TREATMENT TEAM – CLIENT ROLE
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’:
Unity, wholeness, and transcendence of opposites
Perfection and necessity
Justice and order
Ugliness and vulgarity
Arbitrariness or forced choices
Deadness or the mechanization of life
Sloppiness, inconsistency, or accident
Injustice and lawlessness
Grim, humorless, drudgery
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