Treatment Planning Essentials: Skill Building For Clinicians Week 1: Course Overview

Plan for Success! If you fail to plan, you are planning to fail - Benjamin Franklin

Course Learning Objectives  Create a client centered treatment plan  Through group work, strengthen weak goals and objectives  Understand critical chart review mandates  Understand the Golden Thread  Write comprehensive progress notes and treatment plans that would pass Medicaid audits

Polling  Treatment planning is a waste of time and doesn’t help the client very much. It takes time away from the client.  I just want to scream when I think about treatment planning.  There is value in treatment planning but I just fall behind.  I write great treatment plans and love the treatment planning process. They never stress me out.

The History of Treatment Planning  The formalized treatment plan is a relatively new component of mental health treatment that began in the 1970’s  Prior to this period of time, treatment plans were not so important (Maurish, 2002)

What is a Treatment Plan? At worst: ◦A piece of paper that I have to fill out to make my supervisor happy  At best: ◦A road map to my client’s hopes and dreams ◦A contract between my client and I describing what we will both do to help the client achieve recovery ◦A collaborative, creative, client-driven activity between the counselor and the client that focuses on the client’s view of their stated problems 3 ◦A client-driven tool that strengthens the Treatment Alliance between the client and counselor 6 Proprietary and Confidential May 2015

Collaborative Treatment Planning  Client and counselor work together to identify and clarify goals and strategies for achieving goals  Plans are regularly reviewed and revised as goals develop, are achieved, or as strategies change 7

Who/What is Involved in Treatment Planning? Clinician Client/consumer Members of a multi- disciplinary team Screening results Assessment Collateral Interviews Probation Reports

Functions of Collaborative Planning I.Identify and clarify goals and strategies II.Help both the counselor and client work purposefully and systematically III.Support the strengths-based approach IV.Contribute to building a positive therapeutic alliance -Vanderbilt University. 9

The Problems with Program Driven Plans (BREAK OUT SESSION) Problem: PTSD Goal: Symptoms of PTSD will be eliminated Objective: Will participate in outpatient services Intervention: Client will see counselor once a week

Individualizing a Treatment Plan I Plans should be able to pass the “first glance” test Based on collaborative treatment plan approach Ideally, you should be able to pick up a plan and recognize who it fits

First Glance Test The plan belongs to a 19 year old African American male who was molested by his uncle between the ages of 12 and 15. He lives with his grandmother and is experiencing hyperarousal (e.g., trouble sleeping, easily agitated, hypervigilant) and avoidance symptoms (e.g.,efforts to avoid thoughts about the abuse; isolation). He drinks between 4 to 6 beers daily to cope with these uncomfortable emotions. He is participating in cognitive processing therapy weekly with his counselor, where he is learning how to cope effectively with PTSD symptoms. He also participates in a weekly seeking safety group….

Results from the PHS National Chart Review So how is Providence Human Services doing with Treatment Planning?

National Chart Review Results Question Score Is there a current Treatment Plan in place? 93% Was the Treatment Plan that is in place now completed on time? 84% Does the Treatment Plan list all services that are currently being provided to clients? 90% Are we providing all of the services to the client that we have listed on the Treatment Plan? 87% Were Treatment Plans individualized for each participant? 94% Were Treatment Plan goals/objectives measurable? 82% Did the Treatment Plan goals/objectives include achievable target dates? 82% Did the Treatment Plan contain service-specific clinical interventions to reach goals and objectives? 92%

Audit Results Scenario: During a routine payer audit, it was discovered that the program was providing medication management services to a client who met medical necessity; however, there was not a medication management goal or objectives on the Treatment Plan. Outcome: All medication management services were disallowed. Cost: $7,500

Audit Results Scenario: QI department received a “tip” that there was credible evidence of fraud in a PHS program. The national QI team investigated and reviewed all charts open during the previous year. Outcome: It was discovered that the Clinical Supervisor failed to sign and date a significant number of treatment plans during the past year, rendering them invalid. Cost: $50,031.16

Audit Results Scenario: State came to program to conduct annual Medicaid audit. Outcome: Treatment plan objectives were not specific or observable; interventions on treatment plans were not being provided; Treatment plan interventions did not have a frequency (ad hoc is not a frequency); client signatures on Treatment Plans were late (no documentation of refusal or unavailability) Cost: $14,000

Questions/Comments

References Jongsma, A.E. & Peterson, L.M. (1999). The complete adult psychotherapy treatment planner (2 nd edition). New York: Wiley. Makeover, R.B. (1992). Training psychotherapists in hierarchical treatment planning, Journal of Psychotherapy Practice and Research, 1, Maruish, M.E. (2002). Essentials of treatment planning. New York: Wiley. United Behavioral Health (2000). General treatment planning. (online). Available from