With the advent of detailed treatment plans, outcome data can be more easily collected for interventions that are effective in achieving specific goals. The foundation of any effective treatment plan is the data gathered in a comprehensive evaluation. As part of the process prior to developing the treatment plan, the family counselor must sensitively listen to and understand what the parents struggle with in terms of family dynamics, cognitive abilities, current stressors, social network, physical health and physical challenges, coping skills, self-esteem, extended family support, and so on.
We have identified five specific steps for developing an effective treatment plan based on assessment data. Step One: Problem Selection Although the parents may discuss a variety of issues during the assessment, the family counselor must ferret out the most significant problems on which to focus the treatment process. Usually a primary problem will surface, although secondary problems may also be evident. Some other problems may have to be set aside as not urgent enough to require treatment at this time. An effective treatment plan can deal only with a few selected problems or treatment will lose its direction.
Step Two: Problem Definition Each parent presents with unique nuances as to how a problem behaviorally reveals itself in his or her life. Therefore, each problem that is selected for treatment focus requires a specific definition about how it is evidenced in the particular family.
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The Planner offers behaviorally specific definition statements to choose from or to serve as a model for your own personally crafted statements. You will find several behavior symptoms or syndromes listed that may characterize one of the 31 presenting problems identified in the Planner. Turn to the chapter that identifies the presenting problem being experienced by parents or their child.
These statements need not be crafted in measurable terms but can be global, long-term goals that indicate a desired positive outcome to the treatment procedures. The Planner suggests several possible goal statements for each problem, but one statement is all that is required in a treatment plan.
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Step Four: Objective Construction In contrast to long-term goals, short-term objectives must be stated in behaviorally observable language. It must be clear when the parents and the identified child have achieved the objectives; therefore, vague, subjective objectives are not acceptable. Various alternatives are presented to allow construction of a variety of treatment plan possibilities for the same presenting problem. The family specialist must exercise professional judgment as to which objectives are most appropriate for a given family. Each objective should be developed as a step toward attaining the broad instructional goal.
In essence, objectives can be thought of as a series of steps that, when completed, will result in the achievement of the long-term goal. There should be at least two objectives for each problem, but the mental health professional may construct as many as are necessary for goal achievement. Target attainment dates may be listed for each objective.
When all the necessary objectives have been achieved, the parents should have resolved the target problem successfully.
The Continuum of Care Treatment Planner
Step Five: Intervention Creation Interventions are the therapeutic actions of the counselor designed to help the parents and the child to complete the objectives. There should be at least one intervention for every objective. If the parents do not accomplish the objective after the initial intervention has been implemented, new interventions should be added to the plan.
The Parenting Skills Treatment Planner contains interventions from a broad range of approaches including cognitive, behavioral, academic, dynamic, medical, and family-based. Other interventions may be written by the provider to reflect his or her own training and experience.
Some suggested interventions listed in the Planner refer to specific books, journals, or Internet sites where specific methodologies can be located for the counselor to look for a more lengthy explanation or discussion of the intervention. Appendix A offers a list of bibliotherapy references that may be helpful to families, referenced by the problem focused on within each chapter. The clinician must compare the behavioral, cognitive, emotional, and interpersonal symptoms that the client presents to the criteria for diagnosis of a mental illness condition as described in DSM-IV-TR.
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The issue of differential diagnosis is admittedly a difficult one that has rather low inter-rater reliability. Psychologists have also been trained to think more in terms of maladaptive behavior than in disease labels. In spite of these factors, diagnosis is a reality that exists in the world of mental health care and it is a necessity for third-party reimbursement. However, recently, managed care agencies are more interested in behavioral indices that are exhibited by the client than in the actual diagnosis.
An accurate assessment of behavioral indicators will also contribute to more effective treatment planning. If the parents are being seen in a family therapy mode, along with a child or children, there may be separate diagnoses given for different members of the family. Appendix B contains all of the suggested diagnoses cited in this book, sorted by presenting problems and chapter titles. Select two or three of the listed behavioral definitions or symptoms of the problem Step Two and record them in the appropriate section on your treatment plan form.
Select one or more long-term goals Step Three and again write the selection, exactly as it is written in the Planner or in some appropriately modified form, in the corresponding area of your Treatment form. Review the listed objectives for this problem and select the ones that you judge to be clinically indicated for your client Step Four.
Remember, it is recommended that you select at least two objectives for each problem. Add a target date allocated for the attainment of each objective, if necessary. Choose relevant interventions Step Five. The Planner offers suggested interventions related to each objective in the parentheses following the objective statement. But do not limit yourself to those interventions. Just as with definitions, goals, and objectives, there is space allowed for you to enter your own interventions into the Planner.
This allows you to refer to these entries when you create a plan around this problem in the future. You may have to assign responsibility to a specific person for implementation of each intervention if the treatment is being carried out by a team. You should now have a complete, individualized, treatment plan that is ready for immediate implementation and presentation to the parents.
Drawing on our own years of parent education and clinical experiences, we have put together a variety of treatment choices. These statements can be combined in thousands of permutations to develop detailed treatment plans. In addition, we encourage readers to add their own definitions, goals, objectives, and interventions to the existing samples. It is our hope that the Parenting Skills Treatment Planner will promote effective, creative treatment planning—a process that will ultimately benefit the parents, the identified child, the family, and the greater community.
Acquire positive discipline strategies that set limits and encourage independence. Agree to form a united parental front and cooperate on all issues of discipline and child management. List the essential needs of an elementary school child and create a plan for accommodating those needs.
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Brainstorm with the parents the essential requirements for the healthy development of their child e. Assist the parents in creating a definition of unconditional love e. Utilize natural and logical consequences to redirect behavior. Differentiate between adult problems and those that belong to the child.
Define natural e. Assist the parents in designing several logical consequences to deal with chronic, inappropriate behavior e. Teach the parents to differentiate problems that belong to the child e. Guide the parents in using proactive strategies e. Diagnosis: V Ask the parents to practice methods of sidestepping power struggles e.
Fail to provide the minimum care, supervision, emotional support, and nurturing required for normal childhood development. Tolerate, condone, or ignore abuse, neglect, or maltreatment from the spouse or another caregiver. Value, promote, and demand family secrecy and isolation. Refuse to cooperate with the school, medical care facilities, private agencies, or child protection services that offer treatment programs for abused children and their families.
The child is the recipient of physical, sexual, or emotional aggression, resulting in injury or emotional trauma from a parent or caregiver. The child incorporates aggressive and dysfunctional parental characteristics into own behavior patterns through internalization and modeling. Terminate all abusive treatment of the child. Accept responsibility for the abusive treatment of the child, express remorse, and commit to using positive parenting strategies. Access social and mental health services for self, the child and other family members.
The Continuum of Care Treatment Planner
Reduce personal and family isolation and increase family, faith-based, and community support systems. Gather enough information to categorize the type of abuse and contact an investigative child protection agency if one is not already actively involved with the family. Communicate with the child protection agency and report all known facts and suspicions of abuse.
Cooperate with the child protection authorities to ensure the termination of the abuse and the safety and emotional well-being of the child. Explore the family history with the parents to determine if chronic abuse or maltreatment is present or if the mistreatment of the child is an isolated incident.
Assist the parents in contacting the proper child protection authorities and completing the required forms if they suspect abuse from another caregiver or support them to disclose their own involvement. Instruct the parents to report any suspected abuse by another caregiver to the state authorized child protection services CPS agency or local police department and to keep notes on behaviors, physical marks, or other suspicious evidence in regard to the child. Encourage the parents to cooperate with the CPS caseworkers during the investigative process; request that they permit an exchange of information between the CPS caseworker and their private therapist.
Help the parents and the child deal with the legal aspects associated with disclosure of the abuse by providing information about the process and acquiring legal assistance.