624 week 4 - lecture notes PDF

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Tuesday, July 20, 2021

Week 4 Screening, assessments, and treatment planning!

- screening! • process for assessing the possible presence of a particular problem! - assessment/evaluation! • process for defining the nature of that problem and developing specific treatment recommendations for addressing the problem!

- treatment planning! • comprehensive assessment to serve as the basis for an individualized treatment plan; must be matched to individual needs!

- things to remember! • every agency will have their own procedures for screening, assessing, and treatment planning!

• know the limitations of your certification or license! • be sensitive and aware of cultural differences! • you are not supposed to have all the answers! • use your supervisor! • reality vs ideal! - screening! • allows for the possibility that a potential problem exists! • screening leads to more in-depth assessment and intervention for people identified with a potential problem!

• earliest point of contact! • formal process that typically is brief and occurs soon after the client presents for services!

• determines the likelihood that a client has a COD or that their presenting signs, symptoms, or behaviors may be influenced by COD issues! 1

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• screening does not necessarily identify what kind of problem the person may have or the severity of the problem; it mainly determines if further assessment is warranted!

- integrated screening! • address both mental health disorder and substance abuse disorder, each in the context of the other disorder!

• allows further exploration of related services including medical, housing, victimization, trauma, and so on!

• expedites entry into appropriate services! - screening in mental health or primary care?! • primary care providers are usually the first point of contact with the health system! • those with co-occurring MHD and SUD are more likely to enter the system through a mental health door!

• research supports the application of screening and brief intervention in primary care and mental health!

- types of screening! • instruments (MH)! - mental health screening form-III! - Beck’s (anxiety/depression)! • instruments (SUD)! - ASI! - MSSI-SA! • biological markers! - breathalyzer testing! - urine, saliva, hair testing! • self-report! - one-on-one interview! - self-administered questionnaire! 2

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- benefits of self-report tools! • provide historical picture! • inexpensive! • non-invasive! • highly sensitive for detecting potential problems or dependence! - characteristics of a good screening tool! • brief ! • flexible! • easy to administer, easy for patient! • addresses alcohol, other drugs, and a range of mental health issues! • indicates need for further assessment or intervention! • has good sensitivity and specificity! Assessment!

- assessment/evaluation! • needs to be client-centered in order to fully motivate and engage client in the assessment and treatment process!

• gathers information! • enables the provider to establish (or rule out) the presence or absence of cooccurring disorders!

• determines a client’s readiness for change! • identifies strength or problem areas that may affect the processes of treatment and recovery!

• begins the engagement with the client in the development of their treatment plan! - 12 step assessments process! • engage the client! • identify and contact collaterals to gather additional information! 3

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• screen for and detect COD! • determine quadrant and locus of responsibility! • determine level of care! • determine diagnosis! • determine disability and functional impairment! • identify strengths and supports! • identify cultural and linguistic needs and supports! • identify problem domains! - medical, legal, financial, housing, income supports, access to healthcare, vocational, family, social, transportation, childcare!

• determine stage of change! - pre-contemplation, contemplation, preparation, action, maintenance, reoccurrence!

• plan treatment! Treatment plan!

- create treatment plan! • determine motivation to address substance use and/or mental health problems! • select target behaviors for change! • determine interventions to achieve desired goals! • evaluate pressing needs! • choose measures to evaluate the intervention! • select follow-up times to review the plan! - things to keep in mind! • remember that different models are used in different settings and programs! • there are no universal or standard models of treatment planning!

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• it varies from discipline to discipline, model to model, and program to program and may include!

- different use of terminology! - different number of steps! - differences in clinician responsibility for a particular step! - treatment planning! • what are the pressing needs?! - clients with COD more likely to have immediate concerns that must be addressed first!

• danger to self or others! • food, shelter, clothing! • medical problems! • legal problems! • acute psychiatric symptoms! • severe substance dependence! • what is their motivation?! - look at both MHD and SUD! • what is feasible?! - concrete measurable goals! - practical steps that are reasonable and in reach! - tailored to the individual’s needs and their motivation based on their stage of change!

• the treatment planning process needs to always begin with a conversation about what the client wants out of treatment!

• deciding goals and interventions is done collaboratively! • recovery for persons with COD is a process of small steps with incremental change being normal!

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- development of a treatment plan! • current and historic issues: what we learned from the assessment about their past and present situation!

• interpretive summary! - your professional impressions of the client; your thoughts, what you observed, the client’s insights, and other information from collaterals!

• DSM-5 diagnosis! - using names and codes listed in order of severity! • treatment placement! - levels of care, ancillary services! • summary of family system! - how family plays a part, history of SUD or MHD! • problems! - a list of issues that need to be treated! • goals, interventions, and target date! - with regard to the problems—what, how, and when! - what is an interpretative summary?! • your clinical impressions of the client; it includes the client’s issues and problems and your insight regarding them!

• the interpretative summary integrates the assessment data and presents findings that are important for developing the treatment plan!

• sets the stage for understanding the individual as a whole person and provides an important bridge from the “what” of assessment data to the “why” of understanding the person!

• becomes an essential tool in helping to prioritize the person’s goals! - writing the interpretative summary! • usually a several paragraph narrative format that discusses the nature of the person’s problems and considers possible solutions!

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• components to include! - practitioner and individual’s understanding of how mental illness impacts the person’s functioning!

- clinical judgements regarding the course of treatment! - recommended/prioritization of treatments! - the client’s readiness for change! - the individual’s strengths, needs, abilities, and preferences! - SNAP! • strengths! • needs! • abilities! • preferences! - treatment placement! • the things to keep in mind include! - what are the patient’s immediate needs, and is there imminent danger?! - what risk is associated with intoxication and/or withdrawal?! - where are the greatest risks, and what does this indicate about treatment needs?!

- how are they functioning across multiple dimensions?! - assessing risk for each dimension! • utmost severity! • serious issue or difficulty coping! • moderate difficulty in functioning with some persistent chronic issues! • mild difficulty, signs, or symptoms! • non-issue or very low-risk issue!

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- treatment planning! • list problems! • goal statements! • interventions with time frame! - review! • review treatment plan every 30 days (sooner if a higher level of care is indicated)! • treatment plan review is done with the client! • something should always change in the treatment plan based on the progress the client is making!

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