Section 2 Practice Dimensions
PD 2 Treatment Planning
Definition
A collaborative process in which professionals and the client develop a written document that identifies important treatment goals; describes measurable, time-sensitive action steps toward achieving those goals with expected outcomes; and reflects a verbal agreement between a counselor and client.
At a minimum an individualized treatment plan addresses the identified substance use disorder(s), as well as issues related to treatment progress, including relationships with family and significant others, potential mental conditions, employment, education, spirituality, health concerns, and social and legal needs.
Competency 37
Use relevant assessment information to guide the treatment planning process.
Knowledge
- The role assessment plays in identifying client problems, resources, and barriers to treatment.
- Stages of change and readiness for treatment.
- The impact that the client and family systems have on treatment decisions and outcomes.
- Other sources of assessment information.
Skills
- Establishing treatment priorities based on all available assessment data.
- Interpreting assessment information con- sidering the client’s age, developmental level, treatment readiness, gender, and racial and ethnic culture.
- Using assessment information to individu- alize the client’s treatment goals.
Attitudes
- Appreciation of the strengths and limitations of the assessment data.
- Recognition that assessment is an ongoing process throughout treatment.
Competency 38
Explain assessment findings to the client and significant others.
Knowledge
- How to apply confidentiality rules and regulations.
- How to communicate assessment data in understandable terms.
- Factors affecting the client’s comprehension of assessment data.
- Roles and expectations of significant others involved in treatment.
Skills
- Summarizing and synthesizing assessment results.
- Translating assessment information into treatment goals and objectives.
- Evaluating the client’s comprehension of assessment feedback.
- Communicating with the client in a man- ner that is sensitive to the client’s age, developmental level, gender, and racial and ethnic culture.
- Communicating assessment findings to interested parties within the bounds of confidentiality rules and regulations and practice standards.
Attitudes
- Recognition of how biases influence com- munication of assessment data and results.
- Recognition of the client’s right and need to understand assessment results.
- Respect for the roles of others.
Uses of The Competencies
The former Caribbean Basin and Hispanic ATTC in Puerto Rico translated The Competencies into Spanish and had widely distributed it in Puerto Rico and the mainland. (The translation is posted on the CBHATTC Web site, http://www.attcnetwork.org/regcenters/productDocs/1/productpdf/Manuales/ TAP21/TAP21.pdf.)
The curriculum of the Substance Abuse Graduate Program of the Universidad Central del Caribe was based on The Competencies.
The Competencies has been used as a resource for trainers teaching workshops such as Clinical Skills in Supervision, S.M.A.R.T., Treatment Planning, and Levels of Care in Substance Abuse.
Some community-based organizations have incorporated The Competencies into their inservice trainings.
The Comisión Certificadora de Profesionales en Substancias Sicoactivas of Puerto Rico (certification board) incorporated The Competencies into its certifications standards.
The Puerto Rico Drug Control Office used The Competencies to develop the Addiction Prevention Specialist Licensure standards in Puerto Rico.
Competency 39
Provide the client and significant others with clarification and additional information as needed.
Knowledge
- Verbal and nonverbal communication styles.
- Methods to elicit feedback from the client and significant others.
Skills
- Eliciting and integrating feedback during the planning process.
- Working collaboratively with the client and significant others.
- Establishing a trusting relationship with the client and significant others.
Attitudes
- Willingness to communicate interactively with the client and significant others.
- Openness to client questions and input.
Competency 40
Examine treatment options in collaboration with the client and significant others.
Knowledge
- Treatment interventions, client placement criteria, and outside referral options.
- Current research findings on various treatment models.
- Alternatives to treatment, including no treatment.
Skills
- Presenting the range of treatment options and settings available.
- Using assessment data to make treatment recommendations.
- Considering the client’s needs and prefer- ences when selecting treatment settings.
- Using the treatment planning process to foster collaborative relationships with the client and significant others.
Attitudes
- Willingness to negotiate treatment options with the client.
- Openness to a variety of approaches.
- Respect for the input of the client and significant others.
Competency 41
Consider the readiness of the client and significant others to participate in treatment.
Knowledge
- Stages-of-change process.
- Methods of tailoring treatment strategies to match the client’s motivational level.
Skills
- Assessing the client’s stage of change.
- Developing strategies to address ambivalence.
- Eliciting the client’s preferences.
- Promoting the client’s readiness to engage in treatment.
Attitudes
- Respect for the client’s values, goals, and readiness to change.
- Recognition and acceptance of behavioral change as a multistep process.
Competency 42
Prioritize the client’s needs in the order they will be addressed in treatment.
Knowledge
- Treatment sequencing and the continuum of care.
- Hierarchy-of-needs models.
- Holistic view of the client’s biological, psychological, social, and spiritual needs and resources.
Skills
- Accessing referral resources necessary to address the client’s needs.
- Using clinical judgment in prioritizing client problems.
- Assessing severity of client problems and prioritizing appropriately.
Attitudes
- Recognition and acceptance of the client as an active participant in prioritizing needs.
- Willingness to make referrals to address the client’s needs.
Competency 43
Formulate mutually agreed-on and measurable treatment goals and objectives.
Knowledge
- Use of goals and objectives to individualize treatment planning.
- Treatment needs of diverse populations.
- How to write specific and measurable goal and objective statements.
Skills
- Translating assessment information into measurable treatment goal and objective statements.
- Collaborating with the client to develop specific, measurable, and realistic goals and objectives.
- Engaging, contracting, and negotiating mutually agreeable goals with the client.
- Writing goal and objective statements in terms understandable to the client and significant others.
Attitudes
- Respect for the client’s choice of treatment goals.
- Respect for the client’s individual pace toward achieving goals.
- Acceptance of the client’s readiness to change.
- Appreciation for incremental achievements in completing goals.
International Applications of The Competencies
International applications of The Competencies are noteworthy. It was translated for use in the Czech Republic, Greece, Hungary, and Slovakia. A Spanish translation has been completed. Committee members have provided consultation on The Competencies in American Samoa, Bulgaria, the Commonwealth of the Northern Mariana Islands, the Federated States of Micronesia, Poland, the Republic of the Marshall Islands, the Republic of Palau, Italy, Slovenia, and the Territory of Guam. The Competencies also is being considered for trainings in Thailand by a Thai delegation through CSAT. In addition, the Web site created for the original version of The Competencies has been visited by individuals from 34 countries.
Competency 44
Identify appropriate strategies for each treatment goal.
Knowledge
- Intervention strategies, onsite services, and outside referral options.
- Client’s interest in various treatment service options.
- Treatment strategies sensitive to diverse populations.
Skills
- Matching interventions to the client’s needs and resources.
- Explaining strategies in terms understand- able to the client and significant others.
- Identifying and making referrals to outside resources.
Attitudes
- Recognition that client retention improves when services are matched to the client’s needs and resources.
- Appreciation for various treatment strategies.
Competency 45
Coordinate treatment activities and community resources in a manner consistent with the client’s diagnosis and existing placement criteria.
Knowledge
- Treatment strategies and community resources.
- Contributions of other professionals and mutual- or self-help support groups.
- Levels of care and existing placement criteria.
- The importance of the client’s age, developmental and educational level, gender, and racial and ethnic culture in coordinating resources.
Skills
- Coordinating treatment activities and resources consistent with the client’s needs and preferences.
- Communicating to the client and signifi- cant others the rationale behind treatment recommendations.
Attitudes
- Acceptance of a variety of treatment recommendations.
- Recognition of the importance of coordinating treatment activities.
Competency 46
Develop with the client a mutually acceptable treatment plan and method for monitoring and evaluating progress.
Knowledge
- The relationship among problem statements, treatment goals, objectives, and intervention strategies.
- Short- and long-term treatment planning.
- Methods for evaluating treatment progress.
Skills
- Individualizing treatment plans that balance strengths and resources with problems and deficits.
- Negotiating and contracting a mutually agreeable plan.
- Writing a plan using positive, jargon-free, and proactive terms.
- Establishing criteria to evaluate progress.
Attitudes
- Sensitivity to the client’s age, developmental and educational level, gender, and racial and ethnic culture.
- Appreciation for measurable criteria of client progress.
- Willingness to negotiate a plan.
Competency 47
Inform the client of confidentiality rights, program procedures that safeguard them, and the exceptions imposed by regulations.
Knowledge
- Federal, State, and agency confidentiality rules and regulations, requirements, and policies.
- Resources for legal consultation.
Skills
- Communicating the roles of various interested parties and support systems.
- Explaining clients’ rights and responsibilities and applicable confidentiality rules and regulations.
- Responding to questions and providing clarification as needed.
- Referring to appropriate legal authority.
Attitudes
- Respect for clients’ confidentiality rights.
- Commitment to professionalism.
- Recognition of the importance of professional collaboration within the bounds of confidentiality.
Competency 48
Reassess the treatment plan at regular intervals or when indicated by changing circumstances.
Knowledge
- How to evaluate the client’s response to treatment.
- When and how to revise the treatment plan.
Skills
- Assessing the client’s response to treatment.
- Modifying the treatment plan based on review of the client’s response to treatment and/or changing circumstances.
- Negotiating changes to the plan with the client and significant others.
Attitudes
- Recognition of the value of client input in revising the treatment plan.
- Openness to critically examine one’s work.
- Respect for the input of the client and significant others.
- Willingness to learn from clinical supervi- sion and modify practice accordingly.
Bibliography
Adams, N., & Grieder, D.M. (2005). Treatment Planning for Person-Centered Care: The Road to Mental Health and Addiction Recovery. Burlington, MA: Elsevier Academic Press.
Allen, J.P., & Mattson, M.E. (1993). Psychometric instruments to assist in alcoholism treatment planning. Journal of Substance Abuse Treatment, 10(3):289-296.
Anderson, A.J. (1999). Comparative impact evaluation of two therapeutic programs for mentally ill chemical abusers. International Journal of Psychosocial Rehabilitation, 4:11-26.
Appelbaum, P.S., & Gutheil, T.G. (1982). Clinical aspects of treatment refusal. Comprehensive Psychiatry, 23(6):560-566.
Argeriou, M., & Daley, M. (1998). An examination of racial and ethnic differences within a sample of Hispanic, White (non-Hispanic), and African American Medicaid-eligible pregnant substance abusers: The MOTHERS Project. Journal of Substance Abuse Treatment, 14(5):489-498.
Barber, J.P., Luborsky, L., et al. (1999). Therapeutic alliance as a predictor of outcome in treatment of cocaine dependence. Psychotherapy Research, 9(1):54-73.
Barber, J.P., Luborsky, L., et al. (2001). Therapeutic alliance as a predictor of outcome in retention in the National Institute on Drug Abuse collaborative cocaine treatment study. Journal of Consulting and Clinical Psychology, 69(1):119-124.
Borkman, T.J. (1998). Is recovery planning any different from treatment planning? Journal of Substance Abuse Treatment, 15(1):37-42.
Cacciola, J.S., Koppenhaver, J.M., et al. (1999). Test-retest reliability of the lifetime items on the Addiction Severity Index. Psychological Assessment, 11(1):86-93.
Carise, D., Gurel, O., et al. (2005). Getting patients the services they need using a computer- assisted system for patient assessment and referral—CASPAR. Drug and Alcohol Depen- dence, 80(2):177-189.
Crevecoeur, D., Finnerty, B., & Rawson, R. (2004). Los Angeles County Evaluation System (LACES): Bringing accountability to alcohol and drug abuse treatment through a collabora- tion between providers, payers, and researchers. Journal of Drug Issues, 32(1):881-892.
DiClemente, C.C., & Scott, C.W. (1997). Stages of change: Interactions with treatment compliance and involvement. In L.S. Onken, J.D. Blaine, & J.J. Boren (Eds.) Beyond the Therapeutic Alliance: Keeping the Drug-Dependent Individual in Treatment. NIDA Research Monograph No. 165. Rockville, MD: National Institute on Drug Abuse, 131-156.
Drake, R.E., & Mueser, K.T. (2000). Psychosocial approaches to dual diagnosis. Schizophrenia Bulletin, 26(1):105-118.
Drake, R.E., Mueser, K.T., et al. (2004). A review of treatments for people with severe mental illnesses and co-occurring disorders. Psychiatric Rehabilitation Journal, 27(4):360-374.
Harkness, A.R., & Lilienfeld, S.O. (1997). Individual differences science for treatment planning: Personality traits. Psychological Assessment, 9(4):349-360.
Hser, Y.-I., Polinsky, M.L., et al. (1999). Matching client’s needs with drug treatment services. Journal of Substance Abuse Treatment, 16(4):299-305.
Huitt, W.G. (2004). Maslow’s hierarchy of needs. Educational Psychology Interactive. Valdosta, GA: Valdosta State University.
Jensen, J. (1992). Treatment planning in the 90’s: Part 1. Addiction and Recovery, 12(7):48-50. Jensen, J. (1993). Treatment planning in the 90’s: Part 2. Addiction and Recovery, 13(3):50-52.
Joe, G.W., Simpson, D.D., & Broome, K.M. (1998). Effects of readiness for drug abuse treatment on client retention and assessment of process. Addiction, 93(8):1177-1190.
Johnson, S.L. (2004). Therapist’s Guide to Clinical Intervention (2nd ed.). San Diego, CA: Elsevier, Inc.
Joint Commission on Accreditation of Healthcare Organizations (JCAHO) (2002). A Practi- cal Guide to Documentation in Behavioral Health Care (2nd ed.). Oakbrook Terrace, IL: JCAHO.
Kadden, R.M., & Skerker, P.M. (1999). Treatment decision making and goal setting. In B.S. McCrady & E.E. Epstein (Eds.) Addictions: A Comprehensive Guidebook. New York: Oxford University Press, 216-231.
Kosten, T.R., Rounsaville, B.J., & Kleber, H.D. (1987). Multidimensionality and prediction and treatment outcome in opioid addicts: 2.5-year follow-up. Comprehensive Psychiatry, 28(1):3-13.
Lordan, E.J., Kelley, J.M., et al. (1997). Treatment placement decisions: How substance abuse professionals assess and place clients. Evaluation and Program Planning, 20(2):137-149.
Luborsky, L., Crits-Christoph, P., et al. (1986). Do therapists vary much in their success? Findings from four outcome studies. American Journal of Orthopsychiatry, 56(4):501-512.
Luborsky, L., Diguer, L., et al. (1996). Factors in outcomes of short-term dynamic psychotherapy for chronic vs. nonchronic major depression. Journal of Psychotherapy Practice and Research, 5(2):152-159.
Makover, R.B. (2004). Treatment Planning for Psychotherapists: A Practical Guide to Better Outcomes. Arlington, VA: American Psychiatric Publishing, Inc.
McLellan, A.T., Carise, D., & Kleber, H.D. (2003). Can the national addiction treatment infrastructure support the public’s demand for quality care? Journal of Substance Abuse Treatment, 25(2):117-121.
McLellan, A.T., Grissom, G.R., et al. (1993). Private substance abuse treatments: Are some programs more effective than others? Journal of Substance Abuse Treatment, 10(3):243-254.
McLellan, A.T., Grissom, G.R., et al. (1997). Problem-service “matching” in addiction treatment: A prospective study in 4 programs. Archives of General Psychiatry, 54(8):730-735.
McLellan, A.T., Hagan, T.A., et al. (1999). Does clinical case management improve outpatient addiction treatment? Drug & Alcohol Dependence, 55(1-2):91-103.
McLellan, A.T., Kushner, H., et al. (1992). The fifth edition of the Addiction Severity Index. Journal of Substance Abuse Treatment, 9(3):199-213.
McLellan, A.T., Luborsky, L., et al. (1980). An improved diagnostic evaluation instrument for substance abuse patients: The Addiction Severity Index. Journal of Nervous and Mental Disease, 168(1):26-33.
McLellan, A.T., Luborsky, L., et al. (1985). New data from the Addiction Severity Index: Reliability and validity in three centers. Journal of Nervous and Mental Disease, 173(7):412-423.
McLellan, A.T., & McKay, J.R. (1998). Components of successful treatment programs: Lessons from the research literature. In A.W. Graham, T.K. Schultz, & B.B. Wilford (Eds.) Principles of Addiction Medicine (2nd ed.). Chevy Chase, MD: American Society of Addiction Medicine, 327-343.
Mee-Lee, D. (1998). Use of patient placement criteria in the selection of treatment. In A.W. Graham, T.K. Schultz, & B.B. Wilford (Eds.) Principles of Addiction Medicine (2nd ed.). Chevy Chase, MD: American Society of Addiction Medicine, 363-370.
National Institute on Drug Abuse (NIDA) (1999). Principles of Drug Addiction Treatment: A Research-Based Guide. NIH Publication No. 00-4180. Rockville, MD: NIDA.
Perkinson, R.R. (1997). Chemical Dependency Counseling: A Practical Guide. Thousand Oaks, CA: Sage Publications.
Prochaska, J.O., & DiClemente, C.C. (1982). Transtheoretical therapy: Toward a more integrative model of change. Psychotherapy: Theory, Research, and Practice, 19:276-288.
Prochaska, J.O., & DiClemente, C.C. (1986). Toward a comprehensive model of change. In W.R. Miller & N. Heather (Eds.) Treating Addictive Behaviors: Processes of Change. New York: Plenum Press, 3-27.
Roget, N., & Johnson, M. (1995). Pre- and Post-Treatment Planning in the Substance Abuse Treatment Case Management Process. Carson City, NV: Nevada Bureau of Alcohol and Drug Abuse.
Rollnick, S. (1998). Readiness, importance, and confidence: Critical conditions of change in treatment. In W.R. Miller & N. Heather (Eds.) Treating Addictive Behaviors (2nd ed.). New York: Plenum Press, 49-60.
Sanchez-Craig, M., & Wilkinson, D.A. (1997). Guidelines for advising on treatment goals. In S. Harrison & V. Carver (Eds.) Alcohol and Drug Problems: A Practical Guide for Counselors (2nd ed.). Toronto, Canada: Addiction Research Foundation, 125-139.
Schuckit, M.A. (1999). Goals of treatment. In M. Galanter & H.D. Kleber (Eds.) American Psy- chiatric Press Textbook of Substance Abuse Treatment (2nd ed.). Washington, DC: American Psychiatric Press, 89-95.
Schultz, J.E., & Parran, T., Jr. (1998). Principles of identification and intervention. In A.W. Graham, T.K. Schultz, & B.B. Wilford (Eds.) Principles of Addiction Medicine (2nd ed.). Chevy Chase, MD: American Society of Addiction Medicine, 249-261.
Semlitz, L. (2001). Treatment planning and case management. In T.W. Estroff (Ed.) Manual of Adolescent Substance Abuse Treatment. Arlington, VA: American Psychiatric Publishing, Inc.
Sobell, M.B., & Sobell, L.C. (1999). Stepped care for alcohol problems: An efficient method for planning and delivering clinical services. In J.A. Tucker, D.M. Donovan, & G.A. Marlatt (Eds.) Changing Addictive Behavior: Bridging Clinical and Public Health Strategies. New York: Guilford Press, 331-343.
Soden, T., & Murray, R. (1997). Motivational interviewing techniques. In S. Harrison & V. Carver (Eds.) Alcohol and Drug Problems: A Practical Guide for Counselors (2nd ed.). Toronto, Canada: Addiction Research Foundation, 19-59.
Sylvestre, D.L., Loftis, J.M., et al. (2004). Co-occurring hepatitis C, substance use, and psychi- atric illness: Treatment issues and developing integrated models of care. Journal of Urban Health, 81(4):719-734.
Tickle-Degnen, L. (1998). Communication with clients about treatment outcomes: The use of meta-analytic evidence in collaborative treatment planning. American Journal of Occupational Therapy, 52(7):526-530.
Tickle-Degnen, L. (1998). Using research evidence in planning treatment for the individual client. Canadian Journal of Occupational Therapy, 65(3):152-159.
Waltman, D. (1995). Key ingredients to effective addictions treatment. Journal of Substance Abuse Treatment, 12(6):429-439.
Weed, L.L. (1968). Medical records that guide and teach. New England Journal of Medicine, 278:593-600.
Wiger, D.E., & Solberg, K.B. (2001). Tracking Mental Health Outcomes: A Therapist’s Guide to Measuring Client Progress, Analyzing Data, and Improving Your Practice. New York: John Wiley & Sons.
