Creating An Individual Treatment Plan: CDCMHC Version

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Creating An Individual Treatment Plan C/DCMHC
Version

• A Recovery-based Clinical Approach
• 
  January 2005

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Part I Guiding Principles

• Creating the Individual Treatment Plan with the
  client (and family member, as appropriate) is a
  partnership. The client provides the information
  as the clinician clarifies, reframes and asks
  further questions to reflect the client's
  strengths, needs, abilities and preferences in
  the Individual Treatment Plan (ITP).
• The roles change over time. Initially the
  clinician may be more active in the development
  of the ITP. Increasingly the client assumes more
  of the leadership role and requires less input
  from the clinician to develop the ITP.
• Clients need to own their treatment plan -
  Without the buy-in of the client, success is
  unlikely.

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Part I Guiding Principles in this Process-contd

• The Individual Treatment Plan (ITP) is a working
  , living document. As the client moves in the
  treatment process towards recovery, the goals,
  objectives, interventions, services should
  change the diagnoses may also change.
• Goals need to be in the clients own words, i.e.
  verbatim or a paraphrase of the client's
  statements.
• Objectives need to be understandable to the
  client, measurable and achievable. Clients have
  to understand what they are working for and how
  they will know when they have succeeded.

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• Objectives are the steps the client needs to take
  to achieve the goal (s) of treatment.
• Objectives must be achievable for the goal to be
  reached.
• The method (s) to be used to achieve a particular
  objective are the interventions.
• The outcome of the objective must be measurable
  to assure the objective was met.

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Part I Guiding Principles - contd

• Interventions - can include methods, specific
  treatment approaches, strengths or abilities of
  the clients, activities conducted by a family
  member that will lead to the successful
  achievement of the objective, e.g., cognitive
  behavioral therapy relaxation, role-playing,
  behavior modification or any other
  psychotherapeutic techniques.
• Target Dates refer to the expected time to
  accomplish a particular objective. It should not
  be automatically related to the duration of the
  ITP (which is one year, with renewal up to 2
  years, per CMHC) but to the expected time in
  which the client will accomplish the objective.

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Part II Using all the Clinical Resources

• The Initial Clinical Assessment has some of the
  most valuable information including
• current needs
• preferences
• strengths abilities
• what brought the client to treatment as well as
  lingering problems, concerns
• bio-psycho-social history

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Part II Using all the Clinical Resources

• The information collected from the Initial
  Clinical Assessment (ICA) is not just from the
  client, but from the family member(s) or
  significant other (s).
• The clients strengths, needs, abilities and
  preferences (SNAPs) are the foundation of the
  ITPs goals and objectives.

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Relationship between the SNAPs and content of the
ITP

• Strengths Can be used as part of
• the interventions to
• Abilities reach an objective.
• Needs Relate to the Goals
• and/or objectives
• Preferences Help determine how the
• treatment will be
• provided

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Part III Using SNAPS to develop the ITP

• Strengths Abilities strengths and abilities
  are elements used by the client in the past or
  present to help him/her cope with stressful
  situations. Tap into the client's assets and
  talents by asking
• Which of your good points do you most often
  forget that have
• helped you feel better in the past?
• What kinds of things do you do well that you can
  use to meet
• some of our objectives?
• What natural talents do you have?
• Who has stuck by you through the ups and downs
  ? Who
• could help you while you are in treatment
  with us?

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• Using SNAPS to develop the ITP-contd.
• Strengths Abilities
• What do you enjoy doing?
• What do you like to read?
• Are you good at any sports?
• What do you like to make with your hands?
• How are you at working on cars?
• Do you like to cook or sew?
• Do you belong to a church group

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Part III Using SNAPS to develop the ITP cont.

• The clients needs can be the goals for treatment
  or what
• the goals/ objectives should include. Some
  questions that
• may provide further information about the
  clients needs
• include
• If you did not feel as you do today because of
  the problem/illness, what would your life be
  like?
• Would you be working? If so, what kind of job?
• How about your family? How would you relate to
  them?

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• Using SNAPS to develop the ITP cont.
• The clients needs
• How do you want this treatment to help you do
  these____?
• What would you like this treatment to do for you?
• Of the things we have talked about today, what
  gives you the most problem, or causes you the
  most stress?
• What do family or friends say concerns them
  about you?
• Provide examples if needed mood swings, sleep
  problems, medication side effects, money
  management, housing, employment

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Part III Using SNAPS to develop the ITP

• The clients preferences are in regards to
  treatment and the following questions may help
  the client to state what they prefer
• If we can accommodate, would you prefer a male or
  female counselor? A counselor familiar with your
  particular culture, spiritual beliefs and/or
  race?
• If we can accommodate, would having your
  appointments first in the morning, over
  lunchtime, before 4 p.m. or after 5 p.m. make it
  easier for you to make?

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• Using SNAPS to develop the ITP-contd
• The clients preferences -contd
• If we can accommodate, would you prefer
  individual or group treatment or a combination of
  both ? (Note most clients will need an
  explanation of group treatment and its benefits)
• Do you have a psychiatrist in your community that
  you would prefer to continue with?

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Part IV Clinical Example

• Sam has been assessed at intake with and
  diagnosed with
• Paranoid Schizophrenia. He is a 32 y/o male with
  10th grade
• education. Sam states, on his meeting with
  clinician to create
• the Individual Treatment Plan, I want to live
  by myself.
• (Goal 1 clients quote)
• Clinician asks Sam What do you need to
  have/know/learn
• to be able to live on your own?
• Sam responds Nothing, I just need an apartment,
• I can take care of myself.

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• Clinical Example-contd.
• The clinician then asks necessary questions to
  ensure the
• clients is capable to meet this goal, e.g. do
  you have
• money to pay an apartment, know how to cook, have
• transportation to move from and to the apartment,
  know
• how to take your medicine, etc?
• Based on the responses made by the client, the
  objectives
• and their outcomes are identified. For example
• Objective/Intervention 1A. Sam will learn
  skills to obtain employment by such activities as
  visiting State Employment Office, filling out job
  applications, et.al. and will share job search
  results with Counselor

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• Clinical Example-contd.
• Objective/Intervention 1B.- Sam will learn basic
  cooking housekeeping skills by practicing these
  skills with STAD Counselor, with successful
  meals prepared and living quarters cleaned by
  inspection
• Objective/Intervention 1C. - Sam will learn how
  to use city bus system as coached and witnessed
  by STAD Counselor
• The target date for each Objective may vary
  according to the clients abilities. For example,
  Objective 1A may take 6 months, Objective 1C may
  only take 3 months

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Clinical Example-contd

• Sams progress in treatment will be reviewed
  every 90 days
• to determine whether the objective (s) were
  accomplished
• or if strategies need to be changed to help the
  client
• achieve his objective (s).
• The initial treatment services identified
  specifically for Objectives 1A-1C could be
  Skills Training and Development (major service),
  and PRS (especially as group version of ILS ).
• Other services needed initially would probably
  be Mental Health Assessment , Psychiatric
  Medical Assessment , Nursing Service (Med.
  Monitoring piece).

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Part V Revised Individual Treatment Plan Form
Page 1

• The ITP has a duration of 12 months.
• The current form can be used for up to three
  years as long as the Progress Summaries are done
  every 90 days and the Annual Reviews (360 Day
  Progress Review). The Addendum ITP is provided
  for the anticipated changes in goals and
  objectives over the duration of the ITP.
• The ITP should show the signed and dated
  authorization of all services and additions of
  new services by Physician.
• The ITP must include the Medicaid of the client.
• Note all signatures for the ITP are at the
  bottom of this first page.

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• New Individual Treatment Plan Form Page 1
• Clinician's signature and license, degree or
  title and date as well as the Physician's
  signature, license and date are required for each
  of the three (3) years.
• The Client's signature/initials and date, and
  whether they accepted or declined a copy of the
  ITP, is required for each of the three (3)
  years).
• At least one objective (with intervention) is
  required for each goal.
• Service and corresponding frequency apply to all
  goals (1-3) on first page.

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New Individual Treatment Plan Form Page 2

• Complete the SNAPS boxes. You may wish to do this
  first so this information can assist you and
  client in developing the goals on page one of the
  ITP.
• Include referrals to other service providers,
  outside of the MHC, as needed. This often is the
  case where there are co-occurring disorders. The
  next box is for specific contact information.
• The clinical program where the client is
  currently receiving treatment is noted and
  updated as needed.
• Continue to update the Discharge/Transition
  criteria as the client moves toward recovery.

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New ITP Form Addendum -Page 3

• In order to justify continued treatment, most
  clients and their counselors would change goals
  or objectives, services or frequencies until all
  treatment needs met. This also demonstrates
  movement towards recovery.
• This addendum page permits more than three (3)
  goals initially or, when goals are completed and
  more goals need to be added.
• Additional Addendum pages may be added, as
  needed. Just remember to keep the goal numbers
  sequential, e.g. first Addendum Page would
  contain Goals 4-6, if another Addendum Page
  added, then Goals would be numbered 7-9, etc.

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New ITP Form Addendum -Page 3

• Note all three (3) signatures and dates are
  required at the bottom of each Addendum page.
  Obtain these signatures when starting the
  Addendum Page.
• The M.D. must initial and date all added services
  and/or changes in frequency of services, as well
  as the ITP and the Addendums.

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New ITP Form- Progress Summaries 90-Day,
180-Day, 270-Day 360-Day

• There will be four (4) progress summaries for a
  12-month time period.
• They are done every 90 days from the date of
  admission for new admissions, and from the date
  of the Renewal ITP on existing clients.
• It is important to rate your goals appropriately.
  If the client has mastered a goal, it should so
  noted, and another goal added, if necessary.

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New ITP Form- Progress Summaries 90-Day,
180-Day, 270-Day 360-Day

• The last 90-Day Progress Summary (at 360 days) is
  also the Annual Review of the Treatment Plan.
  Please note additional requirements as outlined
  on form and next slide/page.
• Remember to review the clients rights and
  responsibilities at this time as appropriate.

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The end!

• If you have any questions, please contact your
  Quality Assurance/Improvement Staff at your
  Center.