Components of a treatment plan
Information gathered through a comprehensive assessment should be used to guide the negotiation of a treatment plan with the client. Problem areas and strengths should be clearly identified.
The treatment plan should specifically address how each problem area will be managed. For each problem area, the treatment plan should specify the specific nature of the problem(s), the desired change (short- and long-term goals) and the means by which the goals will be achieved. It should also describe how the problem will be managed, including the type of treatment (e.g., group vs. individual counselling, the frequency of treatment contact, the provider(s) responsible for the treatment service and the time frame for re-evaluating treatment progress).
The treatment plan should prioritize problems requiring immediate focus and those of less urgency.
All major problems, once formulated, regardless of whether or not they will be addressed, should be documented in a formal treatment plan. If a decision is made not to address a major problem, the justification for this decision should be explained in the treatment plan.
Treatment planning as a collaborative process
Treatment plans should take into account the client's motivation to engage in counselling. Clients and counsellors need to collaboratively develop a treatment plan.
To foster a sense of individual responsibility, clients need to feel they control decisions about their treatment. This will also help clients to feel that their concerns are being addressed and help reduce client resistance to the counsellor's interventions.
Readiness for change
Miller and Rollnick observed that people entering treatment for substance use problems exhibit varying degrees of motivation for change. People in the Precontemplation Stage have not yet acknowledged that they have a problem, whereas people in the Action Stage have begun to take steps toward change.
As Miller and Rollnick emphasize, if treatment interventions are to succeed, they should be consistent with the client's level of readiness for change. For example, although the treatment team may decide that a pregnant woman who is living on the street should be in a shelter, unless the client also regards her homelessness as a problem, it would be inappropriate to confront and pressure the woman to move to a shelter.
Nowhere is it more important to use warm, supportive, empathic and non-confrontational interventions than when clients are in a Precontemplation or Contemplation Stage of readiness.
With clients who have multiple problems, treatment is best initiated in graduated steps so as not to overwhelm them.
Referrals to external treatment services
Although clients may identify many problems during the assessment phase, it is not always possible to manage all of these problems at one site. Each treatment facility should identify and develop particular areas of expertise. Other problems may be better managed by additional treatment elsewhere.
The MMT counsellor should act as a case manager (see Chapter 6) to ensure that all aspects of the treatment plan are implemented in a co-ordinated and synergistic way. However, MMT clients are less likely to access other services if the services are not conveniently located and practical.
It is highly desirable, where feasible, to increase the capability of on-site services.
In some instances, consultation may be used to extend the range of on-site services. For example, a psychologist or psychiatrist may be most qualified to manage a client with serious mental health problems. However, if the only available psychologist or psychiatrist is located in a nearby town, it may be more feasible to manage the client's problems with the combined efforts of the local physician and counsellor who consult with a psychologist or psychiatrist.
Monitoring and revising the treatment plan
Treatment plans should be reviewed during the first year at a minimum of every three months. After the first year on MMT, and/or after a client has reached the Maintenance Stage, treatment plan reviews may be conducted less frequently.
During a treatment review, progress should be discussed with the client, and the treatment plan should be revised if necessary. The client's previous goals should be reviewed and progress in each area evaluated. Where possible, operationalized criteria, such as the outcome measures of the ASI, should be used in evaluating treatment progress.
Team meetings and case conferences (where more than one service is involved) should be an integral part of the review process. The case manager should initiate, co-ordinate and document these review processes.