PSYC-528 Evidence-Based Practice, Case Conceptualization & Treatment Planning Flashcards
ADDRESSING model
“ADDRESSING” model is a framework that facilitates recognition and understanding of the complexities of individual identity.
Age Disability at birth Disability acquired Religion Ethnicity Socioeconomic status Sexual orientation Indeginous population Nation of origin Gender (Pronouns)
Adjunct treatment
one or more secondary interventions used concurrently with a primary intervention to enhance treatment effectiveness.
ex. medication may be used concurrently with cognitive behavior therapy, with CBT as the primary form of intervention
Case conceptualization/formulation
The case conceptualization (sometimes called a case formulation) is the clinician’s collective understanding of the client’s problems as viewed through a particular theoretical orientation; as defined by the biological, psychological, and social contexts of the client; and as supported by a body of research and practice that links a set of co-occurring symptoms to a diagnosis and, ultimately, a treatment plan.
A strong case conceptualization is guided by the utilization of a theoretical orientation that provides a framework for the clinician from which to condense and synthesize multiple pieces of information into a coherent and well-developed narrative.
Client factors
The client factors include the client’s level of motivation, perceptions of the therapy, commitment to the therapy framework, and integration of concepts into everyday life.
Other factors that contribute to successful therapy mentioned include: being collaborative, teaching skills and giving tangible assignments, consistency of the therapist, higher number of sessions, client’s personality, and client’s ability to feel safe.
Common factors
in psychotherapy, any of several variables that are common to various types of therapy, such as the therapeutic alliance, and that promote therapeutic success regardless of the different approaches used;
common factors can thus be contrasted with factors that are unique to a particular therapy, such as the use of interpretation. The concept of common factors is a premise underlying integrative psychotherapy.
Efficacy vs effectiveness research
Efficacy trials (explanatory trials) determine whether an intervention produces the expected result under ideal circumstances.
Effectiveness trials (pragmatic trials) measure the degree of beneficial effect under “real world” clinical settings.
Empirically Supported Treatments
Empirically supported therapies (ESTs) are behavioral health interventions that have met stringent scientific criteria:
1) at least 2 randomized controlled trials (RCT) comparing treatment to placebo and/or established treatment, a large # of single case experimental design studies, or meta-analysis;
2) well-defined treatment protocol that can be independently replicated usually following a manual;
3) independent investigators reach similar conclusions; form basis of evidence based practice
Evidence based practice
the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences
The purpose of EBPP is to promote effective psychological practice and enhance public health by applying empirically supported principles of psychological assessment, case formulation, therapeutic relationship, and intervention.
Ex. Exposure therapy
Failure to respond
Situations in which patients do not respond to standard treatments for their disorder
Informed Consent for Treatment
the consent by a client to a proposed medical or psychotherapeutic procedure, or for participation in a research project or clinical study.
In order for the consent to be informed the client must first achieve a clear understanding of the relevant facts, risks and benefits, and available alternatives involved. Informed consent requires legal documentation in all 50 states.
The concept of informed consent originated with the recognition that individuals have rights: to freedom, autonomy and human dignity.
Clients (whether in inpatient or outpatient treatment) possess these rights and cannot be denied their rights due to mental health status or condition.
Legal Aspects: Comprehension, Capacity, and Voluntary
Practice Guidelines
APA practice guidelines provide evidence-based recommendations for the assessment and treatment of psychiatric disorders and are intended to assist in clinical decision making by presenting systematically developed patient care strategies in a standardized format.
Precipitants of the problem
Proximal factors that trigger or worsen the client’s symptoms and problems.
Precipitants can be internal—physiological symptoms that trigger a panic attack—or external—a stressful life event that triggers a depressive episode.
Primary vs. Secondary evidence
Primary: Original materials gathered in research and using first-hand accounts
Secondary: Interpretation and analysis of primary source
Problem list
An important task during the assessment phase of therapy is to identify client difficulties. The Problem List worksheet is a helpful way of gathering information about current problems and includes client and therapist versions.
Mechanisms of action
Factors which cause and maintain a client’s symptoms
Nonadherence
failure of an individual to follow a prescribed therapeutic regimen.
Although nonadherence has traditionally been ascribed to oppositional behavior, it is more likely due to inadequate communication between the practitioner and the individual, physical or cognitive limitations that prevent the patient from following therapeutic recommendations (e.g., physical disabilities), or adverse effects that are not being adequately addressed.
A primary aspect of health psychology involves methods of reducing nonadherence and increasing adherence.
Also called noncompliance
Outcome measures
tools that evaluate changes in mental health by capturing metrics across multiple areas of client functioning, symptoms, and treatment experiences at baseline and after treatment has begun.
measurable changes in health, function or quality of life that result from our care.
Use of outcomes measures can guide treatment decisions, pinpoint the need for additional professional education and training, and help patients recognize their own improvement.
Origins of mechanisms
Build the foundation for the mechanisms that keep the problem around; Distal
Ex. Relationship with dad- anger/ alcohol Family conflict Family view of mental health Biological predisposition Self fulfilling prof Anxious child
Spheres of influence
This assessment tool will get the individual to look at areas of their life and see which areas may be impacting and influencing them.
Some spheres of influence to consider are: themselves, immediate family, friends, husband or wife, extended family, job or school, community, culture or religion, and any external influences.
Therapy interfering behavior
according to dialectical behavior therapy (DBT), things that get in the way of therapy. These are behaviors of either the patient or the therapist.
-More obvious examples include being late to sessions, not completing homework, cancelling sessions, and forgetting to pay.
-More covert or subtle TIBs examples include:
Behaviors that shut down the productivity of sessions, e.g. not answering questions or saying “I don’t know,” yelling at or criticizing the therapist, and uncontrollable sobbing
Not acknowledging a problem or downplaying the severity of that problem
Derailing the focus of a session — particularly to topics that are unrelated to treatment
Not setting clear treatment goals
-Once the discussion has been initiated, it is essential for the therapist to maintain the client’s participation. This can be done via:
Confirmation: Make sure the client fully understands what is being said — and why. Ask the client to repeat back what they are hearing. Then, have the client clarify if they are willing to change the TIBs.
Collaboration: Once the client understands and commits to change, this must be a collaborative effort. Both parties can work together to set goals and identify what role each of them will play.
Treatment goals
Treatment planning is a team effort between the patient and the counselor.
Both parties work together to create a shared vision and set attainable goals and objectives. A goal is a general statement of what the patient wishes to accomplish.
Examples of goals include:
The patient will learn to cope with negative feelings without using substances.
The patient will learn how to build positive communication skills.
The patient will learn how to express anger towards their spouse in a healthy way.
Treatment monitoring
Collection of data throughout treatment to assess for progress
Since the aims of treatment are to maximize benefits and minimize harms, monitoring the individual patient should provide information that serves those aims. This can be done in different ways. Clinical monitoring Ideally, one should measure the desired outcomes directly and watch for undesired ones.
Treatment plan
In mental health, a treatment plan refers to a written document that outlines the proposed goals, plan, and methods of therapy. It will be used by you and your therapist to direct the steps to take in treating whatever you’re working on.
the treatment plan is always subject to change as therapy progresses.
Presenting problem: A brief description of the main issue or issues.
Goals of therapy: An annotated list of both the short-term and long-term goals of therapy.
Methods: A short, annotated list of the techniques that will be used to achieve the goals.
Time estimate: A brief estimate of the length of time and/or the number of sessions needed.
