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Mental Health continuing education and addictions counselor training series. Narrated versions available at http://www.allceus.com
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Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
Treatment PlanningDr. Dawn-Elise Snipes, PhD, LMHC, CRC, NCC
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
Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
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.
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
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
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 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
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
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.
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)
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
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
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?”
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
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
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
Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
Problem Selection: Motivation
•Changeable•Variable•Components▫Emotional▫Cognitive▫Social▫Physical▫Situational
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
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
Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
PHYSIOLOGICALBiological/Physiological
•Substance Use
•Physical Health Management
•Medication Adherence Issues
Physical Needs
Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
Safety & Security
•Mental health management
•Functional impairments
•Legal issues
Safety & Security
Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
Love & Belonging
•Social & interpersonal skills
•Need for affiliation
•Family relationships
Love & Belonging Needs
Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
Self-Esteem
•Achievement and mastery
•Independence/status
•Prestige
Self-Esteem
Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
Self-Actualization
Self-Actualization
• Seeking personal potential
• Self-fulfillment
• Personal growth
Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
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
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?
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?
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
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
Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
Common Issues
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
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
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
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
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
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
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
Copyright 2008-2012 AllCEUs, a subsidiary of CDS Ventures, LLC
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
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
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
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
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.
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.
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.
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.
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