chapter  4
37 Pages

Finding the Treatment Plan in the Zone: Preparing the Short-Term and Long-Term Plan and Working with Available Resources (Including MCOs)

The therapist has now conducted the initial family contact, which included a brief child-based meeting, gathered checklists, and met with the parents. The parent meeting should have established the parental alliance and evaluated parental skills. Any adult psychopathology that may be present has been identified that may affect parental function. Financial resources, the role of insurance, or managed care should have been reviewed further. The background data of the problem, medical and developmental data, and the family history should now be clear. Any complicating tensions or difficult interactions in the family have been identified. In addition, the therapist has defined the "zone" of care. The third meeting is the point at which the therapist can review with the child, the parents, and then, together, what the treatment approach will be. If resources are limited, discussion with the parents must occur to determine what are their main objectives. Certainly this was underscored in the initial parent and child meeting with its focus on the reason for consultation. This active dialogue, begun in that first meeting and continued in the parent meeting, finalizes what the child and family want to solve and heightens their awareness of what they must do. (See Table 4.1.)

The definition of the zone of care will help the therapist focus on how to prioritize the elements of an initial approach to the presenting problem. In zone 1, a wide range of techniques can be helpful in resolving most problems. (See Table 4.2.) Assessment should have defined what treatment is indicated, choosing among a specific child and family intervention, a focus primarily on the parents' needs, case management, or multimodal therapy. The therapist should know, at this point, whether a therapeutic approach would be valuable or whether the treatment approach should integrate work

TABLE 4.1. Overview oftasks and assessments during first three meetings

Information Collected Tasks Given Assessments Made Session 1 Family Observation of family Nature of family

interview interaction interaction

Child play Observation of the Checklists done Adaptive skills of interview or child by parents the child

Adolescent during play Tentative diagnosis interview interview

Parent check-in School information Initial zone of care to be collected

"Detective work" I nsurance task

Session 2 Parent Social-emotional-Continue "detective Rate child symptom meeting developmental-work" or enhance severity and duration;

medical history emerging Confirm diagnosis Parental history solutions Parental diagnostic Parental style of love, Level of parental limits, real life capacities rated

Information from Zone of care school reviewed finalized

Insurance planning Comorbid school review problems

identified

Session 3 Child/ Response to treatment Prognostic indicators adolescent plan Change in symptoms interview Willingness and ability Definition of balance

to follow treatment of therapeutic guidelines components:

child, parent, family Family Continue solutionmeeting oriented steps

with other systems of care, as is the case in all other zones. In zones 2, 3, and 4, the therapist must have a frank discussion about the severity of the problem and the limits of "fixing" the problem; rather there is the need to "manage" it, or to turn to other resources.