Improving Quality of Rehabilitation Planning in Outpatient Mental

Improving Quality of Rehabilitation Planning in Outpatient Mental Health Dr. Samson Omotosho, Ph. D, RN-BC

Levels of Psych Rehab Planning 1. Rehabilitation Program Development (RPD) – done by the program director, proprietors and board of directors. 2. Individual Rehabilitation Planning (IRP) – done by the rehab treatment team every 3 -6 months. 3. Rehabilitation Contact Planning – (RCP) done by the counselor prior to each patient contact.

1. Rehab Program Development State the mission & goals of the program Form a board of directors Develop the program Follow State regulations (e. g. COMAR) Consider accessibility, collaboration with other agencies, community reintegration, availability of personnel, culture, administration, staff development, program sustainability and funding.

2. Individual Rehab Planning-IRP Developed within a month of admission Based on rehab assessment, diagnostic assessment and/or psychiatric evaluation Developed by the Rehab Treatment Team Reviewed every 3 months for a child Reviewed every 6 months for an adult

Rehabilitation Treatment Team The client or client’s parent/guardian The therapist The psychiatrist The counselor The plan must be signed by the client plus at least 2 of the other 3 above. Any of the above may request a modification to the plan before signing.

Content of IRP The psychiatric diagnoses and rehab needs Long term goals – to be achieved by discharge Short term goals – to be achieved in few sessions Target dates - for achieving the goals Goals must be objective, observable, measurable Activities or intervention to achieve the goals Signatures of at least 3 team members (See sample IRP)

3. Contact Planning & Implementation Counselor’s plan towards next contact Based on knowledge of the client, issues from previous contacts, content of the IRP Should address at least one goal from IRP Must be achievable within the planned time

Symptoms & Feelings to be Addressed Stress and distress caused by the illness Stigmatization – including sense of shame Feeling of loss of relationship, vocation, interests, etc Difficulty in accepting mental illness Need for acceptance by others Hopelessness

Behaviors to be Addressed ADL (activities of daily living) Interpersonal relationships Self esteem Motivation Adherence to medications and rehab plan

Living Skills to be Addressed Physical Emotional Intellectual Cleaning Shopping Cleaning Hygiene Fitness Transportation Recreation Human relations Self control Expressing anger Conversation Impulse control Assertiveness Patience Goal setting Time planning Money management Community resources Problem solving

Learning Skills to be Addressed Physical Emotional Intellectual Punctuality Being quiet Paying attention Staying seated Observing Listening Question asking Volunteering answers Speech making Asking for directions Following directions Reading Writing Arithmetic Study skill Typing Hobby

Working Skills to be Addressed Physical Punctuality Transportation Job strength Use of job tools Job tasks Emotional Job interview Decision-making Human relations Self control Job seeking Job tasks Intellectual Knowledge Job skills Qualifying Job search Job tasks

Values to be Addressed Respect of self, authority figures, and others Respect of other’s properties Respect of other’s personal space Respect of other’s rights Honesty Determination Good attitude

Caregiver Support to be Addressed Emotional Support– acceptance, understanding, empathy, commitment, partnership Feedback Support– listening, affirmation, talking Information Support– the illness, coping, decision, perspective, behavior management, medications. Instrumental Support– resources, respite, care help

Evaluation 1. Program evaluation – usually annually Are the program’s vision and goals being met? Is it cost-effective and regulation-compliant? 2. Rehabilitation evaluation – 2 to 4 times a year How many and how well are the goals achieved? 3. Contact evaluation–at end of each contact/month Are the goals for these contact/month achieved?