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by Neal Adams, M.D., M.P.H., and Diane Grieder, M.Ed.; Burlington, Massachusetts, Elsevier Science Publishing, 2004, 320 pages, $59.95
Many practitioners consider treatment planning to be a time-consuming paper exercise that they are mandated to perform to meet requirements of administrators and accreditation bodies. Treatment planning is often cynically regarded as irrelevant to what really takes place in the treatment context and virtually inconsequential with respect to outcome. In Treatment Planning for Person-Centered Care: The Road to Mental Health and Addiction Recovery, authors Neal Adams, M.D., M.P.H., and Diane Grieder, M.Ed., cogently describe and advocate for an alternative perspective: a recovery-based model with the treatment plan serving as a working and dynamic road map to help clients achieve personally meaningful goals.
Adams and Grieder suggest that person-centered service planning lies at the core of a paradigm shift in which the standard of mental health and addiction care calls for full participation by consumers. The person-centered approach eschews the traditional medical model as paternalistic and often insensitive to the client's world view. Borrowing heavily from the affirming humanistic values of psychiatric rehabilitation and the recovery movement, the person-centered approach emphasizes the development of partnerships between clients and providers. All aspects of person-centered treatment planning rely on shared decision making and client-defined outcomes. Furthermore, the authors posit, this process promotes client choice, empowerment, resilience, and self-reliance.
Readers of Treatment Planning for Person-Centered Care are guided through each step of creating a person-centered treatment plan. Separate chapters cover assessment, establishment of goals, development of objectives, identification of interventions, and evaluation of progress. The chapter on assessment contains excellent outlines for developing narrative summaries or case formulations that form the foundation of the treatment plan. The discussion of goals, objectives, and interventions clearly elucidates the contrast between these elements of the treatment plan within the familiar problem-oriented medical record and the person-centered approach.
Rather than relying on cookie-cutter plans whose primary target is to reduce the symptoms that make up the client's diagnosis, person-centered treatment plans are holistic, are highly individualized, and identify positive outcomes based on clients' strengths and available supports. According to the book's authors, goals and objectives should be written in the client's own words whenever possible. Interventions and outcomes must be consistent with the client's readiness to acknowledge problems and make changes. Throughout the book, the authors stress the need for culturally competent clinical practice and the consideration of co-occurring mental health and addictive disorders.
Although there is a respectable effort to bridge the gap between the theoretical and the practical, the authors are not entirely successful in this regard; they could have made the connections between the principles of person-centered treatment planning and the few case examples more explicit.
The authors are candid in their identification of possible barriers to effective implementation of the person-centered approach, namely systemic resistance in mental health treatment programs and a lack of training, knowledge, and skills on the part of service providers. Clearly the success of this approach depends on the presence of compatible values and competencies that truly support client empowerment, partnership, hope, and recovery. It is unfortunate that at this juncture, the authors' position, although exciting and a potential stimulus for much needed change, does not have an empirical basis.
These limitations notwithstanding, I strongly recommend this book to mental health administrators, supervising clinicians, and others who are concerned with continually improving the quality of their treatment planning process. It would be an outstanding resource for training candidates who are pursuing professional degrees in mental health and addiction treatment.
Dr. Rutter is assistant professor of counseling and human services at Canisius College in Buffalo, New York.
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