Walk the Talk

Self Managed Treatment and Monitoring

(2 Minute Video = Answers you need!)(3 Cartoons Included)

(No Sound – 20-25  Seconds per Slide – Read and Learn)

Download a PDF of Video

Inmate Release Monitoring Progam 052020
Look at and download Program Elements

All Program Elements are Available to Clients – AT NO CHARGE!

Diagnostic Tools  –  Treatment Tools

USE THE LINK BELOW TO ACCESS TOOLS AND PROCESSES

https://1drv.ms/f/s!AkHi_OpkboRwgbJZgxZuzsyoIpl65g

 

Gornik Inmate Solutions

A Felon provided the solutions for a decade

This Video has 6 slides and takes about 3 minutes

Watch the Video – (Us old guys might need an ear piece – although I did get it all – by concentrating.)

watch the video–APPLYING ITS contents TO YOUR OPERATIONS = MIGHT prevent this from happening to you

The link below will take you to a PDF that provides a summary of Mark’s programs.  We at iMResponsible.com have also added a few suggestions based on our 30 years of working with Idaho agencies. The major problem with these solutions is the limited package of individuals that are pro-active in nature and have the courage to make even small changes to their inviolate environments . To download – or more easily read – this document – click on the download arrow.

Link to Gornik Treatment – Recidivism Solution

https://1drv.ms/f/s!AkHi_OpkboRwgbJZgxZuzsyoIpl65g

This Link will take you to a summary of current issues and the solutions Gornik and iMR.com recommend.    If you can get back to Gornik recidivism rates, the savings will exceed $140,000,000 and no new beds.

The Link below will take you to a folder that includes samples of the tools that are used by clinicians as they supply effective solutions to their clients.

Link to Gornik – iMR.com Inmate Tools

iMResponsible.com has designed documents designed to provide Clients with tools that can assist with Post-Release – “Real World” issues.   We will continue to add documents as they are developed.

For additional information: david@imresponsible.com – 208-853-7410 – https://www.imresponsible.com –

 

410

Student Assistance Program

Twenty years of “Real World” Stuff

Student Assistance Program

Two decades ago, a Student Intervention program (IMPACT) was introduced to Idaho educators by the Comprehensive Care/Care Unit Company.  State administrators and School employees participated in training to recognize the needs and the benefits of school Interventions. As a result, some school districts developed programs and policies designed to provide student interventions.  These would occur when Student Attitudes, Attendance, Achievement or Behaviors changed dramatically.  These changes were normally destructive and caused by “something” — to be determined.

Some schools worked with iMResponsible.com to develop processes and policies that provide effective solutions.  Environments were established that allow Interventions to occur as efficiently and smoothly as possible.  20 years later, these schools are still providing effective Interventions for their students.  The results have been addictive. Click on icon below for a one page summary of program ingredients.

Brief Look at SAP Program
Note:  At bottom of this web page -a PDF can be downloaded that contains all of the individual images that are linked/shown on this page.

The iMR Intervention process – rules in – or rules out – Alcohol/Drug issues and provides psychological screening for “dual diagnosis” consideration. Depression, Anxiety, Anger and Cognitive Issues are assessed – which is critical to comprehensive diagnosis of SUD problems.  Current addiction to drugs that are downers or uppers will influence DSM disorder analysis.  If SUD and/or MH issues are diagnosed, appropriate plans are established to improve behaviors.  If these issues are ruled out, other steps can be taken – as appropriate.

Teen Alcohol/Drug Result

 

Teen Psychological
Social/Conduct Disorder / Criminal

      Student and Family issues with Diagnostic Results are virtually eliminated.  They are presented with 15 individual scales that support the results.  Student and Family review results and individual responses to each question.  Objective + Validated results are accepted.

15 Scale Results Chart

Analysis of the results of these Intervention processes have documented: (1) reduced student violations and (2) improved attendance for some of the participants.  Post Intervention results should be consistently analyzed; but, other new “movements” tend to keep administrators’ hot buttons busy with other creations.  Suicide, Opioids, Bullying, Tobacco and Mental Health, etc. issues are but a few of these.

Considering attendance reimbursement realities and administrative costs associated with destructive student actions, a case can be made that Interventions result in a significant positive financial return on investment.

Twenty years of association with school counselors, administrators and education boards has resulted in a personal perspective that indicates: there are too many school balls in the air – all the time.  In Idaho, a standard student attendance day is 4 hours.  Considering the variety of things that can influence these four hours of study, it would seem that a focus on the KISS principal is in order.  This means fewer, simpler processes are needed – not more and more new ones.  This KISS perspective has been molded into our efficient iMR Student Assistance Program.

S A P Elements and Prices

Teachers have the unique ability to observe the personal characteristics of students over a consistent period of time.  When significant changes in behaviors are noticed, it is the result of SOMETHING.  The ability to handle these circumstances in a fluid and objective manner will provide solutions that will save lives.  Saving lives should be up at the top of Educational priorities.

All Interventions are beneficial.  Some change behaviors immediately and others provide a package of evidence that makes future needed changes – more likely.

Other than trying to convince our populace that we should learn lessons from history so as not to repeat them, I can think of no other educational option that will be remembered by all participants and will save lives.

We are hopeful that some school administrators and supporting staff members will take the time to reflect on student improvement options – and – conclude that all gets better when students feel better about themselves.

Check the Ingredients of the iMR Student Assistance Program and incorporate these, easy to manage, solutions into your educational package.  Adopting these live saving processes will not reduce attendance and learning time – they will enhance them.

For a PDF that contains a description of our “Student Assistance Program” and our deliverables, click on this Icon

PDF SAP Program Description

http://www.teamfixes.com/wp-content/uploads/2019/02/Description-of-Intervention-Process-V5-.pdf Complete form below and you will be contacted ASAP!

Corrections Autopsy

Compu-Tools (Multi-Scaled, Self Diagnosis, Computerized)

IDOC, Idaho H&W, Boise State University, Idaho Schools, 3 Local Psychologists and multiple clinics assisted in designing multi-scaled, self analysis diagnostic tools that are accurate and have results that are accepted by the clients.

Pg 1 Gornik

The link below will provide a full size copy of the Illustration shown above.  It can then be downloaded or printed.

http://www.teamfixes.com/wp-content/uploads/2018/07/Pg-1-Gornik.pdf

This link provides a copy of all illustrations used in Post.  The 9 page document can be downloaded or printed.

http://www.teamfixes.com/wp-content/uploads/2018/07/IDOC-Autopsy-Working.pdf

Accurate diagnosis results

IDOC provided diagnosis and in-house treatment for many years and used Compu-Tools – (Alcohol/Drug, Psychological (Anxiety, Depression, Anger and Cognitive) and the Social and Criminal Behaviors tools – they assisted in designing.   We also produced a package of treatment lessons that covered: (1) Education, (2) Therapy, (3) Thinking Errors, (4) Cognitive and (5) Others.

These 100 self study workbooks are available for those who wish to provide consistent and effective lesson materials.

Pg 2 Database

The link below will provide a full size copy of the Illustration shown above.  It can then be downloaded or printed.

http://www.teamfixes.com/wp-content/uploads/2018/07/Pg-2-Database.pdf

There are Grant Monies available – let’s get something useful from Canada!

The exhibit that follows was from a presentation that I made as IDOC considered  this new LSI-R tool.  Switching from traditional behavioral treatment (ASAM/DSM) to “criminogenic” risk factors introduces  diagnostic techniques that are: (1) Not self diagnosis, (2) Clinically subjective, (3) Hard to Understand, (4) Difficult to accept and, (5) do not include ASAM/DSM criteria – needed for treatment and honest billing.

Note: Within one year of introduction, new tools were needed and added for diagnosis – as elements were missing.  (e.g. TCU manual, single page drug screening tool>)

Pg 3 Intro LSI

The link below will provide a full size copy of the Illustration shown above.  It can then be downloaded or printed.

http://www.teamfixes.com/wp-content/uploads/2018/07/Pg-3-Intro-LSI.pdf

Let’s see how its worked – 20 Years = 8% Increase in Recidivism!

The exhibit below is from an IDOC publication.  The general consensus of the publication is that an 8% recidivism increase is expected or normal.

Pg 4 Recidivism 32

The link below will provide a full size copy of the Illustration shown above.  It can then be downloaded or printed.

http://www.teamfixes.com/wp-content/uploads/2018/07/Pg-4-Recidivism-32.pdf

Facilities are full – 75% of new entries are based on “failures to control”

This exhibit should be the basis for in-depth analysis.  In the associated information, solid cause and effect details were not available.

Pg 5 75 Recidivism lrg

The link below will provide a full size copy of the Illustration shown above.  It can then be downloaded or printed.

http://www.teamfixes.com/wp-content/uploads/2018/07/Pg-5-75-Recidivism-lrg.pdf

LSI-R + GAIN + PO Case Management + Criminogenic Criteria = ??

The addition of the GAIN tool, the focus on risk factors,  LSI-R scoring and interpretation and other malady fixes have resulted in a treatment or wellness environment that makes the AA suggestion — KISS – Keep it Simple Stupid – come to mind.

Pg 6 PO Role

The link below will provide a full size copy of the Illustration shown above.  It can then be downloaded or printed.

http://www.teamfixes.com/wp-content/uploads/2018/07/Pg-6-PO-Role.pdf

SAMHSA/CMS/H&W + Others publish “Client Rights”

The exhibit that follows provides a summary of Optum “Client Rights”.   The Rights shown in bold are not normally met by healthcare Providers.  These omissions are normally a result of case management – administrative – inadequacies.

Regulatory agencies are beginning to provide incentives that encourage adherence.   Fines and withheld grant payments are getting Provider attention.

Pg 7 Optum

The link below will provide a full size copy of the Illustration shown above.  It can then be downloaded or printed.

http://www.teamfixes.com/wp-content/uploads/2018/07/Pg-7-Optum.pdf

SOLUTION = Pilot test a “Proven Solution”

The elements of this program shift behavioral control from the agency to the individual.  This is where it belongs – if positive results are expected.

Administrative processes are available that provide intense “self generated” monitoring communications – that protects the public and the agency.

Pg 8 5 Step

The link below will provide a full size copy of the Illustration shown above.  It can then be downloaded or printed.

http://www.teamfixes.com/wp-content/uploads/2018/07/Pg-8-5-Step.pdf

David Rae – davidrae6607@gmail.com – 208-853-7410

Behavioral Improvement — 20 Years

What we have learned!

what you need to know!

iMResponsible.com has been providing intensive monitoring and case management services for about 20 years.  Spend a little time reviewing the exhibits provided on this site and you will become convinced that our regional solutions fit the needs of your geography.

The PDF document and exhibit shown below describe the work we have done with those clients who have had critical occupations.  In most of these cases, the involvement of the employer and the related agencies provides a bit of a “hammer” or incentive for the client to comply with his/her commitments.

Our experience with corrections and judicial clients provides evidence that that our 5 Step processes work with these clients – when there are TEAM members who provide ongoing support and consistent communications.

In these circumstances, the most dependable team member was the client.  The agencies rules, regulations and template based recommendations tend to ignore real world demographic issues.  In addition, staff members are burdened by administrative tasks and client numbers that prevent consistent communications and efficient case management.

Professional clinicians and treatment center processes have provided evidence that the tasks of these TEAM members also need to be monitored.

Between organizational requirements and professional proclivities they can hinder the client from being responsible for task completion.  One of our Intervention tasks is the determination of what “real world” circumstances conflict with plan objectives.

Note on Group Sessions:

Several years of personally providing supervision of outpatient group sessions has resulted in an understanding of the pros, cons, misconceptions, priorities and effectiveness of these efforts.  We decided that concise educational and therapy content provides more effective and consistent results than traditional efforts.  Our written lessons and sessions are designed to be completed in less than an hour and a series of questions is presented at the end of the material.  Some clients’ become aware that they can go to the questions and then find the material in the content.  This is harmless since they have to read the article to find the answers.  The completed lessons can be sent to iMR and become part of the case management data.

We have a repository of sessions that can be used – see site exhibits – and will develop additional content should customers desire a specific focus.

The “group therapy” aspects of group sessions are provided by the 5 Step program demand for continuous communications.  AA/NA participation provides the right kind of group therapy.

Our package of improvement processes can be completed by most clients since: – they do not have conditions that disrupt basic life area needs.  The clients also become aware – in short order – that our computer based processes don’t provide an escape mechanism from completing the tasks assigned.  This is another “hammer” encouraging plan compliance.

Our TEAM monitoring processes help insure that TEAM members provide the support promised.

Download PDF – above Diagram with Links

Please give us a call or email us for costs and other support information.  Pilot programs can be setup immediately.

(208-853-7410 — david@imresponsible.com)

Note:  The links on the PDF file – above – provide examples of what we deliver.  Download a copy and look around.

Use form below for more information:

“Behave yourself – we’ve got to get home”

5 Step and AA/NA

The 5 Step Program and AA/NA

  • Self-examination
  • acknowledgement of character defects
  • restitution for harm done
  • working with others

If you are interested in the 5 Step program, it is important that you understand – and “accept” – the basic philosophies that govern our efforts.

Inpatient Treatment – Detox

  • If you are unable to voluntarily discontinue the use of alcohol or other drugs, you will need to enter a treatment program or participate in a detoxification effort.
    • 5 Step treatment participation is based on your desire, and physiological ability, to stop using alcohol or other drugs.

12 Steps to Sobriety

  • The program design is based on indisputable proof that the 12 Steps of Alcoholics/Narcotics Anonymous work.
    • AA/NA attendance and study are mandatory elements.
      • Claims that the program is religious, members are obnoxious, serves lousy coffee, is boring, inconvenient etc. are irrelevant.
        • Meetings deal with behaviors and attitudes
        • Meetings are attended by folks who have won the drug battle.
        • Meetings provide us with an opportunity to help others and volunteer.
      • Our species has social needs that can be met with other AA/NA members. We need different “playmates”.
      • Experience will provide evidence that some solutions get solved – out of the blue.
  • If you are married, we encourage family members to attend meetings of Alanon. The result of family attendance is that our TEAM “mates” tend to stop “enabling” our destructive behaviors.

The Alcoholics Anonymous (AA) guidelines were published in 1938.  This book summarizes the tasks and thought processes that worked for the early founders of AA.

Self-examination, acknowledgement of character defects, restitution for harm done, and working with others are the base elements brought to AA from the Oxford Group.

Since the organizations founding, millions of individuals have discontinued the use of drugs and have improved other destructive behaviors following these precepts.

 One of the founders of AA advocated that AA groups have not the “slightest reform of political complexion”. In 1946, he wrote “No AA group or members should ever, in such a way as to implicate AA, express any opinion on outside controversial issues — particularly those of politics, alcohol reform or sectarian religion. The Alcoholics Anonymous groups oppose no one. Concerning such matters they can express no views whatever. “Reworded, this became the 10 Traditions of AA.”

One of our reasons for trusting the thought processes of the AA founders is the 10 Traditions.  This organizational consideration is “profound”.  We know of no other organization, in the world, that insures that its purposes are never affected by outside issues.  There are no leaders – no politics – no joint finances – each group is autonomous.

Traditional Treatment vs 5 Step (AA/NA/Hazelden/Thinking Errors) 

  • Treatment programs for clients who can afford treatment; recommend intense “post release” monitoring that includes counseling, consistent U.A.s and other elements. These activities are considered effective; but, are expensive; require employer participation and other personal resources.
    • The 5 Step program was designed to provide similar benefits for those of us who have limited resources.
    • Communications are mobile (text & verbal) and electronic.
    • Tele-healthcare counseling and other remote services are used.
  • One element of your treatment will be studies of AA publications. These lessons deliver effective directives on how to change thinking and how to get rid of destructive behaviors.
  • In addition to AA lessons, you will have access to studies produced by the Hazelden Foundation. This non-profit has been working with destructive behaviors since 1954 and is an excellent resource for individual self-directed therapy.
  • Some correctional entities wish to include Thinking Errors lessons and a package of lessons is available for our use.
  • Another critical treatment element included in the 5 Step syllabus, are exercises in meditation. Meditation benefits are indisputable but there are very few of us folks who can spare the few minutes it takes.  Youtube meditations may become a friend.
  • Note on therapy lessons: At most facilities, the tools used for group lessons and therapy are stored – “in house”.  The skills of the group facilitators and the availability of content affect the quality of these on-site sessions.

We have turned meaningful content into form and PDF documents.  These lessons include questions that are completed after reading the lessons.  We have found that these processes provide more knowledge retention than traditional group sessions.  Obviously, these web-based, downloadable, tools are convenient and comprehensive – fitting our real world needs.

Based on your input during registration, other resources will be made available that will guide you through other learning and therapy experiences.  Resources for Local vocational, health, financial and legal assistance will also be provided

As you move through the steps of the iMR program, your participation will be monitored.  These computerized reports will insure that you are completing the “doable” tasks that you committed to – during the Intervention.  Our experience has shown that when individuals are responsible positive results can be expected.  Our processes do insure that irresponsible actions result in immediate accountability.

Your treatment TEAM members are supporting your treatment efforts and will be responsible for completing their tasks.  Communications between TEAM members will be continuous and will support your treatment efforts. There are no “voids” in communications – it is continuous.

Don’t worry!  We’re Educated!  We’ve got things under control!

 A few other treatment comments:

DSM-5 (Psychologists, Psychiatrists and Counselors)

Research conclusions pertaining to addictions and relative behaviors are as varied as the government and medical entities producing them.  Medical professionals and mental health professionals have published documents that do not agree on the origin of some destructive behaviors. The DSM-5 (Diagnostic Statistical Manual) indicates that a collection of disorders is responsible for destructive behaviors.  This American Psychiatric Association publication includes 279 disorders that may relate to our needs.  The experience and skills of the professionals determine how to best treat destructive behaviors.  The role of personal “traumas” also influences treatment modalities and adds to the analysis tasks each professional must complete.

Most insurance payments are based on DSM codes and our Compu-Tools software computes DSM-5 criteria.  Many state agencies require that treatment processes adhere to ASAM criteria.  With varying elements, adhering to these two guidelines can get a little difficult.  Compu-Tools also provide quantitative diagnosis of ASAM Criteria.  Provided with this information, professionals can assist their clients using the tools that fit their specific needs.

ASAM (American Society of Addiction Medicine)

iMR adapted the ASAM criteria for its processes.  This maintains addiction is a “disease” – not a result of a psychological disorder.

Public Policy Statement: Definition of Addiction

Short Definition of Addiction:

Addiction is a primary, chronic disease of brain reward, motivation, memory and related circuitry. Dysfunction in these circuits leads to characteristic biological, psychological, social and spiritual manifestations. This is reflected in an individual pathologically pursuing reward and/or relief by substance use and other behaviors.

Addiction is characterized by inability to consistently abstain, impairment in behavioral control, craving, diminished recognition of significant problems with one’s behaviors and interpersonal relationships, and a dysfunctional emotional response. Like other chronic diseases, addiction often involves cycles of relapse and remission. Without treatment or engagement in recovery activities, addiction is progressive and can result in disability or premature death.

An illustration that supports our ASAM focus is:

Bill Wilson – one of AA’s founders could not stop smoking during his 37 years of alcohol sobriety.  Here is a guy who was able to overcome one addiction; but, not another.  It would be interesting to know what disorders the DSM-5 would focus one, when one addiction is managed and another is not.

This brings up another topic worth discussing.  Giving up one life destroying drug and continuing to use another life destroying drug is not rational.  We encourage our TEAM members to support behaviors that are positive and beneficial to continued good health.  My sister and my AA co-sponsor both bought into AA philosophies and stopped the use of alcohol and drugs; however, they both continued to smoke and it, probably, killed them a decade or two before old age would have got them.

The affect of “Vaping” on the human body will require new government studies: however, it doesn’t seem rational that sucking vapors into our lungs is really a constructive behavior.  Seems like meditation and exercise might be better for our health.

The 5 Step program includes lessons on thinking habits, behaviors, wellness or health, exercise, meditation and other topics that are not part of AA.

I’ve never been to a bad meeting!  It’s a matter of perspective!

School Interventions

History of School Interventions

I got creative and decided that I would produce a single page document that contained everything I know about the benefits of Student Interventions.  I have been involved with Idaho schools who have used these processes for the last 20 years.

I used Adobe Acrobat and linked separate files to the original document – where appropriate.  I didn’t realize that WordPress themes would dislike my creativity.  As you mosey down the document, you will see the push pins.  Highlight each push pin and a description of the “attached document” will appear.

If you download the PDF, a double click on the push pins will bring up a supporting document for each topic commented.    To enlarge the PDF image or download to your device – see the tool bar instructions below.

Included in the supporting documents, is a State Education report that shows students violations went down significantly in those schools that were conscientious about implementing attention to:  BAAA = Behaviors, Attendance, Attitude and Achievements.  There are ethical, humanitarian and financial reasons to perform proper student interventions.

Short term political fads or bandwagons and grant funds – shift local priorities to other issues – that never seem to last.

 Student-Interventions-IMPACT-w-Support 2

Rambling through Treatment

Rambling through – Interventions – Treatment – Enabling – Case Management

Don’t expect any profound treatment miracles to expose themselves as I move through this ditty.  I was preparing a 5 Step marketing piece and began to reflect on things that negatively affect behavioral healthcare treatment.  The following things came to mind; but, I was unable to create a smoothly flowing framework.  So bear with me.

In an ideal world, all our treatment chores would be completed in a timely and effortless manner.  Unfortunately, this is a pipe dream or a conclusion that one would reach after using the wrong kind of drugs.  The gist of today’s message is – “we should minimize the obstacles that prevent “ideal” treatment circumstances”.

Communications, administrative stuff, rules and regulations, emergencies, fatigue, eating, sleep and more – all interfere with flawless goings on.  The 5 Step program design is intended to reduce the impact of these nuisances and provide our Team members with some efficient solutions.

This author believes most individuals want to end each day feeling good about what they accomplished.  They do their best in completing tasks that were presented.  The issues addressed in this article are not intended to be criticisms.  The points made, herein, reflect real world happenings that can affect what we are trying to accomplish.

The other issue that came to mind is: administrative tasks can be a pain in the ass.

Don’t Worry!  I got this under Control!!

For example, I have just completed a fruitful session with an individual and it is important that I document the elements of the session so that my other team members know how we are doing.  I judiciously began my administrative task and an emergency pops out of the woodwork.  Then, ongoing daily tasks prevent me from getting back to my unfinished administrative duties.  These are real world issues and result in less than optimum treatment conditions.  Case management data entries are often done – when possible.  If group activities or external partners are included as treatment elements, getting these case entries into the system may also take some time.

Also, when administrative time is available, the first thing that needs to be completed is the paperwork – to get paid.  Government and Organization processes have been most creative.  They have provided thousands of new code options to make our lives easier and more efficient.

As I compare the data entry tasks for behavioral treatment clients, with regular medical care, I find that the behavioral efforts are more complex and time consuming.  My last two visits with my cardiology team have been 5-10 minutes of silent computer review by the professional and then approximately 5 minutes of a one sided discussion and then a closing silent computer spectacle – that results in a visit summary.

Automating verbal and text input data, using efficient forms, shifting priorities to our clients or patients and simplifying electronic data transfer and integration processes is a start.

Experience with Treatment Processes – (Sensitivity – Empathy)     

Our experience with treatment endeavors has lead us to a bias for AA/NA 12 Step programs.  The principal reason for this focus is that these organizations’ team members believe in individual responsibility and accountability.  Enabling continuing destructive behaviors is not part of their program objectives.

Our experience with counselors and other professional clinicians provides a different set of insights.  To continuously work with a client a degree of sensitivity must be established to provide meaningful dialogue.  Based on human nature, degrees of empathy may also occur.  These relationships will, obviously, be different as we move from clinician to clinician and from client to client.  Perspectives and skills are needed to insure that a tough love atmosphere is part of all treatment programs.

Interventions – Treatment – Enabling

 Helping – can be – Hurtful   

38 years of association with treatment efforts that are related to legal/illegal drug use and dependency have resulted in a few conclusions:

  1. Ignoring that drug dependency is a disease and runs in families’ = kills’ people.
  2. Enabling destructive behaviors is common with family members = kills’ people.
  3. The K.I.S.S. principal needs to be adhered to – or – results will deteriorate.
  4. Keeping it simple means – staying unaffected by alcohol and drugs.
Trauma – DSM-5

Treatment for DSM-5 “trauma – disorders” would be classified as a supplement to the iMResponsible.com programs.  A principal focus of our programs is an effort to stay focused on daily behaviors that need to be changed.  Treatment for trauma disorders is important; however, it is our position that “trauma” treatment results are improved when an individual is sober, stable and working a solid program.

The DSM-5 has defines these trauma disorders as Stressor-Related Disorders :  Anxiety Disorder, Trauma- and Stressor-Related Disorders Acute Stress Disorder, Adjustment Disorder, Posttraumatic Stress Disorder, Reactive Attachment Disorder and Dissociative Identity Disorder.  Physical or medical issues – such as brain trauma, etc., must also be considered.

Interventions

TEAM Interventions conducted to develop righteous and doable treatment plans provide the client with a feeling of group support.  The Intervention also provides the TEAM with an indication that definitive objectives have been established.  “Enabling” behaviors by friends and family are minimized as TEAM objectives are definitive and have been agreed to by all participants.

As an aside, all 5 Step clients do not win.  It has been proven, however, that a TEAM Intervention will assist those who fail to meet treatment contract conditions.  This assistance takes place when the next crisis occurs.  Personal denial is reduced or eliminated and the next try at wellness is enhanced.  20 years of Interventions in Idaho schools has statistically proven that the percent of student violations has reduced since these Intervention practices were initiated.

Enabling

Enabling ones’ destructive behaviors to continue from Intervention – through Treatment is normally a family issue.

 John Southworth has been an Interventionist for several decades and was one of the developers of the 5 Step Intense monitoring solutions.  Last week we met, went to an AA meeting and then had lunch.  John showed me a “no name” copy of a letter he had just received – thanking him for his efforts – with the senders – father.  The letter advised John that the father had died and was found by the family as they visited their vacation home.  John explained that the “father” was participating in an intense treatment and monitoring program that John had recommended.  All was going well.  The client and his wife convinced treatment management that all was going well and they could manage their behaviors in a less intense program.  This new program did not work. The patient died.  John indicated that family enabling is the most consistent anti wellness effort he runs into.

During our discussion, John also indicated that finding treatment facilities that had a treatment priority, higher than the bottom line priority, was becoming more difficult. It seems that business tasks, administrative requirements, regulations, HR matters and finances share time and resources with treatment.

www.southworthassociates.net/

Gotcha’s keep coming up – Even in a well designed Program!

Summary:

The combination of administrative, strategic and relationship conditions associated with each client and clinician affect the results of treatment.  Based on the subjective nature of counseling, it is also difficult to determine when clinical actions are resulting in degrees of dependency or independence.

In our view, anything that interferes with the clients’ acceptance of personal responsibility for treatment tasks is suspect.  The 5 Step program has been designed to emphasis “objective” analysis of treatment elements.  Clients’ become more responsible at case communications and data entry.  TEAM members are provided with forms that enable efficient and effective submission of case information.  Communications via mobile devices are automatically entered into iMR case files.

 Monitoring processes provide quantifiable evidence of how an individuals’ program is working.  These processes also provide an accurate treatment effectiveness score.  This beats the heck out of emergency phone calls just before the reports are due.

One Step at a time!  One Day at a time!  One Life at a time!

I am Responsible!

Team Enabling Tough Love

Client Role – Treatment

TREATMENT TEAM – CLIENT ROLE  

BACKGROUND

30 years of experience with Behavioral Healthcare Treatment has resulted in a collection of perspectives that, I believe, are sound.  As I try to intellectually integrate these insights with the mountain of professional treatment programs being offered to client’s throughout the country, it can get a little confusing.

What is consistent, and not too confusing, is that the primary focus of treatment is satisfying organizational or entity objectives – not user treatment objectives.  Entity needs are revenues, costs, regulations, internal human relations, administrative processes, legal, etc..  Client treatment and case management processes are a lower priority and are standardized to fit organizational needs.

A review of State statistics will show that the majority of historical behavioral treatment referrals are from the Department of Corrections and Justice.  The following exhibits provide samples of objectives and processes that are used by these agencies.

Exhibit A – Corrections/Judicial Objectives

Exhibit B – Sample of Probation Order

The conditions shown are the same for all individuals; regardless of the individual’s abilities to complete the required tasks.  These examples conflict with Federal Treatment Guidelines (SAMHSA) that recommends “Individually based” treatment plans and tasks.

This wasn’t covered in our Study Guide!

DO “RELEASED” INDIVIDUALS HAVE HUMAN NEEDS?

An objective of Departments of Corrections is that the public must be protected from harm that could occur from certain individuals’ actions.  Control is the tool used to accomplish this objective.  It is unclear if diagnosis techniques used can determine what specific risks are present for each individual, what controls are necessary and how treatment plans can be structured.  Since blanket treatment directives are provided to most clients’, it could be assumed that treatment based on improving individual human behaviors could be at cross purposes with current agency objectives.  It might also be true that the “criminal” behavioral profile used by some provides a basis for justifying programs that have not been effective.  Another provocative question is:  – “Is it in the State Agencies internal best interest to reduce inmate populations and existing supporting staffs” – if programs begin to work?

The treatment centers and clinicians handling these referrals are indirect subjects of these agencies policies and requirements.  The treatment entities have their own priorities which are designed to insure they stay in business.  They can only provide treatment services if they have the revenues needed to pay rent, wages, taxes, insurance, legal, overhead, etc.   After these factors are considered, the treatment needs of the individual clients are then covered.

Historical federal statistics validate that these practices have been ineffective.  Correction statistics show that approximately 50% of all released individuals are confined again within three years.  No statistics are available for behavioral treatment efforts that are handled directly with individuals and their professionals.

New ACA/CMS/HIPAA guidelines are resulting in additional referrals from the medical community.  These policies and program solutions are being developed as these services are initiated.  Traditional behavioral and mental health treatment has been handled by individual clinicians, clinics and private and public agencies. Each of these entities has specific policies and practices that insure they can stay in business – to provide needed services.

LEGAL AND ILLEGAL DRUGS 

 Although the current emphasis on Oxycodone and other pain relievers is receiving a great deal of media attention, alcohol and other prescription drug use must be considered as behavioral treatment plans are developed.   Behavioral Treatment Plans should be based on accurate diagnosis of real symptoms.  This would seem to indicate that alcohol and drug use should be considered during a diagnosis.  If clients’ are not abstinent from alcohol or drugs, any diagnosis should be flagged as being questionable.   Side effects for all drugs are extensive.

ROLE OF 12 STEP PROGRAMS

This author and this site are fans of 12 step programs that focus on improving destructive behaviors.  These programs include no “entity” needs. They are a result of people – who have been there – who care – who are helping others – who need to get there.  Unless you have participated in these sessions, you may have no concept of the personal empathy and skills displayed by the participants.  I have been to thousands of meetings; and, never to a bad one.  I carried away a positive message from each one of them.  The Steps and Traditions are unique and profound as are the results of meeting attendance and participation.

USER NEEDS – PROFESSIONAL INPUT

In order to look at objectives and solutions for “human needs” focused treatment, let’s look at what one noted psychologist wrote about the individual life areas that need to be dealt with.  (i.e. Abraham Maslow – humanistic psychologist – “self-actualization”)

He emphasized belongingness, love, affection, respect for others and building self-respect.   These are “outside” the money economy and available to all families and individuals.

 THE BEST MANAGERS increase the health of the clients whom they manage, via gratifying both basic needs and meta-needs.

NEEDS IN THE HIERARCHY INCLUDE:  (iMR focused on “highlighted needs”)

  • Physiological: food, water, air, sleep, sex. (Sobriety | Drug Free = iMR)
  • Safety: Security, stability, protection, order, freedom from fear and anxiety. For healthy persons, safety needs are not overwhelming or compulsive. If a person does not feel safe, growth becomes a secondary factory as safety needs dominate.
  • Belongingness and love needs: Intimate, caring relationships; affiliation with a group.
  • Esteem needs: Esteem from others – precedes self-esteem. It’s hard to think well of ourselves unless we believe that others think well of us.
  • Need for self-actualization: The Army slogan “Be all you can be” borrowed from Maslow’s view. The full use of all our qualities and capacities, the full development of our abilities.
  • Needs to know and understand.

ESTEEM AND SELF-ESTEEM NEEDS ARE UNIVERSAL. Everyone prefers to feel important, needed, useful, successful, proud, respected, rather than unimportant, interchangeable, autonomous, wasted, unused, expendable, disrespected.

I am assuming that these famous man’s thoughts will be echoed by other psychologists. Because, if human needs are defined by each practitioner, suitable treatment design becomes impossible.

Self-actualizer has needs that aren’t as satisfied as, say, food, water, shelter or companionship. He or she seems to require ‘metaneeds’:
Truth
Goodness
Beauty
Unity, wholeness, and transcendence of opposites
Aliveness
Uniqueness
Perfection and necessity
Completion
Justice and order
Simplicity
Richness
Effortlessness
Playfulness
Self-sufficiency
Meaningfulness

Metapathologies:

Dishonesty
Evil
Ugliness and vulgarity
Arbitrariness or forced choices
Deadness or the mechanization of life
Bland uniformity
Sloppiness, inconsistency, or accident
Incompleteness
Injustice and lawlessness
Unnecessary complexity
Environmental impoverishment
Strain
Grim, humorless, drudgery
Dependency
Senselessness
We, as humans, have a lot of needs.  A program designed to fill all of our needs would require a permanent relocation to Nirvana – which is not practical for most of us.

A quick review of our uplifting needs will confirm that few of these needs are part of current “entity treatment plans”.  A quick review of the negative features shows that some of these are occurring during current treatment practices. All in all, these conclusions are confirmed by a lack of effectiveness for these programs during the last few decades.

iMResponsible.com – CLIENT SOLUTIONS

The Image Below depicts how “entity” based programs – by default – become responsible for an individual’s behaviors.  It also depicts how these processes can be fixed to provide workable solutions.

The iMR 5 Step – TEAM Behavioral Treatment Program – attempts to realistically consider user needs. The 5 Step Elements are designed to assist the client in becoming responsible for their behaviors and accountable for the results of these behaviors.

I’m Ready for Anything!

Note:  Next post will include information on the iMR PITA Program.  Personalized – Individual – Treatment – Alternatives

 

 

 

 

Key Treatment Elements

Key Treatment Factors – iMResponsible.com – 5 Step Program

Behavioral Case Management

There are many software applications being used to manage behavioral treatment programs.  Most of these programs are focused on entity needs and not on client or individual requirements.  Bureaucratic demands guide software development challenges and results.

There are a few key elements that affect healthcare treatment results. Some are philosophical in nature and beyond the insights and skills of our domestic and international developers and coders.  Real world experience has proven to iMResponsible.com that these solutions are usually supplements or additions to established application programs.

These key factors are: (1) Client must accept responsibility for their behaviors, (2) Diagnosis must be comprehensive, accurate and convincing, (3) Treatment Contracts must be personalized and doable, (4) TEAM tasks must be completed as specified in the plan and (5) case data and communications must be continuously available to the TEAM.

iMR Key Factors  (Note dates on PDF exhibits – iMR has been doing this since 2000.

Step One – Introductory Documents – (Description, Benefits, Requirements and Acceptance.

Key Elements 5 Step