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--- treatment_plans [2021/09/23 21:54] – roni
+++ treatment_plans [2023/03/06 10:11] (current) – Remove socialite tom
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+{{tag>IEMT}}
 ====== IEMT Treatment Plans ======
 ===== For clients facing complex mental health, emotional and psychological challenges =====
+For IEMT Practitioners working in contemporary and everyday situations, a treatment plan is unlikely to be necessary. Such everyday situations will be clients with simple, item-specific problems such as simple phobias and single-event traumas from a long time ago where there are no other psychological, emotional, slociological or psychiatric complications.
 A treatment plan is a set of written instructions and records pertaining to the treatment and management of a mental health condition and/or crisis. A treatment plan should include the client’s key personal information, the diagnosis and/or presenting problem, an outline of the treatment under consideration, expected and intended outcomes, and the measurement of these outcomes during, and at the conclusion of, treatment.
+There is no one treatment plan model that is preferred by all clinicians in the mental health system. Different teams may have different preferences based on their own training, experiences, and the needs of their clients. However, there are some treatment plan models that are commonly used in mental health settings, including:
+  * **The bio-psycho-social model:** This model takes into account the biological, psychological, and social factors that may be contributing to a person's mental health issues. Treatment plans developed using this model often involve a combination of medication, therapy, and social support.
+  * **The stages of change model:** This model is often used in substance abuse treatment and is based on the idea that people go through different stages as they work towards behavior change. Treatment plans developed using this model may involve different interventions depending on the stage a person is in.
+  * **The trauma-focused cognitive-behavioral therapy model:** This model is used to treat individuals who have experienced trauma and is based on the idea that trauma can affect a person's thoughts, emotions, and behaviors. Treatment plans developed using this model may involve exposure therapy and other techniques to help a person process their trauma and learn coping skills.
+Ultimately, the most effective treatment plan will be one that is tailored to the individual needs of the client and takes into account their specific circumstances and goals.
+{{ :img6.png |}}
 A treatment plan should include:
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   * A description of the treatment proposed by the coach/therapist
   * A timeline for treatment, including frequency and duration of sessions
-  * Identification of the major treatment goals in the SMART format
+  * Identification of the major treatment goals in the SMART[(SMART_criteria>SMART criteria[[https://en.wikipedia.org/wiki/SMART_criteria|Wikipedia]])] format
 Whilst for many clients a treatment plan is not necessary there are many scenarios and presenting problems for which a treatment plan will offer an opportunity for the client to collaborate in their treatment and to provide a structured framework for treatment. Many clients with complex issues and who may be new to therapy/treatment may find this reassuring, professional and motivating.
@@ Line 23: / Line 36: @@
   * Clients with serious physical health issues
   * Clients engaged in the criminal justice system
+  * Clients under compulsory treatment orders
   * Clients engaged with multiple care/support/treatment agencies
   * Clients referred by employers
@@ Line 33: / Line 47: @@
 Each treatment plan is unique to each individual though many similarities and recurring themes will undoubtedly arise over time.
+{{ :img7.png |}}
+----
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   * Session frequency, duration, and number
   * Progress/outcomes – the ability, rate, range, and degree of therapeutic progress will vary enormously between clients
+{{ :img8.png |}}
+----
 ===== Behavioural Observations =====
@@ Line 66: / Line 88: @@
   * Affect - appropriate/inappropriate, labile, stoical, blunted, flat
   * Thought content disturbances - i.e. delusions, hallucinations, obsessions, intrusions, suicidal thoughts
-  * Behavioral disturbances (such as aggression, impulse control, demanding)
+  * Behavioral disturbances such as aggression, poor impulse control, unreasonable demands
   * Motor activity - agitation, calm, restless, rigid
-  * Speech (volume, speed)
+  * Speech (volume, speed, coherence)
-  * Interactional style - i.e. nervous giggling, bombastic, cooperative, erratic
+  * Interactional style (i) - i.e. nervous giggling, bombastic, cooperative, erratic
+  * Interactional style (ii) - active participant, passive, failure to initiate, conversationally domineering, etc
   * Intellectual functioning (impaired, unimpaired)
-  * Memory - short term, long term
+  * Memory - short-term, long term
   * Perceptual disturbances - i.e. hallucinations, the agency of communication and meaning
   * Attention span - ability to focus and concentrate
+{{ :img9.png |}}
+**Recommended Reading**
+"Presentation of Self in Everyday Life" by Irving Goffman [( :harvard:Goffman1959>>
+authors   : Erving Goffman
+title     : The Presentation of Self in Everyday Life
+published : 1959
+publisher : Anchor Books
+isbn      : 978-0-14-013571-8
+url       : https://en.wikipedia.org/wiki/Special:BookSources/978-0-14-013571-8
+)][(The_Presentation_of_Self_in_Everyday_Life>Erving Goffman - The Presentation of Self in Everyday Life[[https://en.wikipedia.org/wiki/The_Presentation_of_Self_in_Everyday_Life|Wikipedia]])]
+"Asylums" by Irving Goffman [( :harvard:Goffman1961>>
+authors   : Erving Goffman
+title     : Asylums: Essays on the Social Situation of Mental Patients and Other Inmates
+published : 1961
+publisher : Doubleday
+isbn      : 978-0-14-013739-2
+url       : https://en.wikipedia.org/wiki/Special:BookSources/978-0-14-013739-2
+)][(Asylums_(book)>Erving Goffman - Asylums[[https://en.wikipedia.org/wiki/Asylums_(book)|Wikipedia]])]
-===== SMART Goals =====
+----
-All outcomes, aims and treatment goals should be measurable using the SMART criteria:
-  * **Specific** – target a specific area for improvement. (//what//)
+===== Specific Assessment Tools =====
-  * **Measurable** – quantify or at least suggest an indicator of progress. (//how much//)
-  * **Assignable** – specify who will do it. (//who//)
-  * **Realistic** – state what results can realistically be achieved, given available resources. (//why//)
-  * **Time-related** – specify when the result(s) can be achieved. (//when//)
+Assessment tools are standardised systems and processes that facilitate the qualification and quantification of specific conditions, disorders, experiences, and problems. Tools include scales, charts, checklists, graphic presentations, and structured interviews. These need to be suited to the client under assessment, culturally sensitive to the context in which they are used, reliable and valid if they are to inform professional judgment and opinion.
-The term S.M.A.R.T. Goals and S.M.A.R.T. Objectives are often used. Although the acronym SMART generally stays the same, //objectives// and //goals// can differ. Goals are the distinct purpose that is to be anticipated from the assignment or project, while objectives, on the other hand, are the determining steps that will direct the full completion of the project goals. (**SAMHSA Native Connections.** "//Setting Goals and Developing Specific, Measurable, Achievable, Relevant, and Time-bound Objectives" (PDF). Substance Abuse and Mental Health Services Administration//.")
+=== Examples of commonly used assessment tools ===
-Two additional criteria create the SMARTER system:
+. Anxiety[(Anxiety>Anxiety disorder diagnosis[[https://en.wikipedia.org/wiki/Anxiety_disorder#Diagnosis
+  * Generalized Anxiety Disorder Screener (GAD-7)[(Generalized_Anxiety_Disorder_7>Generalized Anxiety Disorder 7[[https://en.wikipedia.org/wiki/Generalized_Anxiety_Disorder_7|Wikipedia]])]
+  * Depression Anxiety Stress Scale (DASS)[(DASS>DASS  Depression Anxiety Stress Scales[[https://en.wikipedia.org/wiki/DASS_(psychology)|Wikipedia]])]
+  * Hamilton Anxiety Rating Scale[(Hamilton_Anxiety_Rating_Scale>Hamilton Anxiety Rating Scale[[https://en.wikipedia.org/wiki/Hamilton_Anxiety_Rating_Scale|Wikipedia]])]
-  * **Evaluate** - The sixth step in goal setting using the S.M.AR.T.E.R. method is to ensure that all progress towards each goal is evaluated.
-  * **Readjust** - The seventh step is to adjust treatment according to the evaluation.
-===== SAMPLEs - not for inclusion =====
+. Depression[(MDD>Major depressive disorder diagnosis[[https://en.wikipedia.org/wiki/Major_depressive_disorder#Diagnosis|Wikipedia]])]
+  * Geriatric Depression Scale[(Geriatric_Depression_Scale>Geriatric Depression Scale[[https://en.wikipedia.org/wiki/Geriatric_Depression_Scale|Wikipedia]])]
+  * The Zung Self-Rating Depression Scale[(Rating_Depression_Scale>Zung Self-Rating Depression Scale[[https://en.wikipedia.org/wiki/Zung_Self-Rating_Depression_Scale|Wikipedia]])]
-{{:4c16008b3d0516530846d4426b9f75ff--psychotic-disorder-mental-health-nursing.jpg?800|}}
+. Addiction[(Screening and assessment>Addiction screening and assessment[[https://en.wikipedia.org/wiki/Addiction#Screening_and_assessment|Wikipedia]])]
+  * Addiction Severity Index (ASI)[(Addiction_severity_index>Addiction severity index[[https://en.wikipedia.org/wiki/Addiction_severity_index|Wikipedia]])]
+  * Alcohol Use Disorders Identification Test (AUDIT-C)[(Alcohol_Use_Disorders_Identification_Test>Alcohol Use Disorders Identification Test[[https://en.wikipedia.org/wiki/Alcohol_Use_Disorders_Identification_Test|Wikipedia]])]
+  * South Oaks Gambling Screen Assessment (SOGS)[(SOGS>South Oaks Gambling Screen (SOGS)[[https://en.wikipedia.org/wiki/Problem_gambling#Diagnosis|Wikipedia]])]
+  * Brief Addiction Monitor
+  * Drug Abuse Screening Test (DAST)[(DAST>Drug Abuse Screening Test (DAST-10)[[https://en.wikipedia.org/wiki/Addiction#Drug_Abuse_Screening_Test_(DAST-10)|Wikipedia]])]
-{{:f1.large.jpg?800|}}
-{{:flowerbluenew.jpg?800|}}
+. Trauma
+  * Post-Traumatic Stress Disorder Checklist (PCL-5)[(PCL-5>PTSD Checklist for DSM-5 (PCL-5) [[https://www.ptsd.va.gov/professional/assessment/adult-sr/ptsd-checklist.asp|National Center for PTSD]])]
+  * The Kessler Psychological Distress Scale[(K10>Kessler Psychological Distress Scale (K10)[[https://www.tac.vic.gov.au/files-to-move/media/upload/k10_english.pdf|PDF]])]
-{{:gr1_lrg.jpg?800|}}
-{{ :slide_9.jpg?800 |}}
+. Behavioural
+  * Wahler Self-Description Inventory[(Wahler>H. J. Wahler - The self-description inventory: Measuring levels of self-evaluative behavior in terms of favorable and unfavorable personality attributes[[https://doi.org/10.1002/1097-4679(196801)24:1<40::AID-JCLP2270240111>3.0.CO;2-I|wiley.com]])]
+  * Daily Living Activities (ADL)[(ADL>Activities of daily living (ADL)[[https://en.wikipedia.org/wiki/Activities_of_daily_living|Wikipedia]])]
+  * Parental Stress Scale (PSS)[(PSS>Parental Stress Scale (PSS)[[https://www.corc.uk.net/outcome-experience-measures/parental-stress-scale-pss/|Child Outcomes Research Consortium (CORC)]])]
-{{ :608d54_b4e42a2fb23f45cda004c507044fcfc4_mv2.jpg?800 |}}
+. Pain[(PS>Pain scale[[https://en.wikipedia.org/wiki/Pain_scale|Wikipedia]])]
-{{ :c4073d55901aaa80704987948cc96fc9bbbaf0ec-365x800.png?800 |}}
+  * Numerical Rating Scale (NRS)[(NRS>Numerical Rating Scale (NRS)[[https://en.wikipedia.org/wiki/Pain_scale#|Wikipedia]])]
+  * Visual Analog Scale (VAS)[(VAS>Visual Analog Scale (VAS)[[https://en.wikipedia.org/wiki/Pain_scale#cite_note-pmid6184474-40|Wikipedia]])]
+  * Defense and Veterans Pain Rating Scale (DVPRS)[(DVPRS>Psychometric Testing of the Defense and Veterans Pain Rating Scale (DVPRS)[[https://academic.oup.com/painmedicine/article/17/8/1505/2223242?login=false|https://doi.org/10.1093/pm/pnw105]])]
+  * Adult Non-Verbal Pain Scale (NVPS)[(NVPS>Nonverbal Pain Scale (NVPS)[[https://www.mdcalc.com/calc/3621/nonverbal-pain-scale-nvps-nonverbal-patients|mdcalc.com]])]
+  * Pain Assessment in Advanced Dementia Scale (PAINAD)[(PAINAD>Pain Assessment in Advanced Dementia Scale (PAINAD)[[https://en.wikipedia.org/wiki/Pain_Assessment_in_Advanced_Dementia|Wikipedia]])]
+  * Behavioral Pain Scale (BPS)[(BPS>Behavioral pain scale (BPS)[[https://journals.lww.com/ccmjournal/Abstract/2001/12000/Assessing_pain_in_critically_ill_sedated_patients.4.aspx|Wikipedia]])]
+  * Critical-Care Observation Tool (CPOT)[(CPOT>Critical Care Pain Observation Tool (CPOT)[[https://www.mdcalc.com/calc/2144/critical-care-pain-observation-tool-cpot|mdcalc.com]])]
-{{ :slide_9.jpg?800 |}}
+{{:wong_pain_scale.jpg|}}
-{{ :stepped-care-model-1280x786.png?800 |}}
+----
+===== Targets, Goals and Outcomes =====
+To evaluate the effectiveness of the treatment plan, the coach/practitioner needs to track the client's progress and measure the efficacy of treatment and interventions. In some instances, it may be beneficial to ask the client to keep track of their inner experiences and behaviours in a log, chart, or diary so that progress can be monitored.
+People in treatment are more likely to complete objectives when the goals are personally important to them, thus all goals should add value or meaning to the client's situation.
+<WRAP center round tip 90%>
+“//People are not lazy. They simply have impotent goals—that is, goals that do not inspire them.//” — **Tony Robbins**
+"//If you want to live a happy life, tie it to a goal, not to people or things.//” — **Albert Einstein**
+</WRAP>
+===== SMART Goals =====
+The SMART Goals[(#1)] model is an effective tool used in professional settings to set goals that are Specific, Measurable, Attainable, Realistic, and Time-bound. The acronymn helps professionals identify particular targets worthy of achieving and creates benchmarks for success by defining each goal as a part of the whole. Additionally, the model assists professionals in setting realistic timelines for goal completion which can help reduce risk of underachieving goals.
+{{ :img10.png |}}
+By using this innovative methodology to structure goal-setting practices, organizations will have increased chances for successful goal attainment.
+All outcomes, aims and treatment goals should be measurable using the SMART criteria:
+  * **Specific** – target a specific area for improvement. (//what//)
+  * **Measurable** – quantify or at least suggest an indicator of progress. (//how much//)
+  * **Assignable** – specify who will do it. (//who//)
+  * **Realistic** – state what results can realistically be achieved, given available resources. (//why//)
+  * **Time-related** – specify when the result(s) can be achieved. (//when//)
+The term S.M.A.R.T. Goals and S.M.A.R.T. Objectives are often used. Although the acronym SMART generally stays the same, //objectives// and //goals// can differ. Goals are the distinct purpose that is to be anticipated from the assignment or project, while objectives, on the other hand, are the determined steps that will direct the full completion of the project goals. (**SAMHSA Native Connections.** "//Setting Goals and Developing Specific, Measurable, Achievable, Relevant, and Time-bound Objectives" (PDF). Substance Abuse and Mental Health Services Administration//.")
+Two additional criteria create the SMARTER system:
+  * **Evaluate** - The sixth step in goal setting using the S.M.AR.T.E.R. method is to ensure that all progress towards each goal is evaluated.
+  * **Readjust** - The seventh step is to adjust treatment according to the evaluation.
-{{ :stepped.jpg?800 |}}