Why are some clients in group treatment not committed?
Once clients are engaged actively in treatment, retention becomes a priority. Many obstacles may arise during treatment. Lapses may occur. Frequently, clients are unable or unwilling to adhere to program requirements. Repeated admissions and dropouts can occur. Clients may have conflicting mandates from various service systems. Concerns about client and staff …
What happens when Clients drop out of treatment?
All change contains an element of ambivalence. ... brings about 30% of the outcomes of treatment ... People often go through a series of “stages” as they begin to recognise that they have a problem. 39 First Stage: Pre-contemplation People at this stage:
Why do clients continue to continue with treatment?
The Expected Outcomes section of the note describes the final functional status to be achieved by the end of the skilled therapy intervention provided. Expected Outcomes are commonly called Long Term Goals. The Anticipated Goals, commonly called Short Term Goals, are the stepping-stones for achieving the Expected Outcomes.
Can information obtained “anonymously” be therapeutically useful?
working alliance with the client that can greatly improve that client’s treatment outcome. Research has shown that treatment outcomes are improved when the clinician attends to the relationship between themselves and the client during the initial interview alone. It is through the various clinical interviews that the counselor learns to
What makes a team effective or ineffective in terms of achieving expected outcomes for the patients?
An effective team is a one where the team members, including the patients, communicate with each other, as well as merging their observations, expertise and decision-making responsibilities to optimize patients' care [2].
Why is it important to consider the role of patient expectations in the health care process?
Reactions to unmet expectations can range from disappointment to anger. Thus, knowing the expectations of our patients can help avoid these reactions, enhance their healthcare experience, and reduce our exposure to liability.
What are the 5 principles of trauma-informed care?
The Five Guiding Principles are; safety, choice, collaboration, trustworthiness and empowerment. Ensuring that the physical and emotional safety of an individual is addressed is the first important step to providing Trauma-Informed Care.
Why is it important to treat every client from a trauma-informed perspective?
It reinforces the importance of acquiring trauma-specific knowledge and skills to meet the specific needs of clients; of recognizing that individuals may be affected by trauma regardless of its acknowledgment; of understanding that trauma likely affects many clients who are seeking behavioral health services; and of ...
How might you manage the patient's expectations more effectively?
How to manage patients' expectationsEnsure information is easily accessible. ... Communicate in a way the patient can understand. ... Check the patient's understanding and let them ask questions. ... Show empathy and understanding. ... Be open to feedback.Oct 16, 2020
Can and should nurses be aware of patients expectations for their nursing care?
Nurses who are aware of patients' expectations of them may have a distinct advantage in influencing patients' expectations and thus positively affect patients' level of satisfaction with their nursing care.
What are the 3 E's of trauma?
The keywords in SAMHSA's concept are The Three E's of Trauma: Event(s), Experience, and Effect. When a person is exposed to a traumatic or stressful event, how they experience it greatly influences the long-lasting adverse effects of carrying the weight of trauma.Oct 13, 2014
What is one of the 6 core principles of trauma informed care?
Healthcare organizations, nurses and other medical staff need to know the six principles of trauma-informed care: safety; trustworthiness and transparency; peer support; collaboration and mutuality; empowerment, voice and choice; and cultural issues.Oct 26, 2020
What are the 4 components of trauma informed care?
The trauma-informed approach is guided four assumptions, known as the “Four R's”: Realization about trauma and how it can affect people and groups, recognizing the signs of trauma, having a system which can respond to trauma, and resisting re-traumatization.
What are the 3 components needed for a trauma informed school?
The competencies are self-awareness, social awareness, responsible decision making, self-management, and relationship skills. The explicit instruction of each of these competencies is essential in creating a universal trauma-informed approaches in schools.Feb 2, 2018
What types of interventions will be necessary in trauma informed practice?
Psychological interventions including:Trauma-focused CBT.Cognitive restructuring and cognitive processing therapy.Exposure-based therapies.Coping skills therapy (including stress inoculation therapy)Psychological first aid.Psychoeducation.Normalization.EMDR.More items...
What are the values core principles and features of trauma informed care and practice?
6 Guiding Principles To A Trauma-Informed ApproachSafety.Trustworthiness & transparency.Peer support.Collaboration & mutuality.Empowerment & choice.Cultural, historical & gender issues.
What do people need to change?
What do most people need to change? There are three categories: 1 Change negative thinking patterns discussed above 2 Avoid people, places, and things associated with using 3 Incorporate the five rules of recovery
What is the goal of relapse prevention?
The goal of treatment is to help individuals recognize the early stages, in which the chances of success are greatest . Second, recovery is a process of personal growth with developmental milestones. Each stage of recovery has its own risks of ...
How many stages of recovery are there?
Broadly speaking, there are three stages of recovery. In the original developmental model, the stages were called “transition, early recovery, and ongoing recovery” [2].
Why do people seek treatment for relapse?
Relapse prevention is why most people seek treatment. By the time most individuals seek help , they have already tried to quit on their own and they are looking for a better solution. This article offers a practical approach to relapse prevention that works well in both individual and group therapy.
What is the common denominator of emotional relapse?
The common denominator of emotional relapse is poor self-care, in which self-care is broadly defined to include emotional, psychological, and physical care. One of the main goals of therapy at this stage is to help clients understand what self-care means and why it is important [4].
How to tell if you are relapsed?
These are some of the signs of emotional relapse [1]: 1) bottling up emotions; 2) isolating; 3) not going to meetings; 4) going to meetings but not sharing; 5) focusing on others (focusing on other people’s problems or focusing on how other people affect them); and 6) poor eating and sleeping habits.
Is mind body relaxation good for relapse prevention?
Numerous studies have shown that mind-body relaxation reduces the use of drugs and alcohol and is effective in long-term relapse prevention [28,29]. Relapse-prevention therapy and mind-body relaxation are commonly combined into mindfulness-based relapse prevention [30].
What are the five treatment approaches?
2001#N#Description: This multidimensional instrument assesses five treatment approaches: psychodynamic or interpersonal, cognitive–behavioral, family systems or dynamics, 12–step, and case management. For each of the first four modalities, items assess beliefs underlying the approach, practices appropriate in individual therapy, and practices appropriate in group therapy. Case management is an individual approach, so no group practices items were included. In addition, items were developed to tap general “group techniques” (e.g., “encouraging peer social support”) and “practical counseling” (e.g.,“developing rapport and trust”). The instrument consists of 48 items that assess 14 subscales. Construct validity was supported by the results of a confirmatory factor analysis in which subscale items loaded on the factor they were intended to assess, but not on other factors. Corresponding belief and practice subscales correlated highly, except for case management. Cronbach alphas for all subscales except psychodynamic and family systems beliefs were above 0.50 and most were over 0.70 (Kasarabada et al. 2001, p. 287). The fact that some of the subscales consist of only three items contributed to low internal consistency estimates.
What are proximal outcomes?
Proximal outcome variables (Rosen and Proctor 1981; panel VII in figure 1) refer to cognitions, attitudes, personality variables, or behaviors that, according to the treatment theory under investigation, should be affected by the treatment provided, and should , in turn, lead to positive ultimate outcomes (e.g., abstinence or reduced alcohol consumption). An Institute of Medicine (1989) panel found that “little research has been devoted to the short–term impact of specific [alcoholism treatment] program components” (p. 159), and suggested that such short–term gains could be studied quite readily. Proximal outcome variables can be assessed at any point between treatment entry and the assessment of ultimate outcomes. When assessed during treatment, proximal outcomes constitute an important method that clinicians can use to assess patients’ treatment progress. For researchers, proximal outcomes, assessed during or after treatment, are key components in treatment process analyses.
What is program services?
Program services include those activities oriented toward treating alcohol use disorders, as well as problems in other areas of patients’ lives. Treatment orientation refers to the treatment modality or modalities applied at the program (or in treatment research, in the treatment condition).
How is quality of alcohol treatment determined?
The quality of alcohol treatment is determined, not only by the therapeutic techniques applied, but also by the characteristics of individual treatment providers (panel III in figure 1). In particular, this domain of variables refers to within–program variation in provider characteristics (aggregate, program–level staff characteristics are considered in panel II). Gerstein (1991) argued that “the competence, quality, and continuity of individual caregivers are likely to be critical elements in explaining the differential effectiveness of [substance abuse] treatment programs” (p. 139). In the alcohol treatment field, the few studies that have been conducted (e.g., W.R. Miller et al. 1980; Valle 1981; McLellan et al. 1988; Sanchez–Craig et al. 1991; Project MATCH Research Group 1998; for reviews, see Najavits and Weiss 1994; Najavits et al. 2000) indicate that therapist characteristics play an important role in determining clients’ treatment retention and outcomes.
What is alcohol treatment?
Alcohol treatment programs typically provide psychosocial and/or pharmacologic interventions to patients. To the extent that it is constant across all patients, treatment provided is a program–level characteristic (panel II in figure 1). In most programs, however, the treatment provided varies across patients (panel V).
What is ultimate outcome?
Ultimate outcomes (panel VIII in figure 1) refer to the end points that the treatment is supposed to effect. All treatment programs for alcohol use disorders attempt to impact drinking behavior, with many seeking to eliminate it entirely and others seeking to limit it to levels that do not cause adverse consequences. Some programs also seek to have a broader impact on patient functioning by effecting improvements in such life areas as employment, social functioning, physical health, and/or psychological functioning (for an in–depth discussion of outcome assessment, see Tonigan’s chapter in this Guide ). Treatment process models may specify different dimensions of treatment that should impact different areas of patients’ functioning.
What is the National Drug and Alcoholism Treatment Unit Survey?
Measure: National Drug and Alcoholism Treatment Unit Survey (NDATUS)#N#Citation: Office of Applied Studies 1991#N#Description: The NDATUS is a brief questionnaire (five pages) that covers (a) the overall organization and structure of programs (ownership, funding sources and levels, organizational setting, capacity in different treatment settings using different treatment modalities, hours of operation, etc.), (b) staffing and staff characteristics, (c) services (e.g., methadone dosages), (d) policies, and (e) clients and client characteristics. The 1989 NDATUS was augmented in 1990 by the Drug Services Research Survey (DSRS) (Office of Applied Studies 1992 a, 1992 b) to obtain additional data in the areas of facility organization and staff, client data, services, and costs and charges. Using data from the 1991 NDATUS, Rodgers and Barnett (2000) found that private, for–profit substance abuse treatment programs tended to be smaller and more likely to provide treatment in only one setting. Public programs and nonprofit programs generally had more treatment staff; Federal and for–profit programs had more psychologists and physicians. In 1992, the NDATUS evolved into the Uniform Facility Data Set (UFDS), sponsored by the Office of Applied Studies.
Introduction
Before discussing the details of writing goals, it is important to discuss the relationship between Expected Outcomes and Anticipated Goals in the note. The Expected Outcomes section of the note describes the final functional status to be achieved by the end of the skilled therapy intervention provided.
The Basic Structure of Expected Outcomes and Anticipated Goals
Before writing goals specifically, it is necessary to know the ABCs of writing goals. Like an educational learning objective, a good goal for patient care contains the following four elements:
Why should transitions in treatment always receive the attention of an individual session?
Transitions in treatment should always receive the attention of an individual session (or multiple sessions where indicated) because treatment transitions frequently impact the ultimate success of the treatment as well as lay the groundwork for the next level of treatment. The clinician seeks to discover the client’s views about successes, problems, continued areas of focus, and expectations of future treatment.
What is the point of contact between a counselor and client?
There are many points of contact that occur between a counselor and client over a treatment episode. Each of those contacts has the potential to provide the clinician with valuable information regarding that client and their specific treatment. If the counselor is aware of that valuable information and seeks to take advantage of those contacts they must rely on their interviewing skills to obtain that valuable information.
How are problem statements created?
Problem statements are created as a direct result of the Treatment Assessment. Through the use of the ASAM Six Dimensions, the Treatment Assessment helps the counselor understand where both the client’s strengths and weaknesses lie. The last page of the Treatment Assessment contains the Problem List, which the counselor uses to identify the client’s most immediate areas of need. The Problem List serves as the springboard from which the problem statements on the treatment plan are taken. A good way to check yourself is to compare the completed treatment plan with the last page of the Treatment Assessment; you should find every problem from your treatment plan contained within the Six Dimensions of the Problem List. Make sure you place the problems on the treatment plan in the correct Dimensions.
Why are progress notes important?
Progress notes are vital to good clinical treatment . Counselors often see progress notes as “busywork” and consequently write them in ways that don’t enhance the client’s treatment episode. Carefully documenting the treatment process can be time consuming, and often tedious, but it is critical to quality treatment. The written record supplies the details of how the client utilized their treatment plan. It is similar to drawing a map, in that it charts the client’s journey through the continuum of care.
What makes a good clinician?
Through school and work we have all been taught which qualities make a good clinician. Empathy, genuineness, respect, warmth, immediacy, concreteness, potency, and self-actualization are just a few. Understanding, transparency, tolerance, patience, and skillful validation are other important qualities, along with being flexible, curious, and open-minded. And don’t forget the various listening skills, such as clarification, paraphrasing, and reflection. It seems like a lot, and yet these skills are essential to creating an alliance (a partnership or bond) between yourself and your client.
Why do clients not follow through with their treatment plans?
Try to catch this as early as possible because it may be an indication that the client does not have a “buy-in” on the treatment plan. Or it could be that a new issue has surfaced that is more immediate for the client. Sometimes the client is confused about what they agreed to do and needs additional clarification or help organizing her/his plan.
What does empathy mean in a relationship?
Empathy - the ability to identify with and understand another person’s feelings or difficulties Genuineness - honest and open in relationships with others Respect - a feeling or attitude of admiration and deference toward somebody or something Warmth - affection and kindness, fond or tender feeling toward somebody or something Immediacy - moving away from the contents of the sharer’s problems and placing the emphasis on the process going on in the moment between the helper and the one seeking help.
What It Means
Imposing your values on clients means that you attempt to exert direct influence over their beliefs, feelings, judgments, attitudes and behaviors. This can occur if you're completely unaware of your own attitudes, beliefs and feelings or if you hold strong prejudices against specific groups of people.
Develop Self-Awareness
Self-awareness is perhaps one of the best tools you can use to avoid imposing your values on clients. This involves taking a comprehensive inventory of your feelings, values, attitudes and behaviors and noticing your reactions to your clients' statements or actions, especially those that provoke a strong or negative feeling.
Seek Supervision
Even the most experienced helping professionals need to engage in clinical supervision from time to time, especially in situations involving difficult or challenging clients in which strong value differences can come into play.
Maintain a Neutral Position
At times, sharing your clients' values can be useful to the treatment process, since they want to feel accepted and understood. But you also don't need to share your clients' values to convey this message.
Why is it important to use the right tool for the right job?
Using the right tool for the right job makes it easier to do your work and increases the chances that you’ll wind up with a quality product. If you can grasp the basic ideas of each of the different approaches to ethics, you will be in a better position to make a sound ethical decision.
What are the three schools of ethics?
The three schools are virtue ethics, consequentialist ethics, and deontological or duty-based ethics. Each approach provides a different way to understand ethics.
Patient Characteristics
Program–Level Characteristics
Provider Characteristics
Therapeutic Alliance
Treatment Provided/Treatment Involvement
Proximal Outcomes
Ultimate Outcomes
- Ultimate outcomes (panel VIII in figure 1) refer to the end points that the treatment is supposed to effect. All treatment programs for alcohol use disorders attempt to impact drinking behavior, with many seeking to eliminate it entirely and others seeking to limit it to levels that do not cause adverse consequences. Some programs also seek to have...
Table 1.—Measures of General Program–Level Characteristics
Table 2.—Measures of Treatment Orientation
Treatment Provided/Patient Involvement in Treatment