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Treatment Planning
Purpose Requirements Developing a Plan Updating a Plan Examples Claiming for the Service Using IBHIS LACDMH Quality Assurance Unit – Policy and Technical Development Team – 6/17/
Standard Course of Action
1. Assessing
o Complete a mental health assessment and establish medical
necessity;
o Complete an initial medication evaluation (if needed)
2. Planning
o Develop a client treatment plan (and if applicable, obtain medication
consent) with the client;
3. Treating
o Provide treatment services to address the identified mental health
condition and assist the client in reaching his/her objectives.
Why do we develop
treatment plans?
- Ensure a client’s care is goal directed and outcome focused: What are we working on and is it working?
- To guide treatment:
Develop the plan collaboratively with the client
Focus on the plan throughout treatment – this reinforces its value and
prevents having to ‘put out fires’
Be aware of the plan before the treatment session
- Ensure all payer requirements are met
Purpose of Treatment Planning
Licensed or waivered Psychologists (PhD/PsyD)
LCSW, ASW, or out-of-state licensed-ready waivered Masters in Social
Work
LMFT, AMFT, or out-of-state licensed-ready waivered Marriage and
Family Therapist
Licensed or waivered Professional Clinical Counselor
Licensed Psychiatrists/Physician (MD/DO)
Nurse Practitioners (NP), registered Clinical Nurse Specialist (CNS),
Registered Nurse (RN)
All students of these disciplines w/ co-signature
- The AMHD acts as the person who directs service provision
AMHD – Authorized Mental Health Disciplines
Reference: Organizational Providers Manual
Developing the
Treatment Plan
Treatment Plan Process During the treatment planning session with the client…
- Practitioner and client discuss the plan for treatment
- Client provides input on desired outcomes of treatment
- Practitioner provides input on clinical aspects of treatment
- Recommend that the plan be written with the client (developed collaboratively)
- Practitioner informs client what services are available (group and individual services) and which services might help
- Client agrees to the plan and signs it Before the treatment planning session with the client…
- Review the assessment & any other pertinent information re: client’s current status (e.g. recent progress notes, Community Functioning Evaluation)
- Consult w/ a supervisor to discuss clinical factors to consider
- Come up with initial ideas on what client should address and what to focus on in treatment Treatment Plan Process After the client leaves…
- Finalize the form
- Claim for the time spent via Individual Service Progress Note If applicable, practitioner may need to meet with the treatment team to discuss the plan and delegate which team members will provide specific services
- Treatment team – claim for their time spent informing the treatment plan via the Individual Service Progress Note
Goals
Usually the opposite of the problem
As written, this should be about 2-5 words in length
The broad intention of treatment
Objectives
Develop Objectives that are:
1. Related to the client’s mental health needs
(symptoms/behaviors/impairments documented on the
client’s assessment)
2. Measurable
3. Written in a way that makes sense to the client
How the goal is measured to know if treatment is working
REFERENCE SLIDE Sample Objectives
Client will reduce depressive symptoms from a PHQ-9 score of 17
(moderately severe) to <4 (minimal)
Client will increase daily independent living skills from 0x to 2x per day
Client will obtain a part-time job within 6 months
Client will obtain stable permanent housing
Client will increase social activities from 0x to 3x per week
Client will increase showering from 1x per week to 4x per week
Pause the video if you want to review these examples Interventions
When developing Interventions, make sure the client understands…
1. What the practitioner will be doing
o Description of the intervention
2. Why the practitioner is doing it
o To address client's mental health need
3. How often the practitioner will be doing it
4. When the practitioner will be done (if duration less than a year)
This is what practitioner will do to help the client attain
his/her objective
Annual vs. Update Treatment Plan
- Annual Client Treatment Plan (CTP)
The initial treatment plan created after an assessment and completed
prior to the initiation of treatment
An Annual CTP is developed minimally every 365 days from the date of
the last Annual CTP
- Update Client Treatment Plan
The treatment plan created when new objectives or interventions are
added to an existing Annual CTP
Update Client Treatment Plan
Any new objectives would still need to address the mental health
needs documented on the client’s assessment (or assessment
addenda)
o If any significant changes in the client’s condition occur during the course of treatment (e.g. hospitalizations, new trauma, etc.), the treatment plan should be reviewed and updated
New signatures from the client/legal representative, significant support
persons, if applicable, and staff are required
An Update plan will not change the Plan End Date
Treatment Plan Examples
Problem
Goal
Intervention
Objective
Major Depression
Improve mood
Client will reduce depressive symptoms from a
PHQ-9 score of 17 (moderately severe) to <
(minimal)
Mental Health Service: Provide individual therapy using CBT to identify and modify client’s negative feelings of worthlessness and reinforce active problem-solving skills in order to strengthen self-confidence and improve mood
Intervention
Mental Health Service: Provide collateral services to client’s spouse so that spouse can assist client better with using his problem-solving skills at home Pause the video if you want to review this example
Problem
Goal
Objective
Intervention
Unemployment
Targeted Case Management: Identify available employment resources, assist with application process, & monitor linkage
To obtain employment
Client will obtain employment within 6
months
Intervention
Mental Health Service: Provide individual rehab to role play for job interviews, assist with completing applications, and practice resume building Pause the video if you want to review this example
Claiming for Developing
the Treatment Plan
- Services provided to clients are documented using a
progress note (Individual Service Progress Note)
- Within the progress note:
Select the procedure code based on the service provided
Enter the duration of the service
Face to Face Time = time spent seeing the client
Other Time =
- time spent providing a service to a significant support person
- time spent writing the progress note and completing other applicable forms
- travel time, if this applies Progress Note
Outpatient SMHS covered & provided by directly-operated
(reimbursable services)
Mental Health Services (MHS) Individual, group, collateral or family-based interventions to restore a client’s functioning and ability to remain in the community with goals of recovery and resiliency Assessment Plan Development Therapy Rehabilitation Collateral Intensive Home Based Services (IHBS) An intensive form of MHS that is predominantly delivered in the home, school or community. IHBS is specifically intended for children/youth who are already receiving Intensive Care Coordination. Rehabilitation Collateral Medication Support Services (MSS) Prescribing/furnishing, administering and monitoring psychiatric medications to reduce a client’s mental health symptoms Evaluation of the Need for Meds Evaluation of Clinical Effectiveness & Side Effects of Meds Obtaining Information Consent Medication Education Collateral Plan Development Targeted Case Management (TCM) Services that assist a client in accessing needed ancillary resources (e.g. medical, alcohol/drug treatment, vocational) Assessment Plan Development Referral and Related Activities Monitoring & Follow-Up Intensive Care Coordination (ICC) An intensive form of TCM that facilitates the assessment, planning and coordination of services. ICC is specifically intended for children/youth who are involved in multiple child serving systems and require cross-agency collaboration through a Child and Family Team Planning & Assessment of Strengths & Needs Reassessment of Strengths & Needs Referral, Monitoring, and Follow-Up Activities Transition Crisis Intervention (CI) Unplanned and expedited services to address a condition that requires more timely response than a regular appointment in order to assist a client to regain/remain functioning in the community. Assessment Therapy Collateral Referral
During session w/ client, social worker developed the treatment plan and added individual and group therapy to the plan. Plan Development Scenarios During CFT Meeting, client, family, and treatment team agreed that Rehab Specialist will start meeting with the client 2x per week, and Parent Partner will meet with family 1x per week. Treatment Plan was updated to include these services. Community Worker completed the Community Functioning Evaluation w/ client and added an intervention related to finding housing resources to the client’s treatment plan. Medical Case Worker met w/ client for individual rehab. During the session, the treatment plan was updated to include a group rehab intervention. Psychologist met w/ client and parent to complete the assessment and treatment plan.
H
H
T
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Therapist and case manager meet to discuss client’s lack of progress in treatment and updates to client’s living situation (client now lives w/ paternal grandmother). Based on increased behaviors and change in caregiver, therapist stated that individual rehab w/ the case manager and collateral sessions w/ the therapist will be added to the client’s treatment plan. Case manager suggested adding targeted case management to assist family w/ finding parenting resources in the community. Case Manager: T Therapist: H Practitioner met with the client for the purpose of developing the treatment plan (refer to treatment plan dated 5/1/20). Client and practitioner agreed that individual therapy and targeted case management would be helpful in addressing client’s anxiety and assisting client with obtaining employment resources. Client signed the treatment plan. At the next session on 5/8/20, practitioner and client will meet to begin individual therapy sessions. Practitioner will consult with the case manager to discuss client’s needs related to employment. Procedure Code: H Face to Face: 36 minutes Other Time: 30 minutes (includes writing the progress note and documenting on the treatment plan form) Progress Note Example 1 Pause the video if you want to review this note Reimbursement Clinical Legal
Practitioner met with the client for the purpose of conducting an assessment and developing a plan for treatment. Refer to the Adult Full Assessment dated 5/3/20 and DMH Client Treatment Plan dated 5/3/20. Client was open to services and forthcoming with sharing information about himself. Client and practitioner agreed to group rehab services to help client learn better communication skills, individual therapy to address trauma, and targeted case management to assist with finding stable housing. Practitioner will complete referral to rehab group and consult with group leaders. At next session, practitioner and client will begin individual therapy sessions. Time not billed: Reviewing consent for services, HIPAA, and confidentiality. Client signed all necessary forms. Procedure Code: 90791 Face to Face: 79 minutes Other Time: 66 minutes (includes writing the progress note and documenting on the assessment and treatment plan forms) Progress Note Example 2 Pause the video if you want to review this note Reimbursement Clinical Legal Goal: Client will decrease depressive symptoms from a PHQ-9 score of 19 to a 4 or less. Intervention: Met with the client for the purpose of conducting an individual therapy session. Administered the PHQ-9 – client’s current score is 19 (moderately severe). Client continues to endorse feeling depressed, feeling like a failure, difficulties falling asleep, and fatigue. Discussed lack of progress towards reducing depressive symptoms. Inquired whether client would be open to adding group interventions to the client’s plan. Also discussed whether client was open to a referral for an initial medication evaluation. Focused on challenging client’s underlying belief related to worthlessness, and modifying his tendency toward global self-rating. Assisted client in using statements to rate his behaviors and not his entire self. Practiced using problem-solving skills with the client to help him effectively address his triggers. Response: Client will continue to practice using statements to rate his behavior rather than his entire self and to continue practicing problem-solving skills. Client agreed to trying group rehab to learn more problem-solving and coping skills. Client also agreed to speak to the psychiatrist to determine if medications might help. Client signed updated treatment plan. Plan: To continue working on modifying self-defeating beliefs and strengthening problem-solving skills. Practitioner will complete a referral for a CBT group which will start on 6/8/20. Group rehab was added to client’s treatment plan. Practitioner made an appointment for client for an initial medication evaluation with Dr. X on 6/10/20. Procedure Code: 90837 Face to Face: 68 minutes Other Time: 21 minutes (includes writing the progress note and documenting on the treatment plan) Progress Note Example 3 Pause the video if you want to review this note Reimbursement Clinical Legal
1. Most recent treatment plan will be displayed on the first line
2. Color of the “End Date” will let you know if the plan is current or expired
3. Types of Services noted in the plan
4. Status of the form
Final – plan has been finalized / signed by the practitioner Draft – plan has not been finalized and has not been signed by the practitioner Pending - plan is waiting to be approved / co-signed by a supervisor or AMHD
5. Launch the form directly from this widget
DMH Client Treatment Plan Widget 1
- Pay close attention to pop-up messages DMH Client Treatment Plan Yes – You are adding new objectives and/or interventions to the current/existing Annual No – You are creating a new Annual Plan (starting over) Default from Previous – this means you want to bring in information from the most current/existing plan. This is used when creating an Update Client Treatment Plan.
1. Plan Date = date treatment plan was created
2. Plan End Date = automatically defaults to 365 days after the plan
date
This date cannot be changed to a later date
3. Next Review Date = automatically defaults to 1 month before the
Plan End Date
Practitioner will receive a reminder in his/her My To Do’s (if practitioner is listed as a participant) DMH Client Treatment Plan 1 2 3
- Problems to include in the client’s plan
Only select problems that are the identified mental health need(s) that
will be addressed in treatment
DMH Client Treatment Plan Excluded diagnoses will not be selected as problems to include in the treatment plan
