Treatment Content in Child and Adolescent Mental Health Services: Development of the Treatment Recording Sheet

Abstract

This paper presents a clinician self-report measure developed to record the specific components of treatment used with adolescents attending a Child and Adolescent Mental Health Service (CAMHS). Using action research methodology, 18 clinicians attended up to five facilitated discussion groups during 2006 to discuss the planned implementation of a clinical trial. The clinicians helped adapt a checklist for recording treatment strategies applied in CAMHS with adolescents. The sessions were audio-taped and transcribed for thematic analysis. The final treatment recording checklist is presented. The clinicians reported the instrument was helpful for recording the content of their interventions and understanding their colleagues practice.

Appendices

Appendix A: Treatment Recording Sheet (TRS) Developed for CAMHS Research

Appendix B: Treatment Recording Sheet (TRS) Guide for CAMHS

Derived from the Hawaii CAMDS Service Provider Monthly Treatment and Progress Summary

• Number of Sessions: Is the number of times you have worked with the adolescent or significant others during the preceding month

• Stage of Treatment: Please tick where on the continuum you think you are at with this client (i.e. how close to intake versus closure)

Intervention Strategies—ONLY RELATING TO THE PAST FOUR WEEKS!

• Please tick (√,√√, or √√√ according to frequency) any intervention strategies you used with this client or their significant others during the past FOUR WEEKS

• There is no limit to how many interventions may be checked

• If other strategies were employed that are not included, please record the name of these in the “other” box

Definitions of Intervention Strategies

Note: In defining interventions the term “client” is used generically to refer to the child/adolescent, parent(s), family members, school or others.

• 1.

• Rapport Building—Strategies used when the immediate aim is to increase the quality of the relationship between the client and the clinician. e.g. self-disclosure, reflection, play.

• Risk Assessment—Assessment of risk of harm to self or others.

• Functional Analysis—Arrangement of antecedents and consequences based on a functional understanding of the client’s behavior. This goes beyond straightforward application of other behavioral techniques.

• Mental Status Exam—Assessment of the client’s mental status (including appearance, behaviour, mood, affect, thought, speech, perceptual disturbance, insight, and judgement).

• 2.

• Motivational Interviewing—Strategies designed to increase the client’s readiness to participate in additional therapeutic activity or programs. These can involve cost-benefit analysis, persuasion, or other approaches.

• Supportive Listening—Reflective discussion with the client to demonstrate warmth, empathy, and positive regard without suggesting solutions or alternative interpretations.

• Emotional Processing—Activation of emotional memories in conjunction with new and incompatible information about those memories.

• Problem Solving—Techniques designed to bring about solutions to targeted problems, usually with the intention of imparting a skill for how to approach and solve future problems.

• Psychoeducation—The formal review of information with the client about the development of a problem and its relation to a proposed intervention.

• Goal Setting—Development of realistic, achievable goals to direct behaviour. Goals are identified and developed in collaboration with the client.

• Activity Scheduling—The assignment or request that the client participate in specific activities outside of therapy time, with the goal of promoting or maintaining involvement in satisfying and enriching experiences.

• 3.

• Crisis Management—Immediate problem solving approaches to handle urgent or dangerous events. This might involve defusing an escalating pattern of behavior and emotions either in person or by telephone, and is typically accompanied by debriefing and follow-up.

• Maintenance/Relapse Prevention—Exercises and training designed to consolidate skills already developed and to anticipate future challenges, with the overall goal to minimize the chance that gains will be lost in the future

• Practical Support—Providing tangible support e.g. organizing food vouchers, arranging transport, obtaining financial assistance.

• Line of Sight Supervision—Direct observation of the client for the purpose of assuring safe and appropriate behavior.

• Monitoring Training—The ongoing assessment of some target index by a significant other, or client self-monitoring of a target behaviour.

• 4.

• Interpretation—Reflective discussion or listening exercises with the client designed to yield therapeutic interpretations.

• Catharsis—Strategies designed to bring about the release of intense emotions, with the intent to develop mastery of affect and conflict.

• Insight Building—Techniques designed to help the client achieve greater self-understanding.

• Mindfulness—Techniques that facilitate present-focused, non-evaluative observation of experiences as they occur, with a strong emphasis on the here and now. This can involve the client’s conscious observation of feelings, thoughts, or situations.

• Logical Consequences—Training others in allowing the child/adolescent to experience the negative consequences of poor decisions or unwanted behaviours, or to deliver consequences in a manner that is appropriate for the behavior performed.

• 5.

• Praise—Applying social reinforcements for appropriate behaviour(s)

• Modelling—Demonstration of a desired behavior by the clinician, peers, or others to promote the imitation and subsequent performance of that behavior.

• Self-Reward Training—Techniques designed to encourage the client to self-administer positive rewards contingent on performance of the target behavior.

• Stimulus Control—Strategies to identify specific triggers for problem behaviors and to alter or eliminate the triggers in order to reduce or eliminate the behavior.

• Time Out—The training of or direct use of a technique which removes the client from all reinforcement for a specified period of time following the performance of an identified, unwanted behavior.

• Response Cost—Training parents or teachers how to use a point or token system in which negative behaviors result in the loss of points or tokens for the child/adoloscent.

• Response Prevention—Strategies designed to prevent a maladaptive behavior that typically occurs habitually or in response to emotional or physical discomfort.

• Tangible Rewards—Training parents or others involved in the social ecology of the child/adolescent to administer tangible rewards to reinforce desired behaviors. Rewards can include tokens, social reinforcers, etc.

• 6.

• Relaxation—Techniques or exercises designed to induce physical or mental relaxation. Can include breathing exercises, meditation, and visual imagery.

• Guided Imagery—Use of visual or guided imagery techniques for the purpose of mental rehearsal of successful performance.

• Cognitive Coping—Techniques designed to alter interpretation of events and enhance coping through examining and challenging the client’s reported thoughts, typically through the generation and rehearsal of alternative counter-statements.

• Exposure—Techniques or exercises that involve direct or imagined experience with a target stimulus, whether performed gradually or suddenly, and with or without the clinician’s elaboration or intensification of the meaning of the stimulus.

• 7.

• Communication Skills—Training clients to communicate more effectively with others. Can include a variety of communication strategies e.g. active listening, “I” statements.

• Social Skills Training—Providing information and feedback to improve interpersonal verbal and non-verbal functioning. Can include rehearsal, role play and in vivo exercises.

• Assertiveness Training—Exercises or techniques designed to promote the client’s ability to be assertive with others, usually involving rehearsal of assertive interactions.

• Commands/Limit Setting—Training significant others in how to give directions and commands and set limits in such a manner as to increase client compliance.

• 8.

• Family Engagement—The use of strategies to facilitate the family’s positive interest in participation in an intervention.

• Family Therapy—A set of family-centred approaches designed to shift patterns of relationships and interactions within a family.

• Couple/Marital Therapy—Techniques used to improve the quality of the relationship

• between caregivers.

• 9.

• Directed Play—Exercises involving the child/adolescent and a significant other playing together in a specific manner to facilitate improved verbal communication and nonverbal interaction.

• Play Therapy—The use of play as a primary therapeutic strategy. May include the use of play for clinical assessments or clinical interpretations. Differs from Directed Play where the specific focus is on facilitating communication. Play therapy can be directive (therapist leads the way) or non-directive (child decides what to do within safe boundaries).

• 10.

• Medication/Pharmacotherapy—Prescription, monitoring or review of medication(s) to manage emotional, behavioral, or psychiatric symptoms.

• Therapeutic Letters—Sending a letter to the client between sessions to initiate engagement, offer support or facilitate positive change.

• 11.

• Referral—Record any referrals for services or supports.

• 12.

• Other—Record any other interventions you have used. Include a short description of the strategies used.

Critical Incidents and Medication

Record any critical incidents that have occurred during the PAST FOUR WEEKS and changes made to any medication (e.g. medication added or ceased or dose change).

Thank you!!