Strengthening Clinical Reasoning in Practice Using Clinical Reasoning

Strengthening Clinical Reasoning in Practice Using Clinical Reasoning from Assessment and Understanding through Case Formulation to the Planning of Outcomes, Strategies, and Actions

Module 1 : Session 2 Components of Practice Clinical Reasoning & Case Formulation Modules • By Ray Foster & Kate Gibbons for New Mexico BHSD, 2017

Guiding Principles of Practice Services A B C • Family/Person-Centered, Youth-Guided, Team. Supported • Strengths-Based & Need-Responsive • Outcome-Focused & Results-Driven • Individualized & Coordinated • Trauma-Informed & Responsive • Culturally-Competent • Solution-Focused • Supportive of Resiliency and Recovery (well-being, functioning) • Clinically & Practically Well-Reasoned Clinical Reasoning & Case Formulation • © Child Welfare Policy & Practice Group. , 2014

Guiding Principles of Recovery RECOVERY* is a process of change through which individuals improve their health and wellness, live a self-directed life, and strive to reach their full potential Recovery emerges from hope Recovery is culturally-based and influenced Recovery is person-driven Recovery is supported by Recovery occurs via many addressing trauma pathways Recovery involves individual, Recovery is holistic (whole family, and community person) strengths and responsibilities Recovery is supported by peers and allies Recovery is supported through relationships and social networks Recovery is based on respect * New SAMHSA definition of Recovery, Updated in 2012

Differences in Approaches BUSINESS APPROACH POWER => Authority & enforcement MIND-SET => We run a business Problem-focused (dx / authorization) Rule-based (policy & procedure) Compliance-driven (requirem’ts met) QUALITY => Passing the next PRACTICE APPROACH POWER => Reasoning & consensus MIND-SET => We help change lives Solution-focused (path to recovery) Reason-based (practical & clinical) Outcome-driven (people get better) QUALITY => Interventions that

Elements Should Work Together Operational Structures Approaches & Techniques • Policies & procedures • Recovery & resiliency • Funding requirements • Person-centered care • Electronic health record • Health Homes • Care coordination • Model used for care integration • EBPs • Screening tools & treatment protocols • Motivational interviewing • Solution focused brief therapy Craft Knowledge of Practice • Recognition, connection, rapport, engagement • Situational awareness, clinical grasp, clinical foresight, clinical reasoning, case formulation • Logic of action clinical case in practice

Integrated Approach A collaborative approach works best for integrating functional assessment, clinical formulation, goal-setting, and selection of intervention strategies. This approach is achieved best through consistent, ongoing teamwork. A functional bio-psycho-social approach strengthens clinical formulation and the ability to explain the why’s and how’s of the interventions planned. An integrative case formulation combines concepts and techniques from different approaches, in a systematic way, to meet the unique needs of the person through tailored intervention processes. A good case formulation integrates understandings of the person’s functional strengths, unmet needs, underlying issues, and what must change into a coherent treatment framework designed

Practice Wheel: Basic Practice Functions Craft Knowledge is Used In All Practice Functions Craft Knowledge Involves Clinical Reasoning