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

5 Step Implementation

TEAM TREATMENT WORKS

Brief Intro:

This program does not require that you purchase anything!  All tools are provided as needed.  Case management, communication and data entry tasks are completed by each of the treatment TEAM members.  iMR provides web based case management, reports, monitoring alerts and other tools that enable automatic case data entries as authorized.  (e.g. email, phone, phone text, direct entry, etc..)  Program enrollment is based on client and TEAM acceptance of program conditions.

Summary:

This Summary is being published – first – before any factual basis is established. Our busy lives reduce the amount of time we spend reading stuff.

I have been involved with Behavioral Treatment clinics and agencies for four decades. This has included Inpatient, Outpatient and Self treatment processes. Experience with AA/NA has convinced me that long term alcohol/drug abstinence is as successful via these 12 Step meetings as by organized treatment enterprises and government agencies. AA/NA activities are long term and based on real world conditions. Organized treatment is short term and done in unique environments.

Experience with intense monitored treatment programs that are used for critical employees – i.e. medical, airline, transportation, etc.. has proven that these TEAM treatment processes can provide dramatically improved results. They provide the atmosphere and communications needed to improve “real world” treatment results – on a continuous basis. I am convinced that if these “intense” TEAM treatment processes were available to – all individual’s – positive behavioral and substance abuse results would exceed any treatment processes currently used.

TEAM treatment means that a TEAM* is active and supports diagnosis, treatment plans, treatment tasks and other real world circumstances. (*TEAM = Medical, Clinical, Vocation, Family, Social, Legal and supporting processes)

Historical and Current Treatment Efforts

This nation is inundated with programs that claim they improve drug induced destructive behaviors.  Unfortunately, Federal statistics over the last 5 decades verify that these processes aren’t working. Why is this?

  1. The results of drug assessments do not convince the individuals involved that they are actually responsible for their past behaviors and the results of these behaviors.
  2. Treatment plans include a package of activities that are:

►designed to protect the designer against liability issues

►not designed by a treatment TEAM and the client

►not accepted as doable by the client

  1. Treatment tasks are not definitively monitored, published and updated as needed.
  2. Treatment TEAM members are not defined. Treatment participant roles are not formalized.

Note: A growing number of Professionals are managing treatment programs that use drug management as a component.  These professionals are, in fact, assuming responsibility for the client’s welfare.  They are also assuming responsibility for the results of any treatment programs where drugs are a key component.  Recent issues pertaining to the conflicts between ASAM Treatment criteria and DSM-V elements are related to treatment perceptions.  Substance Abuse and Addiction are classified by some as a Disease and by others as Destructive behaviors – that can be fixed with drugs.  This is not a Common Sense playground.

Personal

With 39 years of recovery, this is what, my final Inpatient Treatment did for me!
1. Kept me from using alcohol/drugs for a period of time
2. Provided an atmosphere that helped develop some new thought processes
3. Convinced me of the benefits of 12 Step Programs
4. Provided me with some educational facts
5. Provided me with a post treatment contact that was a 12 Step participant and willing to work with me as I participated in real world activities. Dan was a Sponsor and TEAM member.

Step #5 is the reason I have 39+ years of sobriety. AA/NA participation is still going on and provides a positive impact on my attitudes and life.

Miscellaneous

My four decades of healthcare experience has created a skeptical perspective of programs that have been designed by treatment entities, agencies and universities. Many propose that behaviors and chemical imbalances can be a reason for dependency, addiction and disease. Most are designed because the one before it hasn’t worked. Nationally, trillions have been spent, hundreds of agencies have been created, thousand of grants used and hundreds of programs introduced and then phased out. During these efforts, the principles of the 12 Step programs that have successfully turned millions of lives around have been ignored or discounted. AA/NA traditions prevent actions that could minimize the possibility of individual improvements, such as: building treatment organizations. Objectives are different.

Many clinicians are ‘recovering’ individuals themselves and are dedicated to providing effective services to their clients.
Most clinics, who employ these clinicians, are concerned with continuing their operations and this requires balancing treatment deliverables with cash flow. Eventually, the focus must be on cash flow and treatment deliverables and effectiveness become secondary. Regulations and audits guide general deliverables; however, bed and group counts are the principal measurement of success.

Common sense would suggest that the diagnosis of an individual’s psychological, social and criminal behaviors would be negatively affected if they are using drugs. (e.g. Alcohol is a depressant, Amphetamines can result in paranoia and stress, etc.) Question: how valid are these diagnosis if the client is using? Shouldn’t substance abuse issues be addressed before behavioral diagnosis processes are begun?

The use of opiates, illegal drugs and medical prescriptions have created withdrawal needs that must be provided by Inpatient treatment and, in some cases, include the use of alternative drugs to ease withdrawal symptoms.  These processes have shifted professional treatment focuses from becoming abstinent from drug use to using appropriate drugs to fulfill individual needs. Individuals that are using these “new generation drugs” are not suitable for the iMResponsible.com TEAM treatment program until they are drug free.

Personal experience with drug recommendations made by physicians has led me to believe that significant study should occur before any drug is used.  I have not taken any prescription that did not have undesirable side effects.  Some are long lasting.  The song that is sung = “the benefits outweigh the negative side effects”.  Common sense is also useful in these circumstances.

TEAM – Key Elements

The attached PDF includes a description of all of the 5 Step Intensive Treatment Elements. 

iMR Program Program Implementation 2017 V1

These Treatment Processes have been used effectively with “Critical Employees” during the last 15 years.

For more info – contact david@imresponsible.com

ASAM – DSM-4 & 5 – SAMHSA – NIH

DSM – IV, DSM-V, ASAM and Other Concepts

This epistle was provoked by current machinations relating to current ASAM, DSM-V, SAMHSA, NIH and other behavioral health diagnostic concepts.  The collective analysis of these creations has resulted in a personal “Peter Principal”.   I am unable to understand what went through the minds of the people creating these programs.  Their creations are based on 40 years of ineffective substance abuse treatment and results.  The new perspectives seem to suggest that more complex processes will provide better solutions.

One of the first sayings I heard when I started AA/NA meetings was: Use the “KISS” principal.  (Keep it Simple Stupid)

Note: While I’m thinking of AA, the following information might be enlightening. When the two founders of AA started the organization in 1936, they developed certain traditions that are unique to AA.  These traditions prevent any organizational activities that would interfere with the main purpose of AA – which is to assist individuals to improve their behaviors.  There are approximately 2 million participants in AA; but, the organization has no regular employees or officers, owns no property and doesn’t advertise.  Each meeting is self supporting and voluntarily staffed.  These traditions are so KISS oriented they are profound.  No other organization that I know of operates in this fashion.

We human beings find this KISS principal too simplistic.  We need more creative solutions.  We need solutions that require training and education to understand.  We need to feel we provide unique solutions because we are so much brighter than other species.

There are hundreds of diagnostic creations that clinicians have developed to determine how individuals should be managed to provide positive treatment results.  A key question might be: “were these developed because other tools weren’t effective.”  If so, we have quite a collection of ineffective tools.

A key to changing individual behaviors is to convince an individual, or client, that they need to change their behaviors.  Diagnostic results and presentation are key elements, when convincing a person that changes are needed.  They need to be accurate, comprehensive, understandable, objective and self diagnosis.

KISS tools:

AA/NA membership requires that a person just “wants to stop using alcohol/drugs.”  Fortunately, the individual has taken the first step toward behavior improvement.  They are at a meeting of like folks – who support accountability – and get results – comparable to organized treatment.

Although the CAGE questionnaire has been endorsed by some Federal agencies and contains four meaningful questions, the results presentation to the client may not be definitive enough to be consistently accepted by the client.

I believe, the Interview Techniques processes presented by Dr. Jon Weinberg in 1972 is a practical KISS tool.  This tool determines if alcohol/drug use has negatively affected any of the individual’s life areas.  (Occupational, Financial, Health, Social, Legal or Family)  If any of these life areas have been negatively affected, it is clear evidence that client actions have resulted in serious life consequences.

The direct correlations between alcohol/drug use, abuse or addiction and the negative life area consequences are hard to dispute and can be convincing.  TEAM treatment processes can also use “life-area” TEAM members to enhance treatment results.

Below, I have enclosed information about DSM-V, ASAM, SAMHSA, NIH and other diagnostic concepts. This information has been included to provide examples of how our non-KISS tools have become so complex that they are hard to understand and will provide the same statistical results as their predecessors have for the last 40 years.

ASAM States: “Addiction is a primary, chronic disease”.

DSM-V States: Every drug, including alcohol, has a separate “disorder” classification.  Each disorder can be mild, moderate or severe.  There are approximately 100 disorders and treatment categories.  This mental disorder bible also claims that legal issues should no longer be used as diagnosis criteria. (If you have 5 dwi’s, don’t fret.)

ASAM vs DSM-V: If addiction is a disease, it seems implausible that you can be a little bit addicted.  Kind of like being a little bit pregnant.  If addiction is a clinically defined collection of circumstances, how does the patient become convinced they need a variety of treatment modalities?

SAMHSA: This agency has now defined drug addiction as a “Behavioral Health” issue.  In a 262 page document, this agency describes how clinicians can determine which of the 100 DSM-V disorders should be used and how to diagnose mild, moderate or severe abuse and dependence.

It is this addict’s opinion: government and treatment entities have created new imaginative processes that try to justify previous efforts and the trillions of dollars spent with no statistical improvements.  This eliminates the need to be Accountable.  This also supports the need for more funds and creations.  Statistics support my conclusions.

The Illustrations shown below support issues noted above.

Drug Problem when I was a kid

Teen Self Assessment Results

CAGE and Weinberg’s Life Areas

ASAM – DSM-IV – DSM-V

SAMHSA Review of DSM-V Criteria

A Review of the Disorders that need to be considered

The Link below will provide you with a PDF that contains the information included in this post.

 http://www.teamfixes.com/wp-content/uploads/2017/05/Post-DSM-V-ASAM-2017-V1-1.pdf