CHAPTER 2: Developing Comprehensive Treatment Plans Treating Those with Mental Disorders: A Comprehensive Approach to Case Conceptualization and Treatment Victoria E. Kress and Matthew J. Paylo Prepared by Neil R. Meloro © 2015 by Pearson Education, Inc. All Rights Reserved

1-2 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Practice Suggestions for Developing Treatment Plans Appropriate conceptualization of client’s situation is crucial in developing an accurate diagnosis, which leads to effective treatment planning Counselor need to utilize a comprehensive treatment planning model (I CAN START) Counselors must be knowledgeable about what treatment models/approaches are useful/effective in treating different disorders Treatment plans need to reflects a client’s strengths, resources, and specific needs

1-3 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Be Collaboration Clients Treatment plans need to meet the individualized needs, strengths, and preferences of the client Treatment needs to complies with ethical standards (ACA Code of Ethics)and third-party payer expectations Counseling and treatment are not things done to clients Clients must be active in treatment (goals and objectives construction) Counselors need to discuss with clients the advantages and disadvantages of different treatment approaches

1-4 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Consider Severity of the Impairment Counselors must consider the severity of the client’s impairment when creating goals, objectives, and expectations. These need to be realistic and achievable Counselors must consider the severity of the client’s impairment when choosing treatment approaches and interventions One resource in assessing a client’s level of functioning is the World Health Organization’s Disability Assessment Schedule (WHODAS 2.0)

1-5 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved World Health Organization’s Disability Assessment Schedule (WHODAS 2.0) WHODAS 2.0 assesses the following 6 domains: 1. Getting around, 2. Self-care, 3. Understanding and communicating, 4. Getting along with people, 5. Life activities, and 6. Participation in one’s community/society

1-6 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Treatment Objectives Make Treatment Objectives SMART Specific—Concrete, use action verbs Measurable—Numeric or descriptive, quantity, quality Attainable—Appropriately limited in scope, feasible Results-oriented—Measures outputs or results, includes accomplishments Timely—Identifies target dates, includes interim steps to monitor progress Identify short-term and long-term goals Assess and measure client change Use of numerical scales to determine severity

1-7 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Follow the “Golden Thread” Diagnosis is the starting place Goals and interventions need to match that diagnosis Treatment and documentation follow a logical progression Diagnosis  Treatment approach  Goals and Interventions  Documentation A cohesive system of treatment needs to be reflected in the documentation process

1-8 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Be Flexibility: Treatment Plans are Not Static Treatment plans are an evolving document Treatment plans need to reflect changes in clients’ diagnosis or symptoms Treatment plans must change as clients’ experiences or situations change, as new issues emerge, and as clients want to change the focus of treatment Counselor must also be flexibility in dealing with clients life crisis which may change the counseling session’s focus. Conversely, clients who routinely have a hard time staying focused on treatment goals may require frequent redirections to the treatment plan and session goals.

1-9 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Conceptual Framework for Case Conceptualization—I CAN START I Individual Counselor C Contextual Assessment A Assessment and Diagnosis N Necessary Level of Care S Strengths T Treatment Approach AAim and Objectives of Treatment R Research-Based Interventions T Therapeutic Support Services

1-10 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Conceptual Framework for Case Conceptualization—I CAN START Individual (I)  Each client is unique  Counselor qualities impact client outcomes  Counselors may receive counseling to identify personal biases and characteristics Contextual Assessment (C)  Counselors must consider intrapersonal, interpersonal, and subordinate contexts or group relationships  Consider attachments, behaviors, biology, cognitions, developmental, emotions, and personality  Bronfenbrenner’s ecological theories

1-11 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Contextual Assessment (C): Cultural Formulation Interview Systematic cultural interview in 4 sections  Cultural definition of the problem  Cultural perceptions of cause, context, and support  Cultural factors affecting self-coping, past health seeking  Cultural factors affecting current help seeking

1-12 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Conceptual Framework for Case Conceptualization—I CAN START Assessment and Diagnosis (A)  Helps counselors understand their clients (diagnostically)  Leads to accurate diagnosis and case conceptualization, and thus comprehensive treatment planning  Can include structured interviews, personality inventories, and specific symptom assessments Necessary Level of Care (N)  Many considerations when assessing appropriate level of care for client (setting, type and pace of counseling, and number of sessions)  Counselors should seek the least restrictive setting  Seek balance of client safety, and client growth

1-13 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Conceptual Framework for Case Conceptualization—I CAN START Strengths (S)  Client’s strengths and resources are used to overcome obstacles  Counselor must assist clients in recognizing their strengths and resources Treatment Approach (T)  Counselors must seek evidence-based treatments  Use of peer-reviewed journals, federal registries  Match client’s unique situation and counseling preferences with an evidence-based approach

1-14 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Conceptual Framework for Case Conceptualization—I CAN START Aim and Objectives of Treatment (A)  Aims/objectives of treatment must be tangible and useful  Goals must be measurable  Use of structured models such as SMART model Research-Based Interventions (R)  Use of validated, research-based interventions  Research-based interventions influence aims/objectives  Counselor must consult contemporary treatment literature

1-15 Kress & Paylo, Treating Those with Mental Disorders: A Comprehensive Approach to Conceptualization and Treatment. © 2015 by Pearson Education, Inc. All Rights Reserved Conceptual Framework for Case Conceptualization—I CAN START Therapeutic Support Services (T)  Services that support and complement a client’s treatment  May involve education, training, socialization or legal assistance  Services should be consistent with treatment goals, and clients’ unique situation