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First 30 Days: Assessment and Goal Setting
Yvette Kelly, LMHC Geraldine Burton, FPA Lydia Franco, LMSW
It’s a Tall Order! …to develop comprehensive treatment plans
based on a thorough mental health assessment within 30 days.
• Why the First 30 Days are Important • The Goals of the First 30 Days • Key Components of the First 30 Days:
– Initial Engagement – Clinical Formulation and Assessment – Collaborative Treatment Planning and Goal Setting
• Questions?
Agenda
Why Are the First 30 Days Important?
• There is a high drop out rate within the first 30 days.
• When clients leave they don’t keep it to themselves • If clients discontinue early, they often return later
with more serious difficulties • If we aren’t successful in the first 30 days, the
underuse and overuse of services is increased
Alignment with practitioner, clinical formulation, and caregiver’s felt needs
How do you know if this is accomplished: There are shared goals or focus of treatment There is an understanding of what treatment is
and the role of caregiver, child, and therapist in successful treatment
There is clear agreement for the treatment plan
Goal of the First 30 Days
The Alignment Model of the First 30 Days
Alignment (shared goals and
focus of treatment)
Shared Understanding of
Treatment
Clear Roles in Treatment
Psychoeducation
Collaborative Treatment Plan
Agreement with Child
Focus on Strengths
Initial engagement Clinical
formulation and assessment
Collaborative treatment planning
and goal setting
Key Components of the First 30 Days
Communicating with caregivers is key to engagement.
Init ial Engagement is Crit ical
What is the most critical message to communicate to caregivers?
How do families describe what therapy is at your
agency to other people ?
What do we want them to say?
How Our Processes May Look and Feel for Parents:
Key Component: Initial Engagement
• Practitioner core competencies: connecting, empathy, active and reflective listening, imparting critical information
• Attending to: • Felt needs (dissatisfaction, catalyst, problem, distress) • Barriers to using services • Previous experiences with treatment (treatment relevance)
• Psychoeducation: What is treatment, roles of practitioner and client, information about the problem
• Transparency • Identification, validation, and reinforcement of caregiver
strengths
Parent Advocates and Family Support
• Family Support Programs are available across the state
• Parent Advocates/Family Partners can provide a vital role in supporting and engaging the family in services
http://www.ftnys.org/regional-parent-parent-advisors-
resource-directories/
• Psychoeducation is a critical component across treatment approaches and diagnoses!
• Key messages to share: – No fault problem (correct this idea) – No right way for everyone – Take care of yourself – Don’t forget the positive (reinforcement is a powerful tool) – Together we can make real progress ( what is my role, your role and the child’s
role. We are partners working together. – Change takes time – You are not alone (your child’s problems have been experienced by others) – Dangerous situations need our immediate attention (self harm and harm to
others and property) – Ask questions (important that we have a shared understanding) – Important to reach out to and use your social supports – Be hopeful (we can develop a plan that can make things better)
Aligning with Families
• Orientation to Services – How does accessing services work at your agency? – What are the services? What is therapy? – Who will the family be seeing to access the services? – Who do they contact with any questions or concerns? – What resources are given to the family? – What is the role of the therapist, caregiver, and child?
Is all of this communicated to the family?
Building Mental Health Literacy
What other messages should we communicate to families at the beginning of services?
Let’s Chat
• Time constraints – productivity demands • Focused on the agency protocol and completing
paperwork • Not used to working in this way • Assumptions about the family (they know that
already) • Perspectives of the family may be skewed or
negative
Are there any other barriers?
Barriers in Consistently Ensuring Alignment
What are some things that you have done to overcome some of these barriers?
Let’s Chat
• Change emphasis of sessions to focus on what will engage families
• Revise agency protocol to incorporate these core concepts – “Just because it’s how it’s always been done doesn’t mean it has to
stay that way” – Why are you doing it that way if it’s not working for everyone?
• Provide guides for providers to support inclusion of concepts – see resources
• Structure supervision sessions to include practicing concepts - role playing, scenarios
• Observation by supervisor • Self-assessment of staff
Some Strategies to Overcome Barriers
• Diagnosis • Presenting problems: Why is the child referred for
services? • Contextual factors: family stress, community
resources and strengths – Example-Family Assessment Device- http://web.up.ac.za/UserFiles/FAD.pdf
• Strengths – People, places, things, and competencies, or skills that you can draw to accomplish
treatment goals for child and caregiver
• Helps to establish a baseline assessment of problem severity and the clinical focus for treatment
Key Component: Clinical Formulation/Assessment
• How can you get information to make the assessment process meaningful and positive for families? – Judicious in questioning – Utilize information already gathered – Be mindful of how difficult this may be for the families – Be creative in how you gather information
• e.g., use pictures in wallet – Coordination of information gathering across providers – “Anything else I should know about your family?” – Invite someone else in the session (e.g., family advocate)
What are some strategies that you have utilized?
Strategies for Gathering Information
Establish Strengths!
Promotes alignment Build on to address
problems Move away from
‘problem’ focus Helps to indicate
outcomes
Establish Baseline
Assists with monitoring progress
Assists with agreement of treatment focus
Assists with collaborative treatment planning and goal setting
&
Once you have a diagnosis, you enter into an important clinical decision-making stage:
TREATMENT PLANNING and GOAL SETTING
What is most helpful to do this successfully?
Key Component: Collaborative Treatment Planning and Goal Setting
• Safety • Urgency • Most important factor(s) bringing the child into
treatment at this time • Focus on a problem area in which the family strengths
can be utilized • What area is aligned with the felt need of the child
and/or caregiver • Where are you likely to get an early win • Begin where you have the most information to develop
a plan
Initial Treatment Planning: Deciding Where to Begin
• What is the diagnosis? What does it mean? • What are the symptoms? • What is the prognosis? • What are best practices in treating the illness?
Sharing Information about the Illness
• Joint selection of high priority goals • Joint selection of treatments • Joint selection of discharge planning criteria
Collaborative Treatment Planning: Transparency, Consensus and Specificity
Shared vision,
mission, power,
resources, & goals.
Respect
Real Listening
Commu-nication
Empathy
Choice
Resources
Collaboration Wheel
•Meeting families where they are: Gain an understanding of the family’s
• Needs • Strengths • Resources • Motivation
Inform family of the resources/options available to assist them in overcoming their difficulties (based on the above)
Inform the family of limitations of resources (i.e., payment, time -limited)
Allow the family time to consider the pros and cons and decide whether or not they would like to participate (legal considerations)
Support the family in their decision and offer to connect them to other services if warranted
How do you create choice?
Joint Selection of Goals
Collaborative Treatment Plan!
What do you need to help with your child’s
behavior?
What can we work on together so that child, your are feeling a little better throughout the day and so
that you, mom, feel heard and respected?
What are 2 things you’d like to work on together with your
child?
What are 2 things you (child) would like to
change?
What does your child need to help with his
behavior?
My child (age 10) disobeys me all of the time and his moods are up
and down throughout the day
• Discussing treatment options to support shared decision-making: – Evidence based treatments
• NREPP: http://www.nrepp.samhsa.gov/Index.aspx
– Common elements approach • The features that characterize successful treatments • Strategies that are common across effective
interventions
Joint Selection of Treatments Involves
A focus of treatment is imperative. If you don’t have a clinical focus, you may be
faced with a heard of COWs (Crisis of the Week).
• Counselor will be meeting with Jerry, a parent who was referred by her child’s school due to her child’s disruptive behaviors in the classroom. Jerry is extremely frustrated with the school as they routinely call her, while she is at work, to inform her of the difficulties they are having with her child. It has gotten to the point where she is at risk of losing her job. Jerry is even more frustrated because her child does not display these behaviors at home. Yet she arrives at the clinic at the recommendation of the school.
Role Play: Putting these Concepts into Action!
The Alignment Model of the First 30 Days
Alignment (shared goals and
focus of treatment)
Understanding of Treatment
Clear Roles in Treatment
Psychoeducation
Collaborative Treatment Plan
Agreement with Child
Focus on Strengths
Collaboration is Key!
Questions
Next Webinars in the Series
• First 30 Days, Part II: Discharge Planning and Outcomes – NEW DATE: Wednesday, February 11th; 12PM to 1PM
• Consultation Webinar for the First 30 Days – Wednesday, February 18th; 12:00-1:00pm – Use the First 30 Days Checklist!
• Next Core Area: – Family Engagement Practices – Check email for announcements!
Yvette Kelly [email protected]
Geraldine Burton
Lydia Franco [email protected]
Thank you for participating with us today!
www.ctacny.com
