6 Treatment Planning
What is treatment planning?
Treatment planning is the process by which the therapist and client develop a treatment plan. Treatment plans are often referred to as the roadmap of the treatment process. They outline the steps both the client and counselor will take toward the client’s successful completion of treatment. They also serve as a tool to measure client progress.
After an initial assessment has been conducted, the counselor will develop a treatment plan. Treatment planning should be done collaboratively with a client, helping both client and counselor to identify problems that need to be addressed and goals related to those problems. By definition, treatment planning is the process by which the counselor and the client identify and rank problems needing resolution, establish agreed-upon immediate and long-term goals, and decide upon a treatment process and the resources to be utilized. Global criteria for treatment planning include:
- Explain assessment results to client in an understandable manner.
- Identify and rank problems based on individual client needs in the written treatment plan.
- Formulate agreed-upon immediate and long-term goals using behavioral terms in the written treatment plan.
- Identify the treatment methods and resources to be utilized as appropriate for the individual client.
Treatment planning is to be individualized. That is, the treatment plan is to include problems, goals, objectives, and interventions specific to the client and their needs. Thus, no two treatment plans will be the same, as no two individuals have the exact same experience.
Identifying Problems
When identifying problems, it helps to look at the ASAM dimensions and the information that was gathered during the initial assessment. As mentioned in Unit 1, the six ASAM dimensions are:
- Acute intoxication and/or withdrawal potential
- Biomedical conditions and complications
- Emotional, behavioral, or cognitive conditions and complications
- Readiness to change
- Relapse, continued use or continued problem potential
- Recovering/living environment
When a client is seeking treatment related to a substance use disorder, the first problem addressed on the treatment plan should be related to ASAM dimension 1 and the client’s use. It is determined whether or not the client will require detoxification and, if so, this is to be included on the treatment plan. If not, the substance use disorder is still the first problem to be addressed, however, in a more global sense.
Examples of Common Problems Addressed on Treatment Plans
- History of a substance use disorder
- Medical conditions that will need to be addressed in treatment or continue to be monitored if the client is already receiving medical care
- Inadequate coping related to emotions/difficulty with emotional regulation
- Diagnosable mental health disorders
- History of trauma
- Unresolved grief
- Lack of adequate support
- Relationship issues
- Employment issues, including, but not limited to, lack of employment and/or employment that places the individual at high risk for relapse
- Inadequate housing and/or housing that places the individual at high risk for relapse
- Involvement with the legal system
Components of the Treatment Plan
There are various components of a treatment plan. Together, these outline the issues to be addressed, outcome goals related to the issues, the steps the client will take to reach the goal, and the interventions the counselor (or sometimes other members of the clinical team) will implement to assist the client in meeting the goal.
Problems
It is not uncommon that clients will discuss several issues they are encountering in their lives during the initial assessment. It is the counselor’s responsibility to identify the most significant problems to address during the time the client is engaged in treatment. Counselors should attempt to choose problems that are going to bring about the most immediate relief. Problems should be stated in behavioral terms.
Goals
Goals are created as resolutions to the problems identified. Each problem listed on the treatment plan will have one corresponding goal. Goals are written in broad terms and identify the long-term desired outcome the client has related to the problem (e.g., “Begin to resolve family conflict related to use while maintaining a lifestyle free of substance use.”)
Objectives
Objectives identify what the client will do to achieve a goal. Objectives highlight the actions a client will take to reach the goal. Because there are often several behaviors clients can or will engage in to reach a goal, it is recommended that each goal identified on the treatment plan have a minimum of two objectives.
Objectives should be written using behaviorally measurable language. This means they should be SMART (specific, measurable, achievable/attainable, relevant, and time-bound).
Creating SMART Objectives
Specific
- What will the client specifically do to reach the goal? What specific actions will they take?
Measurable
- Can you count or otherwise quantify the steps the client will take? Could someone observe and determine the skill/action was completed? Can you measure progress through use of a screening tool or questionnaire?
Achievable/attainable
- Is it realistic, given the anticipated length of stay in treatment, that the client will be able to complete the objective?
Relevant
- Is the objective related to the assessment and problem statement?
Time-bound
- What is the timeline the client has for completing the objective? Is the completion date reasonable?
Suggested Tip: If you can see the client doing something, it is an objective (e.g., “make a list of 5 negative consequences related to use”). If you can’t see the client doing something, it is a goal (e.g., “reduce anxiety”).
Interventions
Each objective on a treatment plan should have a corresponding intervention. Interventions are the actions a counselor (or sometimes another member of the clinical team) will take to assist the client in completing objectives and ultimately in achieving the goal. They outline strategies or services, and similarly to objectives, should be stated in measurable terms.
Diagnosis
Any Substance Use Disorders as determined from the assessment are included on the treatment plan. This section of the treatment plan may also include any mental health diagnosis/es. It is important to note that certain credentials are required to diagnose mental health disorders. In the state of Illinois, a Certified Alcohol and Other Drug Counselor (CADC) cannot diagnose mental health disorders.
Responsible Person
The responsible person is the member of the clinical team who is accountable for the intervention and making sure the objective is completed. Usually this is the client’s primary counselor. However, it may also be the attending psychiatrist, a case manager, or even another counselor on the treatment team who will be providing a specialized treatment or service.
Dates
The treatment plan will be signed and dated by the individual who is responsible for creating it (usually the primary counselor), the client, and the attending physician or psychiatrist. However, this isn’t the only date that will be on the treatment plan. There will be target dates and sometimes review dates for each objective. The target date is the expected date the objective is to be completed and will depend on the anticipated length of treatment. The review dates identify the dates when the plan is to be reviewed. In the state of Illinois, these review dates are determined by the level of care and are outlined in Illinois Part 2060. Please refer back to Unit 1: Illinois 2060 Law for more information.
