Arizona State Hospital

Clinical Therapy/Treatment Planning Services

Statement of Purpose

This program provides treatment planning services and direct active treatment to the hospital patients. The purpose of the program is to ensure that the treatment plans developed by the treatment teams continue to meet all standards and specifically address the behaviors that admitted the patient to the hospital. The purpose of the program is also to make recommendations for treatment interventions and to provide individual and group psychotherapy to patients.

Program Description

There are eight Therapist/Treatment Plan Coordinators who are assigned to the treatment units. The Therapist/Treatment Plan Coordinator serves as a consultant to the multidisciplinary treatment teams and ensures that the treatment plans developed by the treatment teams meet all standards and specifically address the behaviors which admitted the patient to the most restrictive level of psychiatric care available in the state.

The Therapist/Treatment Plan Coordinator provides ongoing training on writing quality treatment plans. They track reviews of patient treatment plans assigned and work with the teams to ensure that all standards and timelines are met. The Therapist/Treatment Plan Coordinator is also responsible for providing specialized treatment approaches specific to the individuals served by the hospital and direct individualized services to the patients referred. They provide individual and group therapies that can positively influence and maximize patient functioning. They work directly with the treatment teams to identify and develop the most appropriate counseling treatment that will affect change and will enhance the success of discharge planning.

The Psychological Services Administrator is responsible for the overall coordination of the program and will ensure that all therapy and treatment planning services meet specific requirements of Medicare, JCAHO, and all other accreditation bodies.

Program Goals

The primary goals of the program are to develop quality treatment plans and to provide individual and group therapy to the hospital patients.

The Therapist/Treatment Plan Coordinators are available to work directly with the multidisciplinary treatment team to identify long and short-term goals of patients and to provide recommendations for treatment interventions.

The Individual Treatment and Discharge Plan (ITDP) is an individualized plan of care that contains measurable long and short-term goals and specific interventions to assist patients towards discharge. The plan is developed using the initial assessments by the patient's clinical team, information from the patient, the patient's family and/or guardian, and the community team representative. An ITDP meeting occurs when the treatment team and others involved in service provision to the patient, meet to discuss, prepare and/or review a written plan outlining the patient's progress.

The preliminary ITDP is initiated at the time of the patient's admission and completed within 24 hours of admission. The master ITDP is developed and completed within 10 days of the patient's admission. Each member of the treatment team comes prepared to present information on the patient's progress towards meeting the identified treatment goals. If they cannot be present at the staffing, they provide written information that is integrated into the treatment plan. The multidisciplinary treatment team consists of the psychiatrist, registered nurse, social worker, psychiatric nurse unit manager, therapist/treatment plan coordinator, rehabilitation therapist, mental health program specialist, other professionals based on the patient's needs, the patient, any persons requested by the patient (family, designated representative, patient advocate), and guardian, if applicable.

The Therapist/Treatment Plan Coordinator also provides direct clinical services to the hospital patients. Based upon a referral from the treatment team, a therapist will be assigned to work with the patient. The Therapist/Treatment Plan Coordinators have varied experience and expertise in a number of specific areas. The assignment of the therapist will be based upon the referral question and the specific expertise of the therapist.

Scope of Service

Treatment Planning

One of the primary goals of the program is to assist the treatment team in the development of the ITDP. The Therapist/Treatment Plan Coordinator works closely with the multidisciplinary team to develop long and short-term goals and specific interventions to achieve the goals. They review patient clinical information at the time of admission and all the initial assessments completed by the multidisciplinary treatment team to identify the primary behavioral issues to be addressed in treatment to prepare the patient for returning to the community. The Therapist/Treatment Plan Coordinator ensures that the goals are based on the behavioral reasons for admission to the hospital and that the goals are measurable and individualized to meet the identified needs of the patient.

Each unit will have a Therapist/Treatment Plan Coordinator who is assigned to work with their team. It is up to each treatment team to decide who will scribe the treatment plan. On most units this is a shared responsibility among the treatment team members. However, on some units, there may be one person who is assigned to the scribe role. The treatment team needs to inform the Therapist/Treatment Plan Coordinator what the process is for scribing the treatment plan. The Therapist/Treatment Plan Coordinator will be available to consult with the team and the treatment team scribe on any issues relating to the development or revision of the treatment plan.

Psychotherapy Services

The Therapist/Treatment Plan Coordinator will provide individual and group psychotherapy services upon referral from the treatment team. They will work directly with the treatment teams to identify and develop the most appropriate treatment approach for the referred patient. The therapies provided will be those shown through "best practice" to most effectively change the patient behaviors.

Therapists will be assigned to work with patients based on the specific referral question and the therapist's specialty areas. The Therapist/Treatment Plan Coordinators have training and expertise in treating various disorders including severe mental illness, substance abuse, dual diagnosis, post-traumatic stress disorder, borderline personality disorder, and eating disorders.

Behavior Management Plan

The Therapist/Treatment Plan Coordinator will assist the treatment teams in the development and implementation of any behavior management plans.

Behavior management refers to the use of basic behavioral or learning-based techniques to help the patient develop socially appropriate and safe replacement behavior. The goal of behavior management is to modify, decrease, or eliminate a patient's problem behavior while at the same time increasing the patient's adaptive and socially acceptable behavior.

Behavior management is used when the patient has been unresponsive to less restrictive interventions or less restrictive interventions are not indicated. The Therapist/Treatment Plan Coordinator will work with the treatment team to identify target behaviors to be addressed in the behavior management process. They will work with the team to select treatment interventions and rewards for demonstrating the appropriate adaptive, replacement behaviors. They will help the team with implementation of the procedure and be available for ongoing consultation/problem-solving relating to the plan.

Quality Control Audits

The Therapist/Treatment Plan Coordinators maintain oversight of all treatment plan processes to ensure that quality standards are maintained.

There are several different ongoing audits to ensure the quality of the treatment plans and to ensure that all noted deficiencies are corrected. A multidisciplinary group meets on a weekly basis to review the treatment plans on each new admission on the civil campus and a sample of new admissions on the forensic campus. The team consists of the Psychological Services Administrator, Therapist/Treatment Plan Coordinators, the Chief Medical Officer, and representatives from Social Work, Nursing, and Nutrition Services. This team reviews the treatment plans and any addendums to the treatment plans for compliance to all standards. The team closely reviews the plans to ensure that the long and short-term goals are measurable and reflect the behaviors that led to the patient's admission to the hospital.

The Therapist/Treatment Plan Coordinators meet with the treatment teams to discuss the recommendations to improve the treatment plan and follow up to ensure that the changes have been made. The Therapist/Treatment Plan Coordinators also conduct audits of the revised treatment plans.

Training Services

The Therapist/Treatment Plan Coordinators provide ongoing training and education to the multidisciplinary treatment team members on developing and implementing a quality, individualized treatment plan for each hospital patient.

Training can be provided on an individual basis or also to the entire treatment team. They also provide training on therapeutic approaches to treatment.

The Therapist/Treatment Plan Coordinator is available to meet with all new staff members of the treatment teams to educate and train them on writing the plans. They are also available for any specialized training needs requested.

Staffing

There are eight Therapist/Treatment Plan Coordinator positions. There are 3.5 assigned to the Civil Program and 4.5 assigned to the Forensic Program. Since the majority of the admissions take place in the Forensic Pre-Trial Restoration to Competency Program, it is necessary to have additional staff to develop the treatment plans for these patients.

Special Needs

The special needs of the patients most often include language barriers and medical/physical issues that require other accommodations. The hospital has staff available to provide translation services for patients in the hospital who do not read or understand English.

In the event that staff is not available in sufficient quantity or are not fluent in the language of the patient, the Arizona State Hospital uses an agency under contract to provide for this need.

Social workers have the primary responsibility for identifying the resources that are necessary to address the special needs of the patients (including sign and other interpreter services). Unit Managers are responsible for procuring these services as well as special medical equipment.