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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Serie: Practice Planners
- Sprache: Englisch
This timesaving resource features: * Treatment plan components for 31 behaviorally based presenting problems * Over 1,000 prewritten treatment goals, objectives, and interventions--plus space to record your own treatment plan options * A step-by-step guide to writing treatment plans that meet the requirements of most accrediting bodies, insurance companies, and third-party payors * Includes new Evidence-Based Practice Interventions as required by many public funding sources and private insurers PracticePlanners¯® THE BESTSELLING TREATMENT PLANNING SYSTEM FOR MENTAL HEALTH PROFESSIONALS The Severe and Persistent Mental Illness Treatment Planner, Second Edition provides all the elements necessary to quickly and easily develop formal treatment plans that satisfy the demands of HMOs, managed care companies, third-party payors, and state and federal agencies. * New edition features empirically supported, evidence-based treatment interventions * Organized around 31 main presenting problems, including employment problems, family conflicts, financial needs, homelessness, intimate relationship conflicts, and social anxiety * Over 1,000 prewritten treatment goals, objectives, and interventions--plus space to record your own treatment plan options * Easy-to-use reference format helps locate treatment plan components by behavioral problem * Designed to correspond with The Severe and Persistent Mental Illness Progress Notes Planner, Second Edition * Includes a sample treatment plan that conforms to the requirements of most third-party payors and accrediting agencies (including CARF, The Joint Commission, COA, and NCQA) Additional resources in the PracticePlanners¯® series: Progress Notes Planners contain complete, prewritten progress notes for each presenting problem in the companion Treatment Planners. Documentation Sourcebooks provide the forms and records that mental health professionals need to efficiently run their practice. For more information on our PracticePlanners¯®, including our full line of Treatment Planners, visit us on the Web at: www.wiley.com/practiceplanners
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Seitenzahl: 384
Veröffentlichungsjahr: 2015
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Table of Contents
Title Page
Copyright
Dedication
PRACTICEPLANNERS® SERIES PREFACE
ACKNOWLEDGMENTS
INTRODUCTION
ABOUT PRACTICE
PLANNERS
® TREATMENT PLANNERS
ABOUT THE SEVERE AND PERSISTENT MENTAL ILLNESS TREATMENT PLANNER
INCORPORATING EVIDENCE-BASED TREATMENT (EBT)
HOW TO USE THIS TREATMENT PLANNER
A FINAL NOTE ON TAILORING THE TREATMENT PLAN TO THE CLIENT
REFERENCES
SAMPLE TREATMENT PLAN
DIAGNOSIS
Chapter 1: ACTIVITIES OF DAILY LIVING (ADL)
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 2: AGING
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 3: ANGER MANAGEMENT
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 4: ANXIETY
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 5: BORDERLINE PERSONALITY
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 6: CHEMICAL DEPENDENCE
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 7: DEPRESSION
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 8: EMPLOYMENT PROBLEMS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 9: FAMILY CONFLICTS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 10: FINANCIAL NEEDS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 11: GRIEF AND LOSS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 12: HEALTH ISSUES
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 13: HOMELESSNESS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 14: INDEPENDENT ACTIVITIES OF DAILY LIVING (IADL)
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 15: INTIMATE RELATIONSHIP CONFLICTS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 16: LEGAL CONCERNS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 17: MANIA OR HYPOMANIA
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 18: MEDICATION MANAGEMENT
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 19: OBSESSIVE-COMPULSIVE DISORDER (OCD)
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 20: PANIC/AGORAPHOBIA
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 21: PARANOIA
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 22: PARENTING
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 23: POSTTRAUMATIC STRESS DISORDER (PTSD)
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 24: PSYCHOSIS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 25: RECREATIONAL DEFICITS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 26: SELF-DETERMINATION DEFICITS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 27: SEXUALITY CONCERNS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 28: SOCIAL ANXIETY
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 29: SOCIAL SKILLS DEFICITS
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 30: SPECIFIC FEARS AND AVOIDANCE
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Chapter 31: SUICIDAL IDEATION
BEHAVIORAL DEFINITIONS
LONG-TERM GOALS
DIAGNOSTIC SUGGESTIONS
Appendix A: BIBLIOTHERAPY SUGGESTIONS
Appendix B: REFERENCES FOR EVIDENCE-BASED CHAPTERS
Appendix C: RECOVERY MODEL OBJECTIVES AND INTERVENTIONS
LONG-TERM GOAL
End User License Agreement
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Guide
Cover
Table of Contents
Begin Reading
PracticePlanners® Series
Treatment Planners
The Complete Adult Psychotherapy Treatment Planner, Fifth Edition
The Child Psychotherapy Treatment Planner, Fifth Edition
The Adolescent Psychotherapy Treatment Planner, Fifth Edition
The Addiction Treatment Planner, Fifth Edition
The Continuum of Care Treatment Planner
The Couples Psychotherapy Treatment Planner, with DSM-5 Updates, Second Edition
The Employee Assistance Treatment Planner
The Pastoral Counseling Treatment Planner
The Older Adult Psychotherapy Treatment Planner, with DSM-5 Updates, Second Edition
The Behavioral Medicine Treatment Planner
The Group Therapy Treatment Planner
The Gay and Lesbian Psychotherapy Treatment Planner
The Family Therapy Treatment Planner, with DSM-5 Updates, Second Edition
The Severe and Persistent Mental Illness Treatment Planner, with DSM-5 Updates, Second Edition
The Mental Retardation and Developmental Disability Treatment Planner
The Social Work and Human Services Treatment Planner
The Crisis Counseling and Traumatic Events Treatment Planner, with DSM-5 Updates, Second Edition
The Personality Disorders Treatment Planner
The Rehabilitation Psychology Treatment Planner
The Special Education Treatment Planner
The Juvenile Justice and Residential Care Treatment Planner
The School Counseling and School Social Work Treatment Planner, with DSM-5 Updates, Second Edition
The Sexual Abuse Victim and Sexual Offender Treatment Planner
The Probation and Parole Treatment Planner
The Psychopharmacology Treatment Planner
The Speech-Language Pathology Treatment Planner
The Suicide and Homicide Treatment Planner
The College Student Counseling Treatment Planner
The Parenting Skills Treatment Planner
The Early Childhood Intervention Treatment Planner
The Co-occurring Disorders Treatment Planner
The Complete Women's Psychotherapy Treatment Planner
The Veterans and Active Duty Military Psychotherapy Treatment Planner, with DSM-5 Updates
Progress Notes Planners
The Child Psychotherapy Progress Notes Planner, Fifth Edition
The Adolescent Psychotherapy Progress Notes Planner, Fifth Edition
The Adult Psychotherapy Progress Notes Planner, Fifth Edition
The Addiction Progress Notes Planner, Fifth Edition
The Severe and Persistent Mental Illness Progress Notes Planner, Second Edition
The Couples Psychotherapy Progress Notes Planner, Second Edition
The Family Therapy Progress Notes Planner, Second Edition
The Veterans and Active Duty Military Psychotherapy Progress Notes Planner
Homework Planners
Couples Therapy Homework Planner, Second Edition
Family Therapy Homework Planner, Second Edition
Grief Counseling Homework Planner
Group Therapy Homework Planner
Divorce Counseling Homework Planner
School Counseling and School Social Work Homework Planner, Second Edition
Child Therapy Activity and Homework Planner
Addiction Treatment Homework Planner, Fifth Edition
Adolescent Psychotherapy Homework Planner, Fifth Edition
Adult Psychotherapy Homework Planner, Fifth Edition
Child Psychotherapy Homework Planner, Fifth Edition
Parenting Skills Homework Planner
Veterans and Active Duty Military Psychotherapy Homework Planner
Client Education Handout Planners
Adult Client Education Handout Planner
Child and Adolescent Client Education Handout Planner
Couples and Family Client Education Handout Planner
Complete Planners
The Complete Depression Treatment and Homework Planner
The Complete Anxiety Treatment and Homework Planner
The Severe and Persistent Mental Illness Treatment Planner, with DSM-5 Updates, Second Edition
David J. Berghuis
Arthur E. Jongsma, Jr.
Timothy J. Bruce, Contributing Editor
This book is printed on acid-free paper.
Copyright © 2015 by David J. Berghuis and Arthur E. Jongsma, Jr. All rights reserved.
Published by John Wiley & Sons, Inc., Hoboken, New Jersey.
Published simultaneously in Canada.
No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording, scanning, or otherwise, except as permitted under Section 107 or 108 of the 1976 United States Copyright Act, without either the prior written permission of the Publisher, or authorization through payment of the appropriate per-copy fee to the Copyright Clearance Center, Inc., 222 Rosewood Drive, Danvers, MA 01923, (978) 750-8400, fax (978) 646-8600, or on the web at www.copyright.com. Requests to the Publisher for permission should be addressed to the Permissions Department, John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, (201) 748-6011, fax (201) 748-6008, or online at http://www.wiley.com/go.permissions.
Limit of Liability/Disclaimer of Warranty: While the publisher and author have used their best efforts in preparing this book, they make no representations or warranties with respect to the accuracy or completeness of the contents of this book and specifically disclaim any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives or written sales materials. The advice and strategies contained herein may not be suitable for your situation. You should consult with a professional where appropriate. Neither the publisher nor author shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages.
This publication is designed to provide accurate and authoritative information in regard to the subject matter covered. It is sold with the understanding that the publisher is not engaged in rendering professional services. If legal, accounting, medical, psychological or any other expert assistance is required, the services of a competent professional person should be sought.
Designations used by companies to distinguish their products are often claimed as trademarks. In all instances where John Wiley & Sons, Inc. is aware of a claim, the product names appear in initial capital or all capital letters. Readers, however, should contact the appropriate companies for more complete information regarding trademarks and registration.
All references to diagnostic codes are reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Copyright 2000. American Psychiatric Association.
For general information on our other products and services please contact our Customer Care Department within the U.S. at (800) 762-2974, outside the United States at (317) 572-3993 or fax (317) 572-4002.
Wiley also publishes its books in a variety of electronic formats. Some content that appears in print may not be available in electronic books. For more information about Wiley products, visit our web site at www.wiley.com.
Library of Congress Cataloging-in-Publication Data
Berghuis, David J.
The severe and persistent mental illness treatment planner, with DSM-5 updates / David J. Berghuis, Arthur E. Jongsma Jr. — 2nd ed.
p. ; cm. — (Practice planners series)
Includes bibliographical references and index.
ISBN 978-1-119-06305-6 (pbk. : alk. paper)
ISBN 978-1-119-06392-6 (eMobi)
ISBN 978-1-119-06398-8 (ePDF)
ISBN 978-1-119-06426-8 (ePub)
1. Mental illness—Treatment—Planning—Handbooks, manuals, etc. 2. Chronic illness—Treatment— Planning—Handbooks, manuals, etc. 3. Psychiatric records—Handbooks, manuals, etc. I. Jongsma, Arthur E., 1943- II. Title. III. Series: Practice planners.
[DNLM: 1. Mental Disorders—therapy—Handbooks. 2. Chronic Disease—therapy—Handbooks.
3. Patient Care Planning—Handbooks. 4. Psychotherapy—methods—Handbooks. WM 34 B497s 2008]
RC480.53.B47 2008
616.89'14—dc22
2008027403
To my wife, Barbara, for whom my love grows every day, and to my children, Katherine and Michael, who make me proud.
—David J. Berghuis
To Tom Van Wylen and Mary Boll, two friends who have stepped forward to show their support for those who work with clients struggling with severe and persistent mental illness. Thank you and God bless you.
—Arthur E. Jongsma, Jr.
To all of those individuals who struggle with severe mental problems and to all of the individuals who dedicate their lives to helping them.
—Timothy J. Bruce
PRACTICEPLANNERS® SERIES PREFACE
Accountability is an important dimension of the practice of psychotherapy. Treatment programs, public agencies, clinics, and practitioners must justify and document their treatment plans to outside review entities in order to be reimbursed for services. The books in the PracticePlanners® series are designed to help practitioners fulfill these documentation requirements efficiently and professionally.
The PracticePlanners® series includes a wide array of treatment planning books including not only the original Complete Adult Psychotherapy Treatment Planner, Child Psychotherapy Treatment Planner, and Adolescent Psychotherapy Treatment Planner, all now in their fifth editions, but also Treatment Planners targeted to specialty areas of practice, including:
Addictions
Co-occurring disorders
Behavioral medicine
College students
Couples therapy
Crisis counseling
Early childhood education
Employee assistance
Family therapy
Gays and lesbians
Group therapy
Juvenile justice and residential care
Mental retardation and developmental disability
Neuropsychology
Older adults
Parenting skills
Pastoral counseling
Personality disorders
Probation and parole
Psychopharmacology
Rehabilitation psychology
School counseling and school social work
Severe and persistent mental illness
Sexual abuse victims and offenders
Social work and human services
Special education
Speech-language pathology
Suicide and homicide risk assessment
Veterans and active military duty
Women's issues
In addition, there are three branches of companion books that can be used in conjunction with the Treatment Planners, or on their own:
Progress Notes Planners
provide a menu of progress statements that elaborate on the client's symptom presentation and the provider's therapeutic intervention. Each
Progress Notes Planner
statement is directly integrated with the behavioral definitions and therapeutic interventions from its companion
Treatment Planner
.
Homework Planners
include homework assignments designed around each presenting problem (such as anxiety, depression, substance use, anger control problems, eating disorders, or panic disorder) that is the focus of a chapter in its corresponding
Treatment Planner
.
Client Education Handout Planners
provide brochures and handouts to help educate and inform clients on presenting problems and mental health issues, as well as life skills techniques. The handouts are included on CD-ROMs for easy printing from your computer and are ideal for use in waiting rooms, at presentations, as newsletters, or as information for clients struggling with mental illness issues. The topics covered by these handouts correspond to the presenting problems in the
Treatment Planners
.
The series also includes adjunctive books, such as The Psychotherapy Documentation Primer and The Clinical Documentation Sourcebook, containing forms and resources to aid the clinician in mental health practice management.
The goal of our series is to provide practitioners with the resources they need in order to provide high-quality care in the era of accountability. To put it simply: We seek to help you spend more time on patients, and less time on paperwork.
ARTHUR E. JONGSMA, JR.Grand Rapids, Michigan
ACKNOWLEDGMENTS
A variety of people should be acknowledged for their assistance in developing this Planner. First, the clients who have been willing to share their lives and troubles have taught us more than can be written. Several staff members of the Community Mental Health Centers in Ionia County and Newaygo County (both in Michigan) have either knowingly or unknowingly provided feedback and ideas throughout the unfolding of this project. While developing the first edition of this Planner, the authors were also involved in the writing of The Mental Retardation and Developmental Disability Treatment Planner, with Kellye Slaggert. Many ideas developed for that Planner were adapted for this one. Barbara Berghuis, wife of the primary author, and a case manager herself, was instrumental in developing and critiquing the manuscript throughout the process. The library staff of Calvin College and Seminary were invaluable in their assistance while researching material for this project.
This second edition has been improved beyond measure by the guidance and contribution of Dr. Tim Bruce. He has been our well-informed expert on the evidence-based content that exists in the professional literature. Thank you, Tim.
Sue Rhoda, our manuscript manager, has been a wonderful assistant who has very efficiently kept all the details organized, allowing us to submit a final product that has been polished by her professional hand. Thank you, Sue.
No project this large gets completed without other priorities being rearranged. The willingness of our families to allow us to take the time to bring this idea to fruition is very much appreciated. It is their support and guidance that have allowed us to help others. The editorial staff at John Wiley & Sons has consistently provided us with supremely competent encouragement and guidance for which we are grateful.
A. E. J.D. J. B.
INTRODUCTION
ABOUT PRACTICEPLANNERS® TREATMENT PLANNERS
Pressure from third-party payors, accrediting agencies, and other outside parties has increased the need for clinicians to quickly produce effective, high-quality treatment plans. Treatment Planners provide all the elements necessary to quickly and easily develop formal treatment plans that satisfy the needs of most third-party payors and state and federal review agencies.
Each Treatment Planner:
Saves you hours of time-consuming paperwork.
Offers the freedom to develop customized treatment plans.
Includes over 1,000 clear statements describing the behavioral manifestations of each relational problem, and includes long-term goals, short-term objectives, and clinically tested treatment options.
Has an easy-to-use reference format that helps locate treatment plan components by behavioral problem or
DSM-5
diagnosis.
As with the rest of the books in the PracticePlanners® series, our aim is to clarify, simplify, and accelerate the treatment planning process, so you spend less time on paperwork, and more time with your clients.
ABOUT THE SEVERE AND PERSISTENT MENTAL ILLNESS TREATMENT PLANNER
The field of treatment for the severely and persistently mentally ill is at a pivotal point in its evolution. New medications have provided stability to people who have been chronically unstable in the past. What started with deinstitutionalization and the growth of community mental health centers has gradually transformed into a myriad of agencies and clinicians who provide treatment in a variety of settings. Many changes have also occurred for the agencies serving this population. In many areas, the service providers have been compelled to become more efficient and competitive for their clientele. Most agencies are required to obtain accreditation from outside auditors, such as the Joint Commission on the Accreditation of Health Organizations (JCAHO), Council on Accreditation (COA), or the Commission on Accreditation of Rehabilitation Facilities (CARF). Payors often demand documentation of positive outcomes for clients whom we serve. With these many changes in the field, the need for better organization, treatment techniques, and documentation becomes self-evident.
To fill this need, we have developed The Severe and Persistent Mental Illness Treatment Planner. This Planner suggests thousands of prewritten behavioral definitions, objectives, goals, and interventions for a variety of problem areas experienced by the men and women who suffer from chronic mental illness. This book will be useful to any clinician working with this population, but care has been taken to write from the perspective of the clinician who manages the client's entire treatment, whether he or she be called a case manager, supports coordinator, social worker, or some other name. Goals and interventions are written for a variety of types and levels of intensity of severe and persistent mental illnesses. It is our hope that this Planner will allow clinicians to quickly and accurately develop and implement helpful treatment plans for their clients. In this second edition, we have made the chapters more focused and, in many cases, shorter. We have also added a few new chapters. But the most significant change for this edition is the addition of evidence-based Objectives and Interventions to those chapters where research data is available to inform the content.
INCORPORATING EVIDENCE-BASED TREATMENT (EBT)
Evidence-based treatment (that is, treatment that is scientifically shown in research trials to be efficacious) is rapidly becoming critically important to the mental health community because insurance companies are beginning to offer preferential pay to organizations using it. In fact, the APA Division 12 (Society of Clinical Psychology) lists of empirically supported treatments have been referenced by a number of local, state, and federal funding agencies, which are beginning to restrict reimbursement to these treatments, as are some managed care and insurance companies.
In this second edition of The Severe and Persistent Mental Illness Treatment Planner, we have made an effort to empirically inform some chapters by highlighting short-term objectives (STOs) and therapeutic interventions (TIs) that are consistent with psychological treatments or therapeutic programs that have demonstrated some level of efficacy through empirical study. Watch for this icon as an indication that an Objective/Intervention is consistent with those found in evidence-based treatments.
References to their empirical support have been included in Appendix B. For information related to the identification of evidence-based practices (EBPs), including the benefits and limitations of the effort, we suggest Bruce and Sanderson (2005); Chambless et. al. (1996, 1998); Chambless and Ollendick (2001); Drake, Merrens, and Lynde (2005); Hofmann and Tompson (2002); Nathan and Gorman (2002); and Stout and Hayes (2005).
In this Planner, we have included STOs and TIs consistent with EBPs that are more programmatic than psychotherapeutic in nature and that have been found efficacious for problems common to those struggling with severe and persistent mental illnesses (SPMIs). Examples include supported employment and family psychoeducation. We have also included STOs and TIs reflective of psychotherapeutic approaches that have shown efficacy for disorders typically subsumed under the SPMI rubric (e.g., interpersonal therapy for depression, cognitive behavior therapy for psychotic features). In addition, we included STOs and TIs reflective of treatments that been found efficacious for problems not commonly characterized as SPMIs (e.g., obsessive compulsive disorder, panic disorder, social anxiety), but that nonetheless present clinically on occasion, have an evidence base within the populations studied, and that therapists may adapt for use with clients who struggle with these problems. Beyond references to the empirical studies supporting these interventions, we have provided references to therapist- and client-oriented books and treatment manuals that describe the use of identified EBPs or treatments consistent with their objectives and interventions. Recognizing that there are STOs and TIs that practicing clinicians have found useful but that have not yet received empirical scrutiny, we have included those that reflect common best practice among experienced clinicians. The goal is to provide a range of treatment plan options, some studied empirically, others reflecting common clinical practice, so the users can construct what they believe to be the best plan for a particular client.
In some instances, the EBPs referenced are short-term, problem-oriented treatments that focus on improving current specific problems or symptoms related to a client's current distress and disability. For those, STOs and TIs reflective of the EBP have been placed earlier in the sequence of STO and TI options. In addition, some STOs and TIs reflect core components of the EBP approach that are always delivered (e.g., exposure to feared objects and situations for a phobic disorders; behavioral activation for depression). Others reflect adjuncts to treatment that may or may not be used all the time (e.g., social and other communication skills, stress management skills). For the EBPs that are more programmatic in nature, such as supported employment, the STOs and TIs are consistent with the types of competencies in which professionals who deliver these inventions are trained. Most of the STOs and TIs associated with the EBPs are described at a level of detail that permits flexibility and adaptability in their specific application. As with all Planners in this series, each chapter includes the option to add STOs and TIs at the therapist's discretion.
Criteria for Inclusion of Evidence-Based Therapies
The EBPs from which STOs and TIs were taken have different levels of empirical work supporting them. Some have been well established as efficacious for the changes they target (e.g., supported employment). Others have less support, but nonetheless have demonstrated efficacy. The EBPs for disorders not typically classified as SPMIs, such as panic disorder and other anxiety disorders, have very strong empirical support for their efficacy, but have established that support through studies whose participants carried a primary diagnosis of an anxiety disorder, not a SPMI. These approaches have been included in this edition because some clients who struggle with SPMIs and also struggle with these other disorders may benefit from these EBP approaches. With that in mind, however, we have included EBPs for which the empirical support has either been well established or demonstrated at more than a preliminary level as defined by those authors who have undertaken the task of identifying them, such as Drake and colleagues (2003, 2005), Chambless and colleagues (1996, 1998), and Nathan and Gorman (1998, 2002).
At minimum, efficacy needed to be demonstrated through a clinical trial or large clinical replication series with features reflecting good experimental design (e.g., random assignment, blind assignments, reliable and valid measurement, clear inclusion and exclusion criteria, state-of-the-art diagnostic methods, and adequate sample size or replications). Well-established EBPs typically have more than one of these types of studies demonstrating their efficacy, as well as other desirable features such as demonstration of efficacy by independent research groups and specification of client characteristics for which the treatment was effective.
Because treatment literatures for various problems develop at different rates, treatment STOs and TIs that have been included may have the most empirical support for their problem area, but less than that found in more heavily studied areas. For example, Dialectical Behavioral Therapy (DBT) has the highest level of empirical support of tested psychotherapies for borderline personality disorder (BPD), but that level of evidence is lower than that supporting, for example, supported employment or exposure-based therapy for phobic fear and avoidance. The latter two have simply been studied more extensively, so there are more trials, replications, and the like. Nonetheless, within the psychotherapy outcome literature for BPD, DBT clearly has the highest level of evidence supporting its efficacy and usefulness. Accordingly, STOs and TIs consistent with DBT have been included in this edition. Last, all interventions, empirically supported or not, must be adapted to the particular client in light of his/her personal circumstances, strengths, and vulnerabilities. The STOs and TIs included in this Planner are written in a manner to suggest and allow this adaptability.
Summary of Required and Preferred SPMI EBT Inclusion Criteria
Required
Demonstration of efficacy through at least one randomized controlled trial with good experimental design, or
Demonstration of efficacy through a large, well-designed clinical replication series.
Preferred
Efficacy has been shown by more than one study.
Efficacy has been demonstrated by independent research groups.
Client characteristics for which the treatment was effective were specified.
A clear description of the treatment was available.
HOW TO USE THIS TREATMENT PLANNER
Use this Treatment Planner to write treatment plans according to the following six-step progression:
Problem Selection.
Although the client may discuss a variety of issues during the assessment, the clinician must determine the most significant problems on which to focus the treatment process. Usually a primary problem will surface, and secondary problems may also be evident. Some other problems may have to be set aside as not urgent enough to require treatment at this time. An effective treatment plan can only deal with a few selected problems or treatment will lose its direction. Choose the problem within this
Planner
that most accurately represents your client's presenting issues.
Problem Definition.
Each client presents with unique nuances as to how a problem behaviorally reveals itself in his or her life. Therefore, each problem that is selected for treatment focus requires a specific definition about how it is evidenced in the particular client. The symptom pattern should be associated with diagnostic criteria and codes such as those found in the
DSM-5
or the
International Classification of Diseases
. This
Planner
offers such behaviorally specific definition statements to choose from or to serve as a model for your own personally crafted statements.
Goal Development.
The next step in developing your treatment plan is to set broad goals for the resolution of the target problem. These statements need not be crafted in measurable terms but can be global, long-term goals that indicate a desired positive outcome to the treatment procedures. This
Planner
provides several possible goal statements for each problem, but one statement is all that is required in a treatment plan.
Objective Construction.
In contrast to long-term goals, objectives must be stated in behaviorally measurable language so that it is clear to review agencies, health maintenance organizations, and managed care organizations when the client has achieved the established objectives. The objectives presented in this
Planner
are designed to meet this demand for accountability. Numerous alternatives are presented to allow construction of a variety of treatment plan possibilities for the same presenting problem.
Intervention Creation.
Interventions are the actions of the clinician designed to help the client complete the objectives. There should be at least one intervention for every objective. If the client does not accomplish the objective after the initial intervention, new interventions should be added to the plan. Interventions should be selected on the basis of the client's needs and the treatment provider's full therapeutic repertoire. This
Planner
contains interventions from a broad range of therapeutic approaches, and we encourage the provider to write other interventions reflecting his or her own training and experience.
Some suggested interventions listed in the Planner refer to specific books that can be assigned to the client for adjunctive bibliotherapy. Appendix A contains a full bibliographic reference list of these materials. For further information about self-help books, mental health professionals may wish to consult The Authoritative Guide to Self-Help Resources in Mental Health, Revised Edition (New York: Guilford Press, 2003) by Norcross et al.
Diagnosis Determination.
The determination of an appropriate diagnosis is based on an evaluation of the client's complete clinical presentation. The clinician must compare the behavioral, cognitive, emotional, and interpersonal symptoms that the client presents with the criteria for diagnosis of a mental illness condition as described in
DSM-5
. Despite arguments made against diagnosing clients in this manner, diagnosis is a reality that exists in the world of mental health care, and it is a necessity for third-party reimbursement. It is the clinician's thorough knowledge of
DSM-5
criteria and a complete understanding of the client assessment data that contribute to the most reliable, valid diagnosis.
Congratulations! After completing these six steps, you should have a comprehensive and individualized treatment plan ready for immediate implementation and presentation to the client. A sample treatment plan for Medication Management is provided at the end of this introduction.
A FINAL NOTE ON TAILORING THE TREATMENT PLAN TO THE CLIENT
One important aspect of effective treatment planning is that each plan should be tailored to the individual client's problems and needs. Treatment plans should not be mass-produced, even if clients have similar problems. The individual's strengths and weaknesses, unique stressors, social network, family circumstances, and symptom patterns must be considered in developing a treatment strategy. Drawing on our years of clinical experience, we have put together a variety of treatment choices. These statements can be combined in thousands of permutations to develop detailed treatment plans. Relying on their own good judgment, clinicians can easily select the statements that are appropriate for the individuals whom they are treating. In addition, we encourage readers to add their own definitions, goals, objects, and interventions to the existing samples. As with all of the books in the Treatment Planners series, it is our hope that this book will help promote effective, creative treatment planning—a process that will ultimately benefit the client, clinicians, and mental health community.
REFERENCES
Bruce, T. J., and Sanderson, W. C. (2005). Evidence-based psychosocial practices: Past, present, and future. In C. Stout and R, Hayes (Eds.),
The Handbook of Evidence-Based Practice in Behavioral Healthcare: Applications and New Directions
. Hoboken, NJ: Wiley.
Chambless, D. L., Baker, M. J., Baucom, D., Beutler, L. E., Calhoun, K. S., Crits-Christoph, P., et al. (1998). Update on empirically validated therapies: II.
Clinical Psychologist,
51
(1), 3–16.
Chambless, D. L., and Ollendick, T. H. (2001). Empirically supported psychological interventions: Controversies and evidence.
Annual Review of Psychology,
52
,
685–716.
Chambless, D. L., Sanderson, W. C., Shoham, V., Johnson, S. B., Pope, K. S., Crits-Christoph, P., et al. (1996). An update on empirically validated therapies.
Clinical Psychologist,
49
(2), 5–18.
Drake, R. E., and Goldman, H. (2003).
Evidence-Based Practices in Mental Health Care.
Washington, DC: American Psychiatric Association.
Drake, R. E., Merrens, M. R., and Lynde, D. W. (2005).
Evidence-Based Mental Health Practice: A Textbook
. New York: Norton.
Hofmann, S. G., and Tompson, M. G. (2002).
Treating Chronic and Severe Mental Disorders: A Handbook of Empirically Supported Interventions.
New York: Guilford Press.
Nathan, P. E., and Gorman, J. M. (Eds.). (1998).
A Guide to Treatments That Work
. New York: Oxford University Press.
Nathan, P. E., and Gorman, J. M. (Eds.). (2002).
A Guide to Treatments That Work, Vol. II
. New York: Oxford University Press.
Stout, C., and Hayes, R. (2005).
The Evidence-Based Practice: Methods, Models, and Tools for Mental Health Professionals
. Hoboken, NJ: Wiley.
SAMPLE TREATMENT PLAN
MEDICATION MANAGEMENT
Definitions:
Fails to consistently take psychotropic medications as prescribed.
Verbalizes fears and dislike related to physical and/or emotional side effects of prescribed medications.
Lacks knowledge of medications' usefulness and potential side effects.
Makes statements of an unwillingness to take prescribed medications.
Goals:
Regular, consistent use of psychotropic medications at the prescribed dosage, frequency, and duration.
Increased understanding of the psychotropic medication dosage, the side effects, and the reasons for being prescribed.
Decreased frequency and intensity of psychotic and other severe mental illness symptoms.
OBJECTIVES
INTERVENTIONS
1.
List all medications that are currently being prescribed and consumed.
1.
Request that the client identify all currently prescribed medications, including names, times administered, and dosage.
2.
Request that the client provide an honest, realistic description of his/her medication compliance; compare this with his/her medical chart.
2.
Describe thoughts and feelings about medication use and willingness or unwillingness to explore personal use.
1.
Conduct Motivational Interviewing to assess the client's stage of preparation for change; intervene accordingly, moving from building motivation, through strengthening commitment to change, to participation in treatment (see
Motivational Interviewing
by Miller and Rollnick).
3.
Identify and replace misinformation and mistaken beliefs that support medication noncompliance.
1.
Request that the client identify the reason for the use of each medication; correct any misinformation regarding the medication's expected effects, the acceptable dosage levels, and the possible side effects.
2.
Request that the client describe fears that he/she may experience regarding the use of the medication; cognitively restructure these fears, correcting myths and misinformation while paying particular attention to the following common biases: underestimating benefits of medication therapy, overestimating the threat posed by side effects, beliefs that medications are not necessary, beliefs that medication is harmful or part of a conspiracy, and beliefs that medication could change his/her personality or make him/her addicted.
3.
Reinforce the client's positive, reality-based cognitive messages that enhance medication prescription compliance.
4.
Family members enroll in a multi-family group educational program for families of the mentally ill.
1.
Refer the family to a multi-family group psychoeducational program (see
Multi-family Groups in the Treatment of Severe Psychiatric Disorders
by McFarlane) to increase understanding of severe and persistent mental illness and the need for medication.
5.
The client and family participate in a family-focused therapy.
1.
Conduct or refer the client and family to a therapy based on the principles of family-focused treatment (e.g., see
Bipolar Disorder: A Family-Focused Treatment Approach
by Miklowitz and Goldstein).
6.
Report the side effects and the effectiveness of the medications to the appropriate professional(s).
1.
Review the potential side effects of the medication with the client and the medical staff.
2.
Obtain a written release of information from the client to his/her primary physician or other health care providers to allow for informing them of the medications, side effects, and benefit that the client is experiencing.
7.
Verbalize positive feelings about the improvement that is resulting from the medication's effectiveness.
1.
Request that the client identify how the reduction in mental illness symptoms has improved his/her social or family system; reinforce functioning and continued medication usage.
indicates that the Objective/Intervention is consistent with those found in evidence-based treatments.
DIAGNOSIS
ICD-9-CM
ICD-10-CM
DSM-5
Disorder, Condition, or Problem
295.90
F20.9
Schizophrenia
Chapter 1ACTIVITIES OF DAILY LIVING (ADL)
BEHAVIORAL DEFINITIONS
Demonstrates substandard hygiene and grooming, as evidenced by strong body odor, disheveled hair, or dirty clothing.
Fails to use basic hygiene techniques, such as bathing, brushing teeth, or washing clothes.
Evidences medical problems due to poor hygiene.
Consumes a poor diet due to deficiencies in cooking, meal preparation, or food selection.
Impaired reality testing results in bizarre behaviors that compromise ability to perform activities of daily living (ADLs).
Demonstrates poor interaction skills as evidenced by limited eye contact, insufficient attending, and awkward social responses.
Has a history of others excusing poor performance on ADLs due to factors that are not related to mental illness.
Demonstrates inadequate knowledge or functioning in basic skills around the home (e.g., cleaning floors, washing dishes, disposing of garbage, keeping fresh food available).
Has a history of loss of relationships, employment, or other social opportunities due to poor hygiene and inadequate attention to grooming.
LONG-TERM GOALS
Increase functioning in ADLs in a consistent and responsible manner.
Understand the need for good hygiene and implement healthy personal hygiene practices.
Learn basic skills for maintaining a clean, sanitary living space.
Regularly shower or bathe, shave, brush teeth, care for hair, and use deodorant.
Experience increased social acceptance because of improved appearance or functioning in ADLs.
Family, friends, and caregivers provide constructive feedback to the client regarding ADLs.
SHORT-TERM OBJECTIVES
THERAPEUTIC INTERVENTIONS
1.
Describe current functioning in ADLs. (1, 2, 3)
1.
Assist the client in preparing an inventory of his/her positive and negative functioning regarding ADLs.
2.
Ask the client to identify a trusted individual from whom he/she can obtain helpful feedback regarding daily hygiene and cleanliness. Coordinate feedback from this individual to the client.
3.
Review the client's diet or refer him/her to a dietician for an assessment regarding basic nutritional knowledge and skills, usual diet, and nutritional deficiencies.
2.
List the negative effects of not giving enough effort to responsible performance of ADLs. (4, 5, 6)
4.
Ask the client to identify two painful experiences in which rejection was experienced (e.g., broken relationships, loss of employment) due to the lack of performance of basic ADLs.
5.
Review with the client the medical risks (e.g., dental problems, risk of infection, lice) that are associated with poor hygiene or lack of attention to other ADLs.
6.
Assist the client in expressing emotions related to impaired performance in ADLs (e.g., embarrassment, depression, low self-esteem).
3.
Verbalize insight into the secondary gain that is associated with decreased ADL functioning. (7)
7.
Reflect the possible secondary gain (e.g., less involvement in potentially difficult social situations) that is associated with decreased ADL functioning.
4.
Identify any cognitive barriers to ADL success. (8)
8.
Refer the client for an assessment of cognitive abilities and deficits.
5.
Participate in a remediation program to teach ADL skills. (9)
9.
Recommend remediating programs to the client, such as skill-building groups, token economies, or behavior-shaping programs that are focused on removing deficits to ADL performance.
6.
Acknowledge ADL deficits as a symptom of mental illness being inadequately controlled or treated. (10)
10.
Educate the client about the expected or common symptoms of his/her mental illness (e.g., manic excitement or negative symptoms of schizophrenia), which may negatively impact basic ADL functioning; reflect or interpret poor performance in ADLs as an indicator of psychiatric decompensation.
7.
Stabilize, through the use of psychotropic medications, psychotic and other severe and persistent mental illness symptoms that interfere with ADLs. (11, 12, 13, 14, 15)
11.
Arrange for an evaluation of the client by a physician for a prescription for psychotropic medication.
12.
Educate the client about the proper use and the expected benefits of psychotropic medication.
13.
Monitor the client for compliance with the psychotropic medication that is prescribed and for its effectiveness and possible side effects.
14.
Provide the client with a pillbox for organizing and coordinating each dose of medication; teach and quiz the client about the proper use of the medication compliance package/reminder system (see the Medication Management chapter in this
Planner
).
15.
Coordinate the family members or caregivers who will regularly dispense and/or monitor the client's medication compliance.
8.
Remediate the medical effects that have resulted from a history of a lack of ADL performance. (16, 17)
16.
Arrange for a full physical examination of the client, and encourage the physician to prescribe any necessary ADL remediation behaviors.
17.
Refer the client to a dentist to determine dental treatment needs; coordinate ongoing dental treatment.
9.
Implement skills that are related to basic personal hygiene on a consistent daily basis. (18, 19, 20, 21)
18.
Provide the client with written or video educational material for basic personal hygiene skills (e.g.,
The Complete Guide to Better Dental Care
by Taintor and Taintor, or
The New Wellness Encyclopedia
by the editors of the University of California, Berkeley wellness letter).
19.
Refer the client to an agency medical staff for one-to-one training in basic hygiene needs and techniques.
20.
Conduct or refer the client to a psychoeducational group for teaching personal hygiene skills. Use the group setting to help teach the client to give and receive feedback about hygiene skill implementation.
21.
Encourage and reinforce the client for performing basic hygiene skills on a regular schedule (e.g., at the same time and in the same order each day).
10.
Utilize a self-monitoring system to increase the frequency of implementing basic hygiene skills. (22, 23)
22.
Refer the client to a behavioral treatment specialist to develop and implement a program to monitor and reward the regular use of ADL techniques or develop a self-monitoring program (e.g., a check-off chart for ADL needs) with the client.
23.
Provide the client with regular feedback about progress in his/her use of self-monitoring to improve personal hygiene.
11.
Utilize community resources to improve personal hygiene and grooming. (24, 25)
24.
Review the use of community resources with the client (e.g., laundromat/dry cleaner, hair salon/barber) that can be used to improve personal appearance.
25.
Coordinate for the client to tour community facilities for cleaning and pressing clothes, cutting and styling hair, or purchasing soap and deodorant, with an emphasis on increasing the client's understanding of this service and how it can be used.
12.
Terminate substance abuse that interferes with the ability to care for self. (26, 27)
26.
Assess the client for substance abuse that exacerbates poor ADL performance.
27.
Refer the client to Alcoholics Anonymous (AA), Narcotics Anonymous (NA), or to a more intensive co-occurring enabled treatment program (see the Chemical Dependence chapter in this
Planner
).
13.
Implement basic skills for running and maintaining a home or apartment. (28)
28.
Teach the client basic housekeeping skills, utilizing references such as
Mary Ellen's Complete Home Reference Book
(Pinkham and Burg), or
The Cleaning Encyclopedia
(Aslett); facilitate this teaching from the client's natural supports.
14.
Report as to the schedule that is adhered to regarding the regular use of housekeeping skills. (22, 29, 30)
22.
Refer the client to a behavioral treatment specialist to develop and implement a program to monitor and reward the regular use of ADL techniques or develop a self-monitoring program (e.g., a check-off chart for ADL needs) with the client.
29.
