P5S4-0008-PowerPoint

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November 28, 2020


"Phoenix Haga: The Individual Treatment Plan":

A PowerPoint presentation and talk

by Kim Johnsrud

Presented at the Conference of the European Federation of Therapeutic Communities

Crete, May 2005


CLICK HERE for the PowerPoint Presentation

For Synopsis of the PowerPoint Presentation, See Below

SYNOPSIS: "Phoenix Haga: The Individual Treatment Plan":

by Kim Johnsrud

EFTC Conference

Crete

May 2005


Page 1

Resident

When the residents arrive at the doorsteps of Phoenix, Haga, they have already been through several meetings with our admissions office. During these meetings the resident’s motivation is charted and if they decide to enter the treatment process, an intake date is decided. On the day of admission, the resident is met at our facilities by a representative from the admissions office, the case manager and a big brother/sister.


Case manager

The case manger takes over the responsibility for the resident from this moment. He introduces the big brother/sister who will follow the resident throughout the treatment process, and he is taken to his room to unpack his personal belongings. The case manager then prepares the process which we label individual treatment planning.


EuropASI

The EuropASI interview is the first step of developing the individual treatment plan. This interview will magnify areas of special concern, and rate the resident’s need for help.

We will get back to this interview in greater detail later on.


EuropASI feedback form

Summarizes the EuropASI interview, and underscores specific problem areas of the resident. We will get back to this in further detail in a little while.


Individual treatment plan

The individual treatment plan is written by the resident, in cooperation with the case manager. It is the plan that the resident will follow for the specific stage of the treatment process which he/she is in. We will take a closer look at what this plan looks like later.


Case manger action plan

This plan is made by the case manager, and contains specific steps that he/she is responsible for carrying out during the treatment process. We will take a look at one of these plans a little later as well.


Page 2

The case manager

The case manager is responsible for the development and implement of the individual treatment plan.

As a matter of fact, the case manager is responsible for the entire treatment process. He follows the resident through his or hers entire program, and is therefore often labeled as primary contact for the resident. All issues the resident needs help resolving during the treatment process are handled by the case manager in cooperation with the TC.


The treatment plan is a systematic process designed to ensure that the resident receives the best possible treatment, according to his /hers individual needs.


Page 3

Admission day, and the first two weeks of treatment

The case manager greets the new resident as he arrives at the treatment center. The resident is introduced to a big brother or sister at this time as well. An admissions office representative who already knows the new resident will also be present to greet the new resident.


The case manager performs the EuropASI interview with the resident within one week of admission.

We will get back to the EropASI interview in a little bit.


The case manager completes the EuropASI feedback form, the individual treatment plan, and the case manager action plan within two weeks of admission.

We will get back to these elements in greater detail in a little while, but the timeframe is as follows: EuropASI, the first week…… the EuropASI feedback form, the individual treatment plan, and the case manager action plan within two weeks of admission.


Page 4

EuropASI

The EuropASI is an assessment instrument designed to be administered as a semi-structured interview in one hour or less to residents who are presented for substance abuse treatment.

Experience dictates that the interview may take longer than an hour to complete, but the main idea is to complete the interview without entering dwelling on possible painful experiences which is revealed in the interview process. The residents often have a traumatic background, so it is easy to fall in to the trap of exploring these as the resident start to reveal problem areas. At the same time it is important to not to ignore the resident’s needs, so we reassure him, or her that these issues will be dealt with later. (Example: sexual abuse).


The instrument gathers information about seven areas of a resident’s life: medical, employment/support, drug and alcohol use, legal history, family history, familiy/social relationships, and psychiatric problems.

(Refer to the form and go through the different areas in a very brief way)


Using a ten point scale from 0 to 9, interviewer severity ratings indicate the degree of patient problems in each of the seven problem areas, based on historical and current information.

The resident also rates the problems and his, or hers, need for help on a separate 5 point scale. (Show what the scales look like, and briefly explain where the values are derived from).


Page 5

EuropASI feedback form

Identifies problem areas which the resident needs to address, and the resources he/she possesses to meet the challenges in the treatment process.


This form is a useful tool for the development of the individual treatment plan and the case manager action plan.

We shall follow the problem area above, and see how we apply it to the individual treatment plan, and the case manager action plan.


Page 6

The individual treatment plan

The individual treatment plan contains all the problem areas from the EuropASI form, and EuropASI feedback form.

The individual treatment plans also contains additional areas of concern to the treatment process, like how the resident is planning on spending his, or hers, spare time.


The resident fills out the individual treatment plan together with the case manager.

What is important to point out here, is that it is the resident him/herself that puts pen to paper. The resident completes the individual treatment plan in his or her own handwriting.


Highlights problem areas in which the resident expresses specific need for help.


Page 7

The case manager action plan

The case manager creates a case manager action plan to be implemented within problem areas of special concern.


A new case manager action plan is created for each problem area, and the case manager is responsible for coordinating all the efforts made.

A new plan is created for each problem area; for example; one for medical attention and a separate plan is created for behavioral problems.


The case manager action plan utilizes both internal and external resources.

In the medical plan, the case manager is responsible for getting the resident to a physician, and making sure that the resident’s medical needs are being met. This can include making sure that the staff within the TC hands out prescribed drugs for a medical condition.

The case manager is also responsible for coordinating external efforts made on the resident’s behalf. Getting reports from physicians and follow up external medical treatment plans.


Page 8

Individual treatment planning

The implementation stage


The goal groups. The residents work in groups to help each other achieve personal goals in addition to the goals set forth in the individual treatment plan. We will take a closer look at the goal group in a little bit.


The case manager.

The case manager oversees the work being done in the goal group and guides the resident’s goal plan, so that he/she achieves the goals set forth in the individual treatment plan. This will also be explained in further detail.


Co-residents.

Peers in the community help the resident in achieving their weekly goals. More on this later.


Page 9

The Goal Group

The goal group takes place once a week.

We have 8 goal groups, with four residents in each, at our treatment center, and we gather them on Thursday mornings.


The resident sets weekly goals to help him/her achieve goals relevant to the Individual Treatment Plan. It is important that the resident come prepared with a new goal to the goal group, and that the goal itself is significant to the resident. By being prepared, and “owning” the goal, the resident becomes more involved in actually achieving the goal. Thus, by achieving the goal, the resident is likely to experience some degree of empowerment.


The goal group members support the resident in achieving the weekly goals.

The other members of the goal group will follow up the resident’s efforts in achieving the goal, by encouraging him/her to work hard on the goal during the week.


The resident evaluates how the goal has helped him in the treatment process.

After a goal has been achieved, the resident will tell the goal group what benefits he/she gained from working on the goal.



Page 10

The case manager

Monitors, and guides the resident in his/her efforts towards achieving the goals set forth in the individual treatment plan.

The case manager will guide the resident, if necessary, to set goals which relate to his or hers individual treatment plan. It is the case managers responsibility to ensure that all the goals set forth in the individual treatment plan are being worked on by the resident.


Implements the TC perspective in helping the resident achieving goals.

The case manager makes sure all the elements within the therapeutic community is facilitated to help the residents achieve their weekly goals. This includes peers in the community, the encounter group, big brothers or sisters, in addition to other clinical interventions.


Writes a weekly journal on the resident’s progress.

The case manager writes a report every week on how the resident progresses in comparison to the goals stated in the individual treatment plan.


Functions as a leader, and facilitates the weekly goal groups.

The case manager will set the time, and place of the goal group and acts as a group leader during the group.


Acts as a rational authority and role model for the resident.

The case manager acts as a rational authority over the residents of goal group. He or she will give stern feedbacks to the resident, if the resident is not working in an active manner on achieving the goal.


Page 11

Co-residents

Supports the resident in his or hers efforts to achieve the weekly goals.

The peers in the community will constantly remind and encourage the resident to achieve his or hers goal.


Helps the resident in forming new goals for achieving desired results in accordance with the individual treatment plan.

The peers in the community will observe the resident in his or her daily regimen, and make suggestions to the resident on what he or she needs to work on.


Page 12

The evaluation stage

As milestones in the program is being reached, the resident’s progress is being evaluated by the case manager, a quality control team, and the resident him or herself. In the end of this evaluation procedure, a written and oral report is given to the resident.

So the progress are being evaluated three times before a written report is issued on the resident’s progress in the program:


Resident’s own evaluation.


Case manager’s evaluation.


Quality control team assessment.


Feedback to the resident.

Page 13

Resident’s own evaluation

The resident evaluates his or hers weekly goals.

Before every goal group, the resident will evaluate what he experienced from working on that specific goal. Was something learned? Did the goal trigger any emotions? Was it a positive experience working on this goal? Etc.


The resident evaluates his or her progress in the treatment process as milestones in the program are being reached.

As different stages of the program are being completed, the resident will evaluate his or her own progress by comparing the goals to the expectations of the individual treatment plan.


Page 14

Case managers evaluation

The case manager writes a weekly journal where he or she evaluates the resident’s progress.

We touched on this journal a little earlier;

The case manager writes a report every week on how the resident progresses in comparison to the goals stated in the individual treatment plan.


The case manager evaluates the progress as the resident reaches important milestones within the program.

In a separate evaluation, the case manager will make out a written report based on comparing the goals that the resident have been working on, to the expectations of the individual treatment plan.


The case manager writes a report on the resident’s progress which is presented to the quality control team, and relevant partners in the treatment process.

The above report is presented to the treatment center’s quality control team, and relevant partners like welfare offices, probation officers etc.

Page 15

Quality control team assessment


Oversees that the resident receives the best quality treatment available, and that expected results are being accomplished.

The quality control team evaluates the resident’s progress in the program, and ensures that the resident receives the full benefits of the treatment center’s program.


Assures that governing laws are being followed.

The quality control team has the responsibility to oversee that national and regional laws governing patients in treatment are being followed, in addition to this, the quality control team also make sure that international human rights laws are respected in the treatment process.


Evaluates results in comparison to goals set forth in the individual treatment plan.

Just like the resident and the case manager, the quality control team will also evaluate the progress of the resident and compare it to the goals set forth in the individual treatment plan.


Offers guidance to the case manager.

The quality control team will offer guidance to the case manager in the treatment process. This may include further clinical interventions, or they may suggest including one or more external resources in the process. (psychiatrists, medical doctors, attorneys etc.)

Page 16

Feedback to the resident


The resident receives an oral feedback on his or her performance in the treatment process, when the results have been evaluated.

When all results have been evaluated, the resident receives an oral and a written report on how he or she is doing in comparison to the expectations set forth in the individual treatment plan, and it will also be made clear to the resident what is expected of his or hers performance in the following stages of the treatment process.


References:

De Leon (2000) The therapeutic community: Theory, model and method. New York: Springer publishing Company.

De Leon (1992) “A recovery stage paradigm and therapeutic communities”. In proceedings in the second therapeutic communities of America planning conference: “ Paradigms past, present and future” Chantilly, Virginia, December 1992. Providence, R.I Manissees.

McLellan, A.T et al (1992)The fifth edition of the Addiction severity index, Journal of substance abuse treatment, 9,199-213.

Europ/ASI Norsk utgave , versjon utarbeidet I 2002. Oslo: Lauritzen/ Hildre SIRUS.

Oberg, d et al (1999) ” ASI feedback formulae : Europ/ASI. Tilbakemeldingskjema fra Europ/ASI til behandlingsplanen (AFF) 4.1,ASI feedback formular4.1” Bergman. H.et al.Manual til svenska addiction severity index. Stockholm: Karolinska institut.

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