1. 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

2. 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

3. 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

4. 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

5. 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)

6. 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

7. 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

8. 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

9. 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)

10. 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