Treatment Planning for Person-Centered Care

The Road to Mental Health and Addiction Recovery

Neal Adams, Diane M. Grieder

• Publisher: Academic Press
• Year: 2004
• ISBN:
  9780080521572
• Topic: Psychology
• Subtopic: Clinical Psychology
• Index: Psychology

Requirements for treatment planning in the mental health and addictions fields are long standing and embedded in the treatment system. However, most clinicians find it a challenge to develop an effective, person-centered treatment plan. Such a plan is required for reimbursement, regulatory, accreditation and managed care purposes. Without a thoughtful assessment and well-written plan, programs and private clinicians are subject to financial penalties, poor licensing/accreditation reviews, less than stellar audits, etc. In addition, research is beginning to demonstrate that a well-developed person-centered care plan can lead to better outcomes for persons served.* Enhance the reader's understanding of the value and role of treatment planning in responding to the needs of adults, children and families with mental health and substance abuse treatment needs
* Build the skills necessary to provide quality, person-centered, culturally competent and recovery / resiliency-orientated care in a changing service delivery system
* Provide readers with sample documents, examples of how to write a plan, etc.
* Provide a text and educational tool for course work and training as well as a reference for established practioners
* Assist mental health and addictive disorders providers / programs in meeting external requirements, improve the quality of services and outcomes, and maintain optimum reimbursement

SECTION II

Getting Started

Introduction to Getting Started

We are now prepared to launch into the journey of individual planning and recovery. Section I, Planning the Trip, outlined the preliminaries. This section will deal with the specifics of actually getting under way. Chapter 4 on Assessment and Chapter 5 on Understanding of Needs are essential to the effort—together they begin to set the individual’s course, to define the purpose of the journey, and to set in motion the destination as well as the route.

Chapter 4 will focus on finding a balance between gathering information and building a relationship. Information about the particulars of the journey is essential as well as the bonhomie and partnership of the fellow travelers. Chapter 5 will discuss the transition from data to information and knowledge. This will become the fuel that sustains the trip. We may know where we want to go, but without understanding, we do not have a good idea about how to get there.

CHAPTER 4

Assessment

Knowing is half the battle.

G.I. Joe

I. STATING THE CASE

Ostensibly, the purpose of an assessment is to gather information; this is the essential first step in creating a person-centered plan. It has been said that any plan is only as good as the assessment. There are many books and references that consider the challenges and issues in the assessment for mental health and addiction recovery services at a level of detail that is beyond the scope of this book—it is a rich and complex topic worthy of its own book and exploration. However, taking the time to understand the process of assessment is a worthwhile investment for the success in providing person-centered services. Understanding the unique attributes and needs of individuals and families is the essence of being person-centered.

The Process of Assessment

Providers have a responsibility to fully understand the individual and family, their strengths, abilities, and past successes, along with their hopes, dreams, needs, and problems in seeking help. Only this knowledge prepares the provider to help create a responsive, efficacious plan, which is consistent with the expressed values, culture, and wishes of those receiving services.

But assessment is more than the mere gathering of information; it is the initiation of building a trusting, helping, healing relationship, the forging of an alliance upon which to build a plan responsive to the individual’s and family’s needs. In terms of the road trip metaphor, this is the point of “getting started” on the road, and gathering the needed provisions in order to begin the trip. While there is no question that the accuracy and quality of information that we gather is important, how the information is gathered is perhaps even more critical. In many instances, it is easy to confuse the process of assessment with the requirements of paperwork and forms, but ultimately assessment is primarily about building a relationship. While forms and documentation need to be completed, it may be better to pursue a natural conversation rather than following a linear approach to completing these forms.

This is akin to the allegory of the road map. Following a decision to travel and the choice of destination, preparations begin, the route is laid out, and the intermediate stops are selected. Simply beginning a journey without a destination should be avoided, to prevent heading in the wrong direction and having to double back. Without following these basic steps, reaching the destination is unlikely. Assessment is the “getting started phase,” identifying what we need to bring with us, choosing the provisions, gathering the essentials, and packing for the trip. In the journey of creating an individual plan, information is the fuel that propels us.

Before continuing with the discussion on assessment, it may be helpful to clarify the terminology. The words “triage,” “screening,” and “assessment” are often used interchangeably, resulting in some degree of confusion. While they are related processes, they also represent distinct clinical functions.

Triage	A process of assigning priorities for access to treatment based on urgency and risk, typically but not necessarily used in emergency or crisis situations.
Screening	A cursory of preliminary assessment process for determining the need and appropriateness of services, often times used in initial determination of eligibility, level of care, and so on.
Assessment	An in-depth gathering of data and information, typically conducted at the initiation of treatment, needed to understand an individual’s or family’s needs as a pre-requisite for developing a plan of care.

This chapter will focus on assessment.

Establishing a Relationship

Too often, initiating an assessment begins by asking and focusing on what is wrong. In a recovery-oriented, person-centered approach, the challenge is to think about more positive, inviting, and affirming ways of responding to and engaging individuals and families seeking help. The need to accept and “meet the person on their own terms” is an often recited phrase, but its real meaning needs to be examined in response to an individual’s or family’s request for assistance. Sometimes simply asking the neutral and inviting question “How can I be of help?” begins to realign some of the inherent and at times undermining power differentials in the relationship between the provider and the person seeking services. This helps to set the stage for a more positive and productive course. There are times when this process is framed as one of alliance-building or engagement. While this may at one level be accurate, the importance of the tone, quality, and experience of the relationship cannot be overestimated. Treating people with dignity and respect should always be our standard of practice and guiding rule, regardless of the circumstance.

The importance of a strengths-based approach to assessment cannot be overstated. A focus on problems and deficits often leads to feelings of shame, blame, and failure. This does not promote or support engagement and does not set the stage for recovery. A deficit-based approach emphasizes a negative perspective and often leaves the individual and family feeling that they are the problem. Instead, there is an opportunity to be empowering even in the process of gathering assessment information. In a strengths-based and person-centered approach, the focus is on action rather than the revealing of all of the problem areas.¹ This helps to build trust, cooperation, and meaningful involvement by the individual and family.

Another approach is to actually begin with some form of an orientation rather than immediately engage in data gathering and assessment. There are multiple levels of orientation to consider: orientation to the larger concept of mental health and addiction, orientation to the planning process, orientation to the service organization and available services, and/or orientation to a particular program. Depending on the needs, experience, knowledge, and sophistication of the individual and family, all four levels of orientation might be indicated. Although providers are generally very familiar with the mental health and addiction services process, many of the individuals and families seeking help are not. For many people, each new experience in seeking services promotes anxiety and uncertainty. Both children and adults will frequently carry fears and misconceptions, not knowing what to expect. Beginning with an explanation or overview of the whole process can help in reducing anxieties, beginning to build the alliance, and supporting the assessment.

Organizing the Steps

Figure 4.1 begins to show a hierarchy for the process of creating a plan. Each step in the pyramid builds upon the preceding one. Like the metaphor of building a house, creating the foundation is the essential first task. Each successive step must not only be completed in order, but must be done properly if the final result is to succeed. Skipping a step or jumping ahead will typically not work well. Perhaps not surprisingly, asse...