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:
- Ignoring that drug dependency is a disease and runs in families’ = kills’ people.
- Enabling destructive behaviors is common with family members = kills’ people.
- The K.I.S.S. principal needs to be adhered to – or – results will deteriorate.
- 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.
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
