groups for:
    • Medical issues
    • Divorce
    • Parenting
    • Sexual abuse
    • AA/NA, Al-Anon, Gambler’s Anonymous
    • Domestic violence
  • Other community supports include:
    • YMCA/YWCA (local community centers)
    • Community support worker(s)
    • Local library
    • Community college classes

Examples of community supports for child or adolescent clients include:

  • Support groups for divorce, anger, etc.
  • Al-anon, AA/NA
  • Sexual abuse groups
  • After school programs
  • Extra-curricular activities
  • Mentor programs such as Big Brothers/Big Sisters
  • Boy Scouts/Girl Scouts
  • Church youth groups
  • Boys and Girls Club

 

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