Treatment Plans and Treatment Planning

Types of Treatment Plans

An initial treatment plan focuses on the client's short-term or preliminary goals and objectives and guides the initial course of treatment. Elements of an initial plan include reason(s) treatment is indicated, a preliminary diagnosis or diagnostic impression, the client's presenting problems, client symptoms, and initial methods or services that will be used to address those problems. A treatment program may require a preliminary treatment plan at admission, followed by a comprehensive, individualized treatment plan shortly thereafter.

A program-driven plan reflects the components or standard activities and services available within the context of a particular treatment regimen. This outdated, "one-size-fits-all" method of treatment planning provides insufficient information to differentiate between clients' unique problems and needs. Program-driven statements are commonly overused. Examples of program-driven statements include the following:

• Client will refrain from using all mood-altering substances now and in the future.
• Client will participate in the outpatient program.
• Client will attend three AA meetings a week.

An individualized treatment plan is a written document that identifies important treatment goals relative to those problems identified in the screening and assessment process. The plan identifies important treatment goals; describes measurable, time-sensitive action steps toward achieving those goals with expected outcomes; and reflects the verbal agreement between the counselor and the client. Information is gathered systematically from the client and other available collateral sources. Validated screening and assessment instruments used in combination with a structured interview format of both closed- and open-ended questions elicit information regarding the client's current situation, symptoms, perceptions of his or her problems, strengths, needs, and readiness to engage in treatment. The counselor assesses the severity of the client's problems and uses clinical judgment to prioritize problems appropriately. The plan is continually updated and revised throughout the course of treatment. Timing of revisions and updates is guided by regulatory and credentialing requirements.

Treatment plan reviews or continued stay reviews reflect client progress in relation to the problems and goals identified in the most current treatment plan and may also adjust the level of care.

Historical Aspects in Substance Abuse Treatment

Until recently, the field of substance abuse treatment operated from a "one-size-fits-all" treatment philosophy. Typically, one approach to treating individuals with substance use disorders was considered superior. Focus was placed on a limited number of tools and strategies that had worked with some consistency. Programs used the same tools, in the same way, with everyone, regardless of clients' specific problems. Unique aspects of clients' problems and treatment needs were not reflected in program-driven plans and were often developed without client or collateral party involvement. In the event the client's situation indicated the need for additional services, plans did not reflect referrals to community service providers, psychiatric clinics, or vocational rehabilitation services. There was little difference among clients' treatment plans. The written document was frequently viewed as necessary, useless paperwork and was filed in the client chart for the duration of the treatment episode. In 2003, R. K. Hester and W. R. Miller conducted a seminal review of treatment outcome literature regarding alcohol treatment interventions and concluded that there is no single treatment intervention that works for all clients. Rather, there are several evidence-based practices that demonstrate efficacy for a variety of clients in multiple settings and levels of care. Research studies have also concluded that individualized treatment planning methods lead to increased client retention. Retention is important because many clients terminate treatment prematurely. This paradigm shift away from a philosophy of one-size-fits-all treatment recognizes that clients have different and unique abilities, goals, lifestyles, socioeconomic realities, work histories, educational and vocational experiences, and cultural backgrounds. Similar to medication dosing, no two clients should have the "same dose of treatment" just as no two clients present with identical problems or strengths.

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