Why Treatment Plans Matter — And 9 Tips
By Barbara Griswold, LMFT (April 2, 2019)
Many of us share the anxiety of getting “the call” from an insurance plan, asking to review your treatment of one of their members. This can happen even to out of network providers. Or perhaps they are calling to review your charts, to see if they meet plan standards.
A key component of the treatment review or documentation review is your treatment plan. If you don’t create a formal treatment plan for each client, you aren’t alone. Many therapists find them too time-consuming or just plain confining. But treatment plans are mandated by some states and professional ethics codes, required by most insurance plans, and can be a helpful guide for you during treatment.
In addition, some common reasons clinicians don’t get approved for more sessions after a treatment review are:
- The therapist couldn’t articulate a treatment plan
- The treatment goals were not “medically necessary” as defined by the plan
- The therapist was too vague in explaining how progress would be measured
- The plan didn’t include clearly articulated interventions
9 Treatment Plan Tips
1. A Treatment Plan needs to include, at its very bones, these components:
- Treatment goals – These should be symptom-focused and measurable
- Measurable objectives – How will you measure your goal has been achieved?
- Time frame: How long do you think it will take to reach these goals?
- Interventions: The actions you plan to take
2. Treatment goals should be symptom-focused. Try to quantify it as much as possible. “Reduction of anxiety” is a good goal, but “reduction of panic attacks from three times monthly to one time monthly” is even better. Also, make sure your goals are related to your diagnosis.
3. Set treatment goals with the client. When a client comes to the intake, I ask them “imagine your last session, and that you got everything you wanted from these sessions. What will be different in your life? How will you be feeling/thinking differently? What will you be doing differently?”
4. Make sure the goals are measurable. If the client’s goal is vague like “I’d like to feel happier at work,” ask “if you were happier, what would you be doing differently?” Try to identify a measurable behavior such as “I wouldn’t be coming late to work every morning because I don’t want to be there.”
5. “Improving sleep” can be a great goal. This is a common issue, affects all life areas, and is easily measurable (e.g. increase the average number of hours that they get per night). You can then name specific interventions that you do with insomnia as part of the treatment plan.
6. “Helping the client build or better utilize their support system” can be a great goal. Insurance plans like to hear that you are working to decrease the client’s dependence on you.
7. List a few interventions you plan to do for each goal. This includes things you do in-session, homework assignments, referrals, and recommendations (ex. suggesting a podcast or book, referral to a support group or for medication, or utilizing DBT, EMDR, teaching progressive relaxation or mindfulness). It is not enough to say “my intervention is weekly individual therapy.” It is better to state that you plan to “help client identify how cognitive distortions and negative self-talk exacerbates their anxiety or depression, and replace with positive affirmations,” for example.
8. Once you’ve put together a treatment plan, bring it out periodically during treatment. Ask your client, “How are we doing with your original goals? Do we need to add new ones?” When reviewing original goals with clients, they are sometimes happy to hear how they have progressed. If no progress is being made on a goal, you can discuss if new approaches are needed. Having the documentation of progress and your evolving treatment plan will help you to be prepared for a treatment review.
9. Don’t Panic — get proactive now. It’s understandable to feel anxious before a treatment review or documentation review. But let your anxiety motivate you now to create useful treatment plans and to get skilled at speaking the language of medical necessity so that you can defend your client’s care (If you’d like help creating treatment plans, improving your notes, or preparing for treatment reviews, contact me).