Treatment Planning with the MATRS and ASI
Instructor; Dr. Dawn-Elise Snipes
Executive Director, AllCEUs Counselor Education and Training
Podcast Host: Counselor Toolbox, Addiction Counselor Exam Review & Happiness Isn’t Brain Surgery
Objectives
• Examine how Addiction Severity Index information can be used for clinical applications and assist in program evaluation activities.
• Identify differences between program-driven and individualized treatment planning processes.
• Gain a familiarization with the process of treatment planning including considerations in writing and prioritizing problem and goal statements and developing measurable, attainable, time-limited, realistic, and specific (M.A.T.R.S./SMART) objectives and interventions.
• Define basic guidelines and legal considerations in documenting client status.
ASI
• Medical Status
• Life interference
• Due to addiction
• Assessed need for medical intervention
• Education, Employment, Finances
• Level of education
• Occupational hx forever and last 30 days
• Drivers license/transportation
• Sources of financial support
• Dependents
• Perception of employment / financial issues
• Assessed need for employment counseling
ASI
• Alcohol/Drug Use
• Drugs (addictive behaviors) used, pattern and method
• Amount of money spent
• Which drugs (behaviors) most problematic
• Voluntary abstinence – When, for how long, how and what triggered relapse
• Hx of medical problems due to use
• Treatment Hx
• Perception of the need for treatment
• Assessed need for treatment
ASI
• Legal status
• Probation or parole
• Is treatment court mandated
• Are you awaiting trial / pending charges
• Catalog charges and frequency
• How many charges are addiction related
• How many charges resulted in convictions
• How many times have you been incarcerated?
• How many days in the last 30 have you been in jail
• Perception of legal problems
• Assessed need for legal services/counseling
ASI
• Family/Social History
• Identify history of addiction or psychiatric issues in 1st and 2nd degree family members
• Marital status and satisfaction
• Living arrangements and satisfaction (Recovery environment)
• Use of alcohol or drugs in the household
• With whom do you spend most of your time
• Who are your close friends
• Have you had serious difficulty getting along with any first degree family member, coworker or friend
• Trauma/abuse history
• Perception of interpersonal problems
• Assessed need for family/social counseling
ASI
• Psychiatric
• How many times hospitalized
• Number of times ever and 30 days you have experienced depression, anxiety, hallucinations, cognitive difficulties, suicidal ideation,
• Are you on or have you ever been on psychiatric medications
• Perception of psychiatric issues
• Assessed need for mental health counseling
Process Review
• An assessment is conducted.
• Data and information are collected from the client, collateral sources, and assessment scales.
• Problems are identified.
• Readiness for change for each problem is identified
• Problem statements are prioritized.
• Goals are created that address the problems.
• Objectives to meet the goals are defined
• Interventions are revised or changed based on client response to treatment
Treatment Plan Overview
• Developed at admission and continually updated
• Individualized
• Problem statements are
• Nonjudgmental
• Not jargony “denial” “resistant” “Codependent”
• Goals must be
• Specific
• Measurable (as evidenced by)
• Achievable
• Relevant
• Time limited (achievable by the end of treatment)
Treatment Plan Overview
• Program-driven plans
• Are one-size-fits all
• Reflect the components and/or activities and services available in the program
• Individualized Treatment Plan is “Sized” to Match Client Needs
• Not all clients have the same needs or are in the same situation.
• The individualized treatment plan is made to “fit” the client based on her/his unique:
• Abilities
• Goals
• Lifestyle
• Socioeconomic realities
• Work history
• Educational background
• Culture
• When treatment programs do not offer services that address specific client needs, referrals to outside services are necessary.
• “Client has low self-esteem.”
• Client averages 10 negative self-statements daily
• “Client is in denial.”
• Client reports two DWIs in the past year but states that alcohol use is not a problem.
• “Client is resistant to treatment.”
• In the past 12 months, the client has dropped out of 3 treatment programs prior to completion. (other possibilities?)
• “Client is on probation because he is a bad alcoholic.”
• Client has legal consequences because of alcohol-related behavior.
Terms
• What Components Are Found in a Treatment Plan?
• Problems identified during assessment
• Goals reasonably achievable in the active treatment phase
• The term objectives used in this training is defined as what the client does to meet the goals
• The term intervention used in this training is defined as what the staff will do to assist the client
Prioritizing Problems
Writing a Specific Goal
• Recovery is not a specific goal
• When a goal is specific, the person can objectively evaluate the data to determine that it has been achieved.
• What problems are you experiencing as a result or your condition? (Problem statement)
• High blood pressure
• Insomnia
• Relationship problems
• Depression
• Financial problems—Job loss and difficult with employment due to felony conviction
Writing a Specific Goal
• How will you know when each of those problems is resolved? (Goal statement)
• Blood pressure will be 135/80 or better
• I will be able to sleep restfully at least 7 hours each night
• At least 5 out of every 7 days I will not get into fights with my partner
• At least 5 out of every 7 days I will rate my happiness at a 3 or better.
• I will acquire a job that pays at least $15/hour
Making it Measurable
• Measurable means an third person can look at the data and say “yes” it was accomplished or “no.”
• Frequency (of the new behavior)
• Number of days per week (went to work, went to meetings…)
• Number of times per day (used a positive coping strategy)
• Intensity (of the new behavior)
• Anchored likert scale (use different words)
• 1=extremely depressed 2=moderately depressed 3=content 4=happy 5=elated
• 1= none 2=a little 3=feeling confident 4=I’ve got this
Making it Measurable
• Duration (of the new behavior)
• Will resolve within 5 minutes (tantrum, panic attack)
• Will pass in less than 30 minutes (urge, grief, anger)
• Number
• List 10 examples…
• Scales
• Beck Depression Inventory will drop 2 points
Achievable/Attainable
• What can the person realistically do in the given time (i.e. 90 days)
• Enroll in school
• Get a job
• Stay clean for 30 days
• Rate her mood a 3 or better on the depression scale 5 out of 7 days
• Increase the frequency that unhelpful thoughts are identified and effectively disputed to at least 70%
Relevant
• Objectives need to clearly related back to goals which need to clearly relate back to the reason for the referral.
• Anyone reading the plan must be able to easily understand why each objective and intervention are there
• In the goal statement, after the as evidenced by, add a statement, this is important to my [recovery] because…
Time-Limited
• All goals need to be able to be completed within the treatment period.
• Objectives need to be constructed so they can be completed
• For children through 5th grade…daily (even if just a star chart)
• For youth 12 and up …weekly.
Documentation
• Plans are constructed WITH the client
• Clients get a copy of their plan
Progress Notes
• If it isn’t documented, it didn’t happen.
• Notes are dated, signed, and legible.
• Client name and identifier are included on each page
• Referral information has been documented.
• Sources of information are clearly documented.
• Client strengths and limitations in achieving goals are noted and considered.
• Documentation should reflect changes in client status including response to and outcome of interventions
• Entries should include the clinician’s professional assessment and continued plan of action
Progress Notes
• Client review sheets can be helpful (complete at the end of session with the client)
• Identify the problems and objectives you worked on this week.
• Problem # ___
• Objective: _____
• Did you complete it? Yes No If no, why not?
• What help do you need with this objective, if any?
• Was it useful? Yes No If no, why not?
• What else could you do to address this problem that would be more useful?
• What problems and objectives are you going to work on next week?
• Give a copy to the client.
Progress Notes
• Progress Notes (S.O.A.P.)
• Subjective – the client’s observations or thoughts; a client’s direct statement
• Objective – the clinician’s objective observations during the session.
• If you must use a subjective term like “withdrawn,” follow it with as evidenced by…
• Mental-status: Orientation (person, place, time), memory, language, future plans
• Assessment of Progress
• Should identify each goal/objective worked on and outcome
• Plans for next session
Progress Notes
• D.A.P.
• D= Describe (or Data)
• A= Assess
• P= Plan
• B.I.R.P.
• B= Behavior
• I= Intervention
• R= Response
• P= Plan
Progress Notes
• C.A.R.T.
• C= Client condition
• A= What action did the counselor do in response to client condition?
• R= Client response to treatment plan
• T= How response relates to treatment plan
• C.H.A.R.T.
• C= Client condition
• H= Historical significance of client condition (i.e. relapse warning sign)
• A= What action did the counselor do in response to client condition?
• R= Client response to treatment plan
• T= How response relates to treatment plan
Summary
• Addiction Severity Index can be used for clinical applications and assist in program evaluation activities because it assesses multiple domains of functioning which can be linked to Maslow’s heirarchy
• Program-driven plans fit the patient into services.
• Individualized plans fit the services to the patient
• Treatment plan goals and objectives should be positive, Specific, Measurable, Attainable, Relevant and Time Limited
• It is important to tie the treatment plan to the assessment and the interventions and client progress to the plans.
• Why is the action being taken
• How does it benefit the client in achieving goals
• What was done this past week (include client activities and referral contacts)
• What was the client response to those activities
• What are the plans for next week
• What referrals were made (if any) and why
Additional Videos
• Treatment Planning
• Using Clinical History to Identify Motivation and Reinforcers
• Goal Setting and Motivation
• Behavior Modification