Chapter 1: The Foundations of Treatment Planning: A Primer Treating Those with Mental Disorders: A Comprehensive Approach to Case Conceptualization and Treatment Victoria E. Kress and Matthew J. Paylo Prepared by Alison A. Zins © 2015 by Pearson Education, Inc. All Rights Reserved

Factors that Influence Treatment Outcomes Counselor Variables Observable Traits (age, sex, race/ethnicity) Observable States (professional disciple, training, professional experience, interpersonal style, directiveness, intervention style, and the use of self-disclosure) Inferred Traits (general personality, coping style, emotional wellbeing, values, beliefs, and cultural attitudes)* Inferred States (therapeutic relationship and theoretical orientation)* (*)= has been shown to affect therapeutic outcomes

Factors that Influence Treatment Outcomes Client Variables Experience, concerns, expectations, mental illness Motivation to change(*) Phases of Change Precontemplation Contemplation Preparation Action Maintenance (*)= has greatest effect on therapeutic outcomes

Factors that Influence Treatment Outcomes Treatment Variables Duration of treatment Therapeutic alliance - the working (collaborative)interaction between the counselor and the client (*) (*)= has greatest effect on therapeutic outcomes

Treatment Planning Basic Steps to Treatment Planning Problem selection (clearly stated treatment focus) Problem definition (concrete, operationally defined problem) Goal development (long-term positive outcomes of treatment) Objective construction (short-term behavioral goals that are attainable and measurable) Interventions (connecting at least one intervention with each goal)

A Treatment Plan Should Be… Evidence-Based Based on research Treatments are often only tested on individuals with a single disorder, so it is difficult to determine the most evidence-based treatment for individuals with multiple disorders. Not all trials are randomized. Individualized Even if evidence-based, must fit the individual’s needs Highlight client’s goals and objectives, resources and strengths Highlight specific strategies to address specific concerns Timeline outlining when each goal will be completed

A Treatment Plan Should Be… Relational Based on a strong client-counselor relationship and sensitive to client’s goals and needs Minimize power differential with empathy, congruence, and positive regard Strength-Based Focuses on client strengths and resources rather than just the diagnosis Contextually-Sensitive Sensitive to client contexts of culture, gender, and other developmental factors Sensitive to what is “normal” in each context and developmental stage

Working With and Within Systems Managed Care Systems Dominance of managed care systems Seeks to control costs and ensure the quality and consistency of care provided to clients Eliminates overlapping systems Increased documentation for counselors More need for counselors to justify client’s need for services

Treatment Restraints Accrediting Bodies 3 Accrediting Bodies: The Commission on Accreditation of Rehabilitation Facilities (CARF), the Joint Commission International (JCO), and the Council on Accreditation (COA). Enhance quality of services provided to clients in an agency Treatment plan specifications set forth by accrediting body Diagnosis and Reimbursements Only certain (more severe) diagnoses are covered by insurance companies Counselors may diagnose a co-occurring disorder Counselors may traditionally want to “downcode” client’s diagnosis but may need to “upcode”a client’s diagnosis to ensure client receives services (which is unethical)

Treatment Restraints Payer Source & Session Number Restraints Insurance companies only reimburse a certain number of sessions and other services (psychiatry, case management, employment services, hospitalization, etc.) May be insufficient for client needs, unless client self-pays Treatment Teams Counselors may be required to work with a team of medical professionals (psychiatrist, community psychiatric support provider, medical doctor) Treatment teams must reach a consensus on the treatment plan for a client, although the counselor may not be the one developing the treatment plan