Treatment or Service Plan
FamilyLightsm: Successor to Bridge to Understanding
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A key issue in services for people with special needs is an individual plan guiding services. We are referring to services for mental health, education, socialization, maturation, and for living. This may be called a treatment plan, an educational plan, an individual service plan, an "IEP" (Individual Education Plan), master treatment plan, or something else. It is common for such plans to focus on mental health and education. We wish these plans were more comprehensive, but in depth plans covering education and mental health are common.
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FamilyLight sm would welcome making comprehensive individual plans for every growing child through young adulthood. Another way to describe it, would be that every person of every age in the education, mental health, health care, rehabilitation, or social service systems should have such a plan. Note the inclusion of health care, which makes this pretty broad. But we digress. Our attention here needs to be on therapeutic schools and programs.
We would like to see every school or program that focuses on change using very carefully constructed plans for every student / client that state exactly where that student / client is now (updated with some regularity), where they (the school / program and the client / student) are trying to go, how they intend to get there, and who is responsible for what. An initial plan needs to be in place immediately upon entry, although that initial plan might be have great similarity from one student /client to another and focus mostly upon gathering information and assessing to get a longer term plan in place. A very detailed plan based upon results of initial assessments needs to be put in place as soon as practical. We see no reason why that should ever take longer than six weeks, and unless this is a very long term program, the time should be much shorter. In a short term program (three months or less), this should happen within ten days at most, probably in less time.
These are areas that should be covered:
• Where the student / client is now: This calls for not only thorough assessment and formulation, but a clear explanation of the assumptions that are being made to fill the gaps in what is actually known about the student / client. If there is disagreement between people on the team providing services that needs to be acknowledged. To the extent feasible, the student / client -- and for children and young adults dependent on their families of origin, the parents, too -- should be part of the team for purposes of the planning process. If there is an outside case manager or referral source with case management responsibilities, that person should also be part of the team.
• Where they are trying to go? The only way an organization or even an individual therapist or teacher can stay focused on getting to particular results, unless there is a specific definition of those results is a very visible reference point that everyone on the team sees regularly. This needs to be divided into sections:
▪ What should the client / student “look like” when ready to return home or move to a lower level of structure or care. More specifically, what needs to change in order for the client/ resident to be ready to go home or to a lesser level of care or structure? We are looking for measureable/ behavioral goals or objectives that, when met, indicate readiness to move on. We are looking for expected outcomes at point of discharge.
▪ What should be different at home in order for the client/ resident to be ready to return home? We are looking for a great specificity as indicated in the bullet above.
▪ What outcomes should be expected at the next time the plan is reviewed or updated? Again these need to be very specific behavioral goals and objectives.
• How they intend to get there? There needs to be a common strategy that is supported by the entire team, that defines the resources to be needed, when and how they are to be applied, and what is the division of labor.
• Who is responsible for what? There needs to be accountability placed on the whole team and then individually, what each team member is responsible for. It also needs to address how we will know if each person individually, and the whole team collectively are delivering. It needs to show how to know whether or not the plan, and strategy are succeeding, and what we must do to revise and update the plan so we are applying what we learn as we go along.
• How frequently should there be a comprehensive review of the progress of the client/ student? For longer term programs this would typically occur once every three months. Shorter term programs may do this very frequently, perhaps weekly or even more frequently.
Schools and programs fall short on this in many ways. First there are those who simply do not provide a written plan. One therapeutic school in Massachusetts admits it does treatment plans and keeps them "in the drawer" where they have no use except to be able to demonstrate to the very naive licensing authorities of the Commonwealth of Massachusetts that they are in compliance with the licensing regulations, even if they are otherwise meaningless documents. If Massachusetts requires treatment plans should they not also require that they be used?
Those who write treatment plans, too often do not state where the student /client is now. They don't tell us the starting point. Others develop a treatment plan as soon as the person enters the program, prior to careful assessment, and never update it.
Some do not tell us how they plan to accomplish the goals. some do not define responsibility. Altogether, too often the "plans" simply confuse accountability.
Those who do use plans too frequently write treatment plans that simply avoid being specific about where they are trying to go. We frequently see so-called "goals" that begin with the word "improve" as in "Improve ability to control anger." That is not a goal; it is a process. There is no indicator to re-direct the process when it becomes evident that what was intended at planning time has not been achieved when review time arrives -- or that it was achieved and it is time to think about what is the next goal after that. Football players do not get points for moving the ball down the field; they get points for taking the ball over the goal line or between the goal posts. When a "goal" begins with a word like "improve," there is no way to know when the goal is reached, unless the intention is that the slightest improvement indicates the goal has been achieved. We expect plans in place that are specific to where they are trying to go. To further clarify, it is completely acceptable to us to have goals that do not meet this standard themselves, but are followed by a set of behavioral objectives that define precisely where the goal line falls.
Some programs are set up with well established procedures and steps all clients/ residents must follow and assume that progress comes to all when those procedures are applied. They describe a program that everyone follows that they indicate effects change. While we agree that some programs that operate that way might be very effective for some of their residents, we do not agree that program design is ever an adequate substitute for meaningful individual planning and focused execution of those plans. We do not believe that there is any single approach that will be effective for all except for establishing quality relationships between staff and clients/ residents.
Some programs defend having therapy be based solely upon what “comes up” in each therapy session. We acknowledge that even with individualized goal oriented treatment plans, there is a place for therapists to leave room in the therapeutic process for some clients/ residents to guide therapy by what they bring to the table in some sessions. In other situations, therapeutic intervention needs to be more goal oriented at all times. That varies with the situation and is an issue for individual treatment plans to address. But in all cases, it is important to define what change is expected and to continue to monitor the degree to which progress is being made toward the defined goals. Therapeutic intervention that is not at every moment consciously focused on the defined goals might serve an important purpose within the implementation of a goal oriented treatment plan. But progress is monitored by comparing actual events to the goals and objectives of the plan.
Feedback is invited. We will publish selected feedback. Email: FamilyLightResponse@yahoo.com
Disclaimer: No program review, no matter how positive, is a blanket endorsement. No criticism is a blanket condemnation. When we express our level of confidence in a school or program, that is our subjective opinion with which others might reasonably disagree. When we assert something as fact, we have done our best to be accurate, but we cannot guarantee that all of our information is accurate and up to date. When we address compliance with our guidelines, you need to remember that these are only OUR guidelines -- not guidelines from an official source. We have also set the bar very high, and do not expect any school or program to be in total compliance. It is not appropriate to draw a conclusion of impropriety (or even failure to live up to conventional wisdom) from our lack of confidence in a school or program or from less than perfect conformity to our guidelines. Some will say we expect too much. Readers are responsible for verifying accuracy of information supplied here prior to acting upon it. We are not responsible for inaccuracies.
Last updated March 17, 2010
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