“By failing to prepare, you are preparing to fail.”
― Benjamin Franklin
Behavioral Health practitioners in the addiction treatment field, are faced with the responsibility to address the complex issues of their clients. Most of the clients in treatment today are voluntary patients. Sure typically there is some outside influence and in many cases coercion, that has motivated the individual to address their addiction. But, they are still voluntary. The clinician’s responsibility is to respect the clients need and right to self-determination.
This is often a challenge in and of itself as the greater the coercion the greater the potential for denial. However, that is where the rubber hits the road for a seasoned clinician. Piecing together the techniques and skills required to professionally break the denial barrier and encouraging the patient to “buy in” or accept the responsibility for their recovery process can be a lengthy process and quite frankly, frustrating! However, inch by inch it’s a cinch!
Preparation is key, during the assessment and engagement process the clinician must begin to develop a plan for what strategies they will employ to help move the client towards wellness. This is often where the frustration lies, as the clinician must answer to the various stakeholders in the process. The clinician’s main priority is the client, however, the payor, accrediting body, regulator, family, and other collaterals and of course the employer let alone the therapists own governing body must be accounted for! Not an easy task!
The ZenChart treatment planning process was set up with this in mind. During the assessment process, the clinician must first identify the main issues the individual faces and or identifies. We call this the Master Problem List (MPL). The MPL is simply that, a list of issues identifying each issue and whether or not these will be addressed, deferred, or referred out during or after the treatment episode.
Once that is determined it is suggested that the therapist begins to draft a Treatment Plan outline, their professional opinion for the client’s roadmap. Remember these are professional recommendations based upon your observations during the engagement and assessment process. This is best to be completed prior to the treatment plan interview with the client. The last thing the client needs is to be subject to a therapist attempting to develop the treatment plan from scratch. In the past therapists’ utilized cookie cutter treatment plans and that was a sure fire way to fail all of the stakeholders!
To prepare, in your treatment plan builder, start with the primary diagnosis, in this case, it is Substance Use Disorder(s). Now we must document the evidence that this is an issue to be addressed. I believe the best approach is to ensure the client’s input, therefore, I will choose based upon what I have learned during the initial engagement and assessment sessions a statement that describes the evidence for the problem description. When I am then working directly with the client I will read this to them and ask them for a statement that they feel best describes their issue(s). I will insert that statement directly after what I have previously entered. I will also rephrase my statement if needed in order to adequately reflect the client’s awareness of the challenge.
Now based on our conversation I am going to build my objectives, typically I have selected a few from the suggested Objectives. However, I want to express these as best as possible in the client’s words. The same with the Treatment Intervention/Strategy. Remember, this is a roadmap for the client, the client needs to buy in for a positive treatment outcome. However, we must utilize our professional experience and protocol, therefore you may want to wordsmith some of your professional recommendations in order to bring light to the client, meet the guidelines of your agency, accrediting and regulating bodies.
Next, set a target date, what the duration of the intervention/strategy will be, i.e. 3 weeks. Then the Frequency, i.e. 3 sessions per week. Finally choose what modality you will be utilizing, i.e. Motivational Interviewing…
This is a brief description of the process, however, the main point of the article is to encourage two practices, 1) Proper Preparation and 2) Client Involvement. Effective addiction treatment requires client buy-in without client involvement in their recovery process and direction planning how can we ever expect client buy-in? Following this workflow enables you to overcome some of the client’s resistance. The client often comes to the treatment process either frustrated or motivated. If they are frustrated, spending too much time asking them redundant clinical questions from an assessment or treatment planning process and developing that plan from scratch, will only enhance their frustration. If they are motivated, they will become frustrated with a lengthy assessment and planning process. ZenCharts was developed with this process in mind, be prepared and utilize the tools to make your client’s treatment experience a great one!