Review from Session 4

(1)

Rutgers, The State University of New Jersey

Zakia Clay, MSW, LCSW

Ann Reilly MA, LSW, CPRP

Anthony Zazzarino MA, LPC, CPRP

[email protected]

Department of Psychiatric Rehabilitation & Counseling Professions

Review from Session 4

• Comprehensive Rehabilitation Needs Assessment

• Knowledge, Skills, Resources Form

Learning Objectives

• Review Knowledge, Skills, Resource (KSR) and its

connection to the rehabilitation plan.

• Practice developing an Individualized Rehabilitation Plan.

• Identify stages of change and its importance in developing

appropriate interventions.

• Develop a framework for documentation (Data, Assessment,

Plan - DAP).

(2)

Rehabilitation Plan Process

CRNA: Identifies goals.

KSR Form: Helps identify the critical

components needed to achieve the goal.

Once prioritized to 3 to 5 identified areas,

written in S-M-A-R-T format, becomes the

objectives in the Rehabilitation Plan.

Rehabilitation Plan: Incorporates the CRNA

with the KSR form. Adds S-M-A-R-T

interventions to match objectives and drives

the intentional billable services.

Why Individualized Rehabilitation Planning?

• Links the steps to achieve the goal with the interventions

– Interventions aim to eliminate the deficits

• Identifies who is responsible for doing what, by when, for how

long, and where

– Increases sense of accountability

• Operationally defines the rehabilitation team approach

(Anthony, Cohen, Farkas, Gagne, 2002)

Individualized Rehabilitation Plan (IRP)

Rehabilitation and recovery goals

Objectives

Strategy/intervention to be employed

Anticipated outcomes

(3)

Individualized Rehabilitation Plan Example

Interventions…

• Assist

• Review

• Check-in

• Support

• Encourage

• Transport

– Are these terms you currently use?

• What is the intended service that you are providing?

Individualized Rehabilitation Plan –

Activity Part 1 (10 min)

• Step 1: Partner up with someone that you don’t know

• Step 2: Identify a NEW goal that you are working on

• Step 3: Work with your partner to break the goal down into the

critical components utilizing the KSR Form

(4)

Individualized Rehabilitation Plan –

Activity Part 2 (10 min)

• Step 1: Identify your strengths and areas for improvement by

checking off the appropriate boxes on the KSR form.

• Step 2: Talk with your partner; prioritize 3 to 5 areas of need that

your want to work on first.

• Step 3: Break down the 3 to 5 prioritized items into S-M-A-R-T

format.

Switch roles at the buzzer

Individualized Rehabilitation Plan –

Activity Part 3 (10 min)

• Transfer the information from the KSR Form to your Individualized

Rehabilitation Plan

– Keep in mind:

• Strengths

• S-M-A-R-T objectives

• Develop S-M-A-R-T interventions to match each objectives

Switch roles at the buzzer

Rehabilitation Plan Process

CRNA: Identifies goals

.

KSR Form: Helps identify the critical

components needed to achieve the goal.

Once prioritized to 3 to 5 identified areas,

written in S-M-A-R-T format, becomes the

objectives in the Rehabilitation Plan.

(5)

Stages of Change

Pre-contemplation Contemplation Preparation Action Maintenance

Stages of Change

• Pre-Contemplation-Not seeing a problem behavior or not

considering change.

• Contemplation-Acknowledging that there is a problem but struggling

with ambivalence. Weighing pros and cons and the benefits and

barriers to change.

• Preparation-Taking steps and getting ready to change.

• Action-Making the change and living the new behaviors, which is an

all-consuming activity.

• Maintenance-Maintaining the behavior change that is now integrated

into the person's life.

(Miller, 2009)

(6)

Stages of Change Activity

How does this translate to visits

Pre-Contemplation

Contemplation/Preparation

Action

Maintenance

• Outreach • Trusting Relationship • Practical Support • Assessment • Motivational Interventions • Education • Skill building • Social Support • Cognitive Behavioral Interventions • Planning • Recovery Lifestyle • Social Support

Rehabilitation Plan Revisions

• Goal (s) have been accomplished

• Consumer no longer wants to work on chosen goal (s)

• Unforeseen events

• Disengagement

(7)

Documentation

• Should be:

– Concise

– Timely

– Readable

– Easily understood

– Complete

– Accurate

– Must relate to a service on the rehabilitation plan

– There is adequate content for time billed

– Should reflect the intervention(s) being addressed during the

visit

D-A-P Format

Data

Assessment

Plan

Data

Linkage to the

rehabilitation

goal

Review of

consumers

follow-up

activities

Specific

interventions

Consumer report

(8)

Assessment

Consumer response to the intervention

Assessment of progress towards IRP

goals, objectives, and interventions

Assessment of change in consumer

behavior

Plan

Staff/Consumer next steps

Date and time of next service delivery

Plan

(9)

D-A-P Checklist

Golden Thread of Documentation

CRNA

Rehabilitation

Plan

Progress

Note

Documentation Do’s and Don’ts

• Why do some claims get returned?

(10)

References

Alexander, M. J., & Haugland, G. (2000). Integrating services for

co-occurring disorders. Final report prepared for the New York State

Conference of Local Mental Hygiene Directors.

Orangeburg,

NY: Center for the Study of Issues in Public Mental Health,

Nathan S.Kline Institute for Psychiatric Research. Retrieved from

http://www.clmhd.org/UploadedFiles/Resources/Integrating%20

Services%20for%20CoOccurring%20Disorders_12835913305

2805216.pdf

Anthony, W., Cohen, M., Farkas, M., & Gagne, C. (2002).Psychiatric

rehabilitation. (2nd ed., pp. 141-151). Boston: Center for

Psychiatric Rehabilitation.

Larosiliere, V (2011). Community Support Services [memo].

Retrieved from

http://www.state.nj.us/humanservices/dmhs/info/CSS_Notice_t

o_provi ders.pdf.

References (continued)

Miller, W.. & Rollnick, S. (2009). Ten things that Motivational interviewing is

not. Behavioral And Cognitive Psychotherapy, 37, 129--140.

Miller, W. R., & Rollnick, S. (2002). Motivational Interviewing. New York:

Guilford Press.

New Vitae. (2014). Documentation, the D.A.P. Format, and Writing Incident

Reports [Module #5]. Quakertown, PA: Human Resources.

References (continued)

Pratt, C. W., Gill, K. J., N.M, & Roberts, M. M. (2014). Psychiatric

Rehabilitation. (3

rd

_{ed.) San Diego, CA: Elsevier Inc.}

Prochaska, J. O., & DiClemente, C. C. (1983). Stages and processes of

self-change of smoking: Toward an integrative model of self-change. Journal

of Consulting and Clinical Psychology, 51(3), 390-395.

Retrieved from http://www.sfu.ca/medialab/archive

/2010/426/Readings/Theoretical%20Framework/Stages%20of

%20Change%20%20Prochaska%201983.pdf