Chapter 3 of 515% of exam

Treatment Planning

Treatment planning turns an assessment into goals the client agrees with, measurable objectives, the right level and mix of services, and a plan for ending well. Exam cases test whether you plan with the client, revise when things change, and coordinate with others appropriately.

Collaborative, measurable goals

Plans are built with clients, not for them. Goals should fit the diagnosis and the client's abilities and circumstances, and objectives should be specific enough that both parties can tell whether they have been met.

Joint planning
Counselors and clients build plans together that have a realistic chance of working, and review them regularly.
ACA Code of Ethics (2014) A.1.c; NBCC Code of Ethics (2023) standard 35
Measurable objectives
Specific, measurable, action-oriented, realistic, and time-bound objectives can double as progress indicators.
CDC, Introduction to Program Evaluation (2011)
Safety first in trauma work
Establishing safety is the first goal of trauma-informed treatment and may need revisiting as treatment proceeds.
SAMHSA TIP 57 (2014)
Strengths and barriers
Build on past successes and remove practical barriers such as child care and transportation that interfere with attendance.
SAMHSA TIP 57 (2014); SAMHSA TIP 41 (2005)

Levels of care and concurrent treatment

Some clients need more than a counselor alone can offer: medical evaluation, psychiatric medication, specialized programs, or a more intensive setting. The planning task is to recognize this and coordinate with consent.

Move up when problems intensify
Transfer to a more intensive level is appropriate when problems intensify or new problems can be handled only there.
ASAM Criteria (2013), as presented by D. Mee-Lee (2014)
Coordinate with other providers
When a client sees another mental health professional, request a release and work collaboratively.
ACA Code of Ethics (2014) A.3
Bipolar disorder
Bipolar disorder usually needs long-term treatment that combines medication with psychotherapy.
NIMH, Bipolar Disorder
Early psychosis
Coordinated specialty care combines therapy, medication, education and work support, and family involvement after a first episode.
NIMH, Schizophrenia
Release the minimum
Share records with other providers only with written permission, and only what is relevant.
ACA Code of Ethics (2014) B.6.g, B.2.e

Reviewing, revising, and ending treatment

Plans change as diagnoses, goals, and circumstances change, and every change is documented with the client's approval. Termination is planned when goals are met or when the client is not benefiting, and transitions in care are periods of higher risk.

Document changes
Update the record when goals, techniques, or diagnoses change, and obtain the client's written approval.
NBCC Code of Ethics (2023) standard 36
Terminate appropriately
End when the client no longer needs help, is not benefiting, or is being harmed; provide pretermination counseling and referrals.
ACA Code of Ethics (2014) A.11.c
No abandonment
Arrange continued care during interruptions and after termination.
ACA Code of Ethics (2014) A.12; NBCC Code of Ethics (2023) standard 26
Transitions carry risk
Suicide risk may rise at transitions such as discharge from inpatient care; plan follow-up and coordinate with the other team.
SAMHSA TIP 50 (2009)

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