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Clinical Documentation
What Works? Scott Miller
Groups General
Group Therapist Tasks
Mixed
100
3 Main Types of Clinical Documentation
What are 1. Assessment, 2. Treatment Plan, and 3. Progress/Therapy Notes
100
Number one factor of client success?
What is Alliance ! (client view of therapeutic relationship)
100
Two Types of Group Process
What are 1. Agenda Controlled (Psychoeducational) 2. Free Form (Process)
100
Do NOT do this a facilitator
What is do not become the central figure in the group
100
Two types of group skills
What is Continuous and General of Contingent
200
* The who, what, where, when, why, how * Past, present, and future * Strengths, resources * Bio-psychosocial-spiritual model * Should determine treatment course
What is Assessment
200
Reasons for client drop out (3)
What are: Cost (81%), Lack of Confidence in Outcome (78%), Stigma (Fewer than 5%)
200
The purpose of Therapeutic Groups is to... (3)
What is 1. Provides the opportunity to meet and talk with others in the same plight 2. Disrupt isolation, link with common experience 3. Methodology expands the purpose (i.e. narrative groups assist to link people together, expose and undermine oppressive discourse, and discuss new way of being free from problematic discourse)
200
*Set time and place *Select members *Prepare members prior to the initial group session
What is Create the Group
200
Thinking group: The group as a whole comes first, the individual second. The group relationship is the primary helping agent. Think of both individual goals/interactions & groups goals/interactions Scanning. (show when talking) (ask another to talk to you) Fostering cohesiveness: (1) Use "We and "our" not I me you yours. (2) Voice group achievement & summarize what "we" have done or accomplished. (3) Preserve group history; begin with where "we" left off, etc. (4) Allow the group to create and maintain ground rules & verbalize them. (5) Develop traditions and rituals, hugs, greetings, sayings, etc.
What are Continuous Skills
300
*Clarify treatment focus, Set measurable goals *Facilitate communication between professions *Support authorization for treatment *Ensure quality of treatment Utilizes: Problem, Goals, Objectives, Interventions
What are Treatment Plans
300
Where to focus in clinical therapy?
What is *Technique, *Allegiance (belief in the ability of the therapy to work for the client), *Alliance, *Outcome (measurable)
300
Group Stages of Development
What are: 1. Pre-Group Orientation 2. Orientation (forming) 3. Exploration and Testing (storming and norming) 4.Problem Solving (performing) 5. Termination
300
*Work to prevent attrition *Replace drop-outs if possible (open/closed group) *Deter anti-cohesion factors
What is Maintain the Group
300
According to Scott Miller's literature review, does treatment work?
What is Yes, the average treated client is better off than 80% of an untreated sample of clients
400
Following every encounter/session Could Use: SOAP (Subjective: statements from the client, Objective: my observations,Assessment: my assessment/analysis of the situation,Plan: what will I do next?) Considerations
What are Notes
400
Three steps to putting "What Works" into therapy
What is 1. Create a “culture of feedback”; 2. Integrate alliance and outcome feedback into clinical care; 3. Learn to “fail successfully.”
400
Group Cohesiveness Enhances
What is 1. Responsible Activity 2. Interpersonal Influence. 3. Similarity of Values 4. Development of Security
400
*Promote norms of honesty and spontaneity *Support open communication in which members communicate directly, not through you *Foster high levels of involvement *Value self understanding and change *Make members aware of the importance of the group *Acknowledge members as change agents *Shape norms by: Allowing members to set and change rules, Modeling understanding and openness, Not taking an all knowing position
What is Build the Group Culture
400
Examples include: Amplifying Subtle Messages, Softening Overpowering Message, Reaching for a Feeling Link, Reaching for an Information Link, Redirect the Message, Clarifying the Message, Inviting Full Participation, Turning Issues Back to the Group, Reaching for Consensus, Reaching for Difference
What are General Of Contingent Group Skills
500
6 Reasons why to Document
What is 1. Provides a map, 2. Continuity of Care, 3. Legal Issues, 4. Evaluation of Intervention/Service Delivery, 5. Accountability, 6. Reimbursement ***If you didn't document, it didn't happen***
500
*Client places a mark on the line to indicate how they are doing in the areas of Individually, Interpersonally, Socially, Overall *Each line is 10cm (100 mm) in length *Score to the nearest millimeter *Add the four scales together for total score
What is the Outcome Rating Scale
500
General Facilitator Tasks
What are... 1. Provide a safe environment 2. Help members develop mutual support 3. Do NOT run or lead groups; help organize, develop and run themselves 4. Groups are entities with many helpers 5. Gradually helps the group participants to take control Note: Different methodologies have different clinical procedures
500
*Acknowledge the here and now as it emerges *Explore horizontal not vertical disclosure *Note the kinds of tension themes that arise in any group such as the struggle for dominance and ambivalences
What is Maintain a Process Focus
500
Describe the History of Clinical Documentation
* Rooted in initial SW practice, *End of 19 C- increased detail/verification of facts, *1933 Fed. Emergency Relief Agency-Standardization, *1930s Process Recordings, *1960s-1970s: increased demand for accountability *1980s: new therapeutic models, increase in technology use *1990s-today: focus on technology, HIPAA, NASW Code of Ethics, legal implications, reporting for regulatory purposes