People Driven vs. Paperwork Driven
Historically we have been driven by a paperwork model of treatment instead of a Person centered model of treatment. Often times a client may call for help with marital, family, parenting, emotional, financial, legal or addiction problems only to be put “on hold” so providers can get through a stack of paperwork to get to know the client before addressing the problem the client came in for. This often led to weeks of waiting……..and waiting.
Many times causing people to feel “heavier” and more burdened then when they first contacted us for help. If we address the issue or presenting concern on the first encounter we validate the client and immediately develop the infrastructure for a trusting relationship.
Data Mining or Discovery?
I suppose the intent behind the requirements in a comprehensive assessment might have a purpose in data tracking, outcomes tracking and research around the poorest populations. Take private commercial insurance for example, the regulations regarding needed information to provide behavioral health is much less cumbersome. For those of us with commercial insurance think about the last time you sought out counseling, did you have to go through the same assessments, treatment plans and screening tools we require in Medicaid driven business? Why are we putting our most vulnerable populations through the gathering of this data? We all want to cure poverty. Perhaps we want to get to the root of the problems so that we can treat them and help the client overcome a lifetime of pain so they can return to a higher functioning in society. These can be good reasons but the question begs, is this necessary process to get people to positive outcomes.
Take the ACES assessment for example, some of us may have very high ACES scores but over the years we have built coping skills and resiliency necessary to function in our families, workplaces and then community that are not necessarily the reason we might be having a problem today. Sure there could be contributing factors or furthermore our response to daily problems of life may be impacted by something traumatic in our past but the research shows that we actually do harm by forcing our clients to uncover their trauma history before we treat them. This often leaves clients more “broken” than when they came in. Why do we do this we might ask?
TreatFirst gives us a tool to move people through a treatment program that is based on the problem they are presenting to us, not the problems we may go “digging” for. Generally the client is given the opportunity to have counseling within a few days, crisis are addressed immediately, not after assessment, treatment plan and 3 weeks waiting for counseling. Granted some problems may need more than the 4 visits to address and there may be more serious matters at hand including severe impairment related to symptoms of SMI or SUD and at that time referrals can be made for more specialized care within our organization. TreatFirst gives the professionals more time to holistically look at what the client may need by using Motivational Interviewing to identify client strengths that will be utilized to navigate through services. By doing so providers can address and develop a coordinated plan of care with a warm hand off to our other levels of care. The 4 visits gives the client a chance to get comfortable and the clinician a longer period of time to get to know the client in a meaningful and less intrusive way.
Task driven vs. Trust driven
Often times the first session with a Therapist or Psychiatrist performing the assessment can feel like a game of 50 questions ranging from your mother’s prenatal care to your first sexual encounter. Often our clients get discouraged because they don’t think these questions are pertinent to how they feel and what they are going through at this point in time AND they may not be emotionally prepared to “go so deep on the first date”. When engaging with the client through a natural rapport building conversation a lot of material is covered in those sessions/visits that lead to fill in the blank space in an assessment. With informal conversation trust can be built faster than looking like your reading a script asking a lot of questions. Building trust in the first couple of appointments is very important. By getting to know the client and building trust the client should feel more comfortable answering more personal questions on the assessment, should the client need to extend services beyond the 4 visits.
The Good News - Quiz
With TreatFirst you can visit with a client “in 4 and out the door” or if the recovery needs are extended the assessment can then the assessment is ready to be developed. By this point a therapist will have learned enough about a client to easily plug this data in to the assessment and treatment plan without the client feeling so unprepared for in depth disclosure. The conversation should be more natural and rapport is generally established. The model in itself is strength based and client driven which leads to better outcomes, higher “show rates” and less provider frustration.
[insert multiple choice quiz questions/answers here]
Intro to Talk 4
Treat First emphasizes meeting the client where they are and engaging clients quickly in services that address immediate needs. Talk 4 will go over the 5 P’s approach to developing a case formulation, drawn from conversational style of engagement helps clinicians to move away from a stiff and sterile approach to formulation and treatment planning and helps clinical staff to listen to the client voice in approaching treatment.