Treatment/Recovery

Planning
Developed by: Chrissie Martin, LMFT, LAC-S, CS
National Clinical Director, Central
Presented by: Boni-Lou Roberts, MSHE, CADC II, MATS
National Clinical Trainer
 Today’s Objectives

01 02 03
Understand the central Learn strategies to Walk through the
role of the treatment create individualized, components of a
plan in guiding care outcome-oriented treatment plan and
treatment plans learn how to develop
goals and methods
which are measurable
and time-bound
Why is
Treatment
Planning
Important?
Purpose of Treatment
Planning
• Provides a roadmap for attaining
goals that both the patient and
the treatment team can follow
• Maintains the outcome
orientation in our work
• Provides structure and guides
service delivery
A Treatment Plan is NOT
• It is NOT a written document that:
• Identifies what the program’s goals are for
the patient
• Lists program expectations for the patient –
rules they must follow
• Is meaningless and tedious and generally
ignored
• Remains static
• Is the same patient to patient
• Is program driven
A Treatment Plan IS
• A written document that:
• Identifies what the patient’s goals are for treatment
• Describes measurable, achievable, and time-bound
steps that the patient can take towards achieving
those goals
• Describes the services, interventions, and supports
the treatment team will provide to assist the patient
in achieving those goals
• Is founded upon a thorough biopsychosocial
assessment, tying the assessment information to the
patient's treatment
• Is individualized and outcome driven
Where do we
start?
• Treatment Planning starts
with assessment
• Assessments must be
comprehensive and
multidimensional to plan
effective care
• Assessments help us to
determine clinical severity,
identify needs, and
identify strengths
 Multi-
Dimensional
Severity
Risk Ratings
4 – This rating would indicate issues of utmost severity.
The patient would present with critical
impairments in coping and functioning, with signs and symptoms, indicating an “imminent danger”
concern.

3 – This rating would indicate a serious issue or difficulty coping with in a given dimension. A
patient presenting at this level of risk may be considered in or near “imminent danger.”

2 – This rating would indicate moderate difficulty in functioning.However, even with moderate
impairment, or somewhat persistent chronic issues, relevant skills, or support systems may be
present.

1 – This rating would indicate a mildly difficult issue, or present minor signs and symptoms. Any
existing chronic issues or problems would be able to be resolved in a short period of time.

0 – This rating would indicate a non-issue or very low-risk issue. The patient would present no
current risk and any chronic issues would be mostly or entirely stabilized.
Strengths Needs
Abilities & Preferences
• While identifying problem areas is an important part of
our assessment and treatment planning process, it is
equally important that we also gather information on
the patients SNAP
• Treatment Plans should:
• address what the patient perceives as their
greatest needs
• consider and attend to any preferences they’ve
expressed for their treatment
• and should leverage the patient’s strengths and
abilities
Recovery
Capital
“ Recovery capital (RC) is the
breadth and depth of internal and
external resources that can be
drawn upon to initiate and sustain
recovery from severe AOD
problems”
(Granfield & Cloud, 1999; Cloud &
Granfield, 2004)
How can we use
the Patient’s
Strengths &
Abilities in the
Treatment Plan?
 Forming the Plan

Explanation Identification Formulation

Negotiate the plan with the
Explain the results of the Identify and rank problems and patient.
assessment, including priorities
recommendations for treatment. Come to agreement on the short-
Attend to the patient’s own and long-term goals and the
Explore their reactions, listen to priorities and preferences strategies that will be used to
their concerns achieve them.
 Lack of
Health Trauma
Insurance

Parenting
Heroin Use Needs

Employment
Needs

High Risk
Dental Issues Living
Situation

Family
Stressors Tobacco Use

Stimulant use

Educational
Goals

Depression
Identification:
How to Target & Focus Treatment Priorities
What does the patient want?
1

Are there any immediate needs/imminent risks?

2

What is the diagnosis?

3

What are the severity results of the patient’s multi-dimensional assessment?

4 Which dimensions are currently most important / highest risk?
What happens
when we don’t
listen to what
the patient
wants?
Who Else Might
Give Input?
• The development of the
treatment plan should
involve input from the
counselor and the patient
• This partnership should
result in a mutual
agreement of what the
goals for treatment will be
and what the road to get
there will look like
• Who else can give input?
Formulation
• There are four necessary steps
to creating a treatment plan:
• identifying the problem
statements,
• creating goals,
• defining objectives to reach those
goals, and
• establishing interventions
BHG Policy 417: Treatment Plans
Let’s Review!
Policy 417: Timeframes
• The counselor who conducted the admission
assessment prepares an initial treatment plan at the
time of admission that is based upon at least an
assessment of the patient’s presenting problem(s),
physical health, emotional status, behavioral status and
drug use history.
• This initial treatment plan will be utilized to implement
immediate treatment goals and objectives
• Within 30 days after admission, a comprehensive
Individualized Treatment Plan must be developed
based on the Comprehensive Assessment with the
patient’s participation
Policy 417: Who is Involved
• The treatment plan reflects BHG’s treatment philosophy and includes the
participation of team members from appropriate disciplines as well as the
patient. The multidisciplinary team could include the physician, nurse
practitioner, nurses, program director, counselor supervisor, primary
counselor and counselor(s) other than the patient’s primary counselor.
• Both the initial and updated treatment plans reflect the consideration of
the patient’s clinical needs and the recognition of opioid dependency as a
primary medical diagnosis. The patient is asked to sign the treatment plans
and is given a copy for their review if desired. Included in the treatment
plan will be the patient’s goals, objectives and methods and services for
achieving them.
 Policy 417 “Each Treatment Plan Contains: Identified
Problems.”

Consider the priorities based on your multidimensional

Forming assessment and which dimensions are of most concern.

the Consider what the patient identifies as the “problem” and

the areas they want to focus on.
Problem It is easy to overgeneralize problem statements. When we
Statements do that, we lose both specificity and individualization.

Check the problem you have decided to address on the

treatment plan for specificity and individualization by
asking yourself, "What made me say that?".
Problem Statements – “What made me say
that?”
• Example:
• For a problem area you put down, “Patient lacks sober
social supports.”
• Ask yourself, “why did I just put that?”
• Answer, “John lives in an environment with people
who still use heroin and doesn’t really have any
friends or know anyone that doesn’t use drugs or
alcohol.”
• Individualized problem statement: “John lives in an
environment with people who still use and doesn’t really
have any friends or know anyone that doesn’t use drugs
or alcohol.”
Goal Statements
• Should be based on the Problem
Statement
• Should be reasonable and
achievable within the established
Target Date
• Based on our problem statement
from the last slide, what are
some goal statements you might
see?
Goal Statements
• The direction you take for the goal
statement is going to depend largely on
what the patient wants to and is willing to
work on.
• “John will find new housing more supportive of
his recovery efforts.”
• “John will establish relationships with peers
who are in recovery.”
• “John will evaluate how his social relationships
may impact his recovery efforts and consider
whether he needs to make changes.”
 Words of the
Patient
• BHG Policy 417: Each Treatment
Plan contains goals :
• based on patient needs,
identified in the assessment(s),
and expressed in the words of
the patient.
• Understandable, agreeable and
appropriate to the patient
• Based on patient’s problems,
needs, abilities, strengths and
preferences
• Achievable
 • Problem: John lives in an
environment with people who still
use and doesn’t have friends or
support who do not use.
• Goal: John has a stable job and
steady income (STRENGTH!!) and
Example would like to find housing that
would be more supportive of his
recovery.
• Words of the patient: “I know I
need to get out of there. I’ll never
stop using if I stay there.”
Objectives
• Objectives (methods) identify what the patient is going
to do or accomplish in order to achieve the goal.
• If our goal is for “John to find new housing more
supportive of his recovery”, some methods might be:
• John will establish a budget for what he can afford
to spend on housing and share it with his counselor
• John will call the recovery housing options in the
area to find out about availability and whether they
allow MAT medications, and will report back to his
counselor
• John will be able to verbalize the coping strategies
he will use until he is able to establish new housing.
Making objectives
measurable: “How will I
know?”
• Its important that the goal and
methods we develop with our
patients are attainable AND
measurable. Making it
measurable is how we will know
if the patient has or has not
attained the goal.
• Test the measurability of your
method by asking yourself
afterwards, “How will I know my
patient has attained this.”
How will I know?
• Example:
• John will learn how his home environment negatively
impacts his recovery efforts.
• How do you measure whether or not John has learned?
• John will discuss with his counselor at least 3 ways in
which his home environment might negatively impact his
recovery efforts.
• How will I know? John has verbalized it to me.
 • Write in your suggestions how
you could re-frame the following
methods in order to make them
more measureable:
1. Patient will further develop his
Make it insight into his relapse triggers.
measureable 2. Patient will understand the
concept of addiction as a disease.
3. Patient will learn healthier
coping strategies for managing
stress that leads to relapse.
Don’t forget the BAM
• BHG Policy 417: Each Treatment Plan
Contains: Brief Addition Monitor (BAM)
Score
• The BAM is a multidimensional,
progress-monitoring instrument for
patients in treatment for a substance
use disorder (SUD).
• It provides a score across 3 domains:
Use, Risk and Protective Factors
• The BAM is completed at intake and
with every treatment plan review and
should be used as a part of the
patient’s treatment plan.
Examples
• Goal #1: “I need to stop using heroin.”
• Objective: Within the next 90 days, John will achieve a 50% reduction in his
BAM Risk score of ____.
• Goal #2: “I could use more supports and some better stuff to do with
my time.”
• Objective: Within the next 90 days, John will increase his BAM Protective
Score by at least 3 points.
Using the BAM

• You can also use specific questions from the BAM to support measurable objectives on
the treatment plan.
• Examples: Goal #1: John Doe will enjoy healthy sleep.
• Objective #1: By (a certain date), John will report no nights with sleep disturbances
(BAMQ2).
• Objective #2: By (a certain date), John will report no use of alcohol in the past 30
days (BAMQ4).
• By using BAM scores and responses in the objectives, we are able to provide measurable
evidence of progress
 Target Dates

Both Goals and Methods Target dates should be Policy 417: “Objectives
should have target dates realistic, and should make must have specified time
sense in relation to the frames or target dates.”
goal or objective
Target Dates
• Sarah will complete an All-Purpose
Coping Plan to utilize when feeling
triggered and vulnerable to use.
Target Date: 04/23/2023
• Within the next 90 days, Sarah will
participate in a guided exercise on
urge surfing with her counselor.
• As needed over the next 90 days,
Sarah will complete a functional
analysis following any episodes of
substance use during her weekly
counseling sessions.
Interventions
• While objectives reflect what the
patient is going to be doing, the
interventions should reflect what
the treatment team will do to
help facilitate the patient
achieving the objectives.
• There should be connection
between the objectives and the
interventions.
Interventions
• The interventions should include the
specific services that will be provided to
the patient, including the frequency of
services.
• Additional interventions should provide
information on clinical interventions
and strategies that will be implemented
to assist the patient in achieving their
objectives.
• Interventions should list the team
member responsible for that
intervention
What interventions would you use?

• Within the next 30 days, John will establish a budget for what he
can afford to spend on housing and share it with his counselor
• Within the next 60 days, John will identify housing options within
his budget and review them with his counselor
• Within the next 60 days, John will call the recovery housing
options in the area to find out about availability and will report
back to his counselor
• Within the next 30 days, John will be able to verbalize coping
strategies he will use until he is able to establish new housing.
Examples
• Counselor will provide patient with referrals
for housing options in the community
• Counselor will complete session 13 of
Matrix with the patient on Being Smart, Not
Strong
• Counselor will complete a refusal skills
exercise with the patient, prompting the
patient to identify strategies for avoiding
substance use when presented with
opportunity to use.
• Counselor will assist the patient in the
development of a coping plan to implement
when faced with external triggers for use
Stages of
Change
• When developing the
Goals, Objectives and
Interventions, it is
important to consider
the patient’s stage of
change
Mismatched Goals
• John lives in an environment with people
who still use and doesn’t really have any
friends or know anyone that doesn’t use
drugs or alcohol. “Everyone I know uses.”
• Possible Goals:
“John will find new housing more
supportive of his recovery efforts.”
“John will establish relationships with
peers who are in recovery.”
“John will evaluate how his social
relationships may impact his recovery
efforts and consider whether he needs
to make changes.”
Discovery Planning
• Discovery Plans (or Dropout Preventions
Plans) are for individuals in pre-
contemplation or contemplation, who may
not yet be interested in making a change.
• Discovery plans help patients to discover for
themselves (with our help) that what they
are doing with their emotions, behavior
and thinking is not getting them what they
want.
• “We need to do all we can to prevent them
from dropping out of services, so we have a
chance to attract them into recovery.”
David Mee-Lee, MD.
Discovery Plan for John
• “John will evaluate how his social relationships may impact his
recovery efforts and consider whether he needs to make changes.”
• John will complete a decisional balance activity weighing the pros and cons of
not changing his social environment
• John will complete a values clarification activity and will identify how his
social relationships help him to achieve his values and how they may hinder
him from achieving his values.

• Counselor will utilize motivational interviewing to develop discrepancies

between John’s desire to discontinue his substance use and his choices in
living and social environments.
When might you
need to use a
“discovery” plan
with a patient?
 • Discovery Plans may be useful when
adding a goal required by a certain
regulatory body, but that the patient
Including does not have much interest in
addressing.
Required
• CTS.03.01.01
Goals • Element of Performance: 9
• For Opioid Treatment Programs: The
program includes smoking and tobacco
cessation as an integral part of the
treatment of patients who use tobacco.
 • BHG Policy 417:
• Periodic reassessments and revisions to the
Individualized Treatment Plan are made with input
from the patient

Reviewing • At a minimum, this review occurs at a frequency

per state-specific regulations and around major key
decision points in the patient’s treatment episode.
the Plan These reviews are completed at the time of:
A. Admission to treatment
B. Transfer to/from level of care
C. A major change in the patient’s condition
D. Every 90 days or three months of treatment
(or per state-specific regulations)
Reassessment
Periodic Reassessment
BAM
Updates/Changes in
patient’s life since Treatment Plan
Outcome
last treatment plan measurement – is
review and Update the Plan
the current plan accordingly based
assessment working on the information
we’ve gathered
Treatment Plan Reviews
• At each Periodic Assessment and Treatment Plan
review, the plan should be updated to reflect:
• Goals that were achieved that can be removed
from the plan.
• New Problem and Goal areas that have
emerged since the last assessment.
• Changes in the patient’s treatment status or
service delivery plan
• New objectives and interventions if previous
ones did not result in the desired outcomes
Questions
[email protected]