Speaker 1: Welcome back everybody. Today we're going to be looking at
E triple P and today we're going to be looking
at outcome evaluation and treatment planning methodologies. Treatment planning begins
with functional analysis, case conceptualization, and smart goal setting. It's
SMA r T. We'll look at the acronym later. Outcome
evaluation includes standardized measures, clinical self report, behavioral observation, and
clinical judgment. Therapeutic alliance, client motivation, and therapist skill are
strong predictors of outcome regardless of the approach. Progress is
tracked through baseline data, session by session monitoring. Treatment readiness
for termination depends on goal completion, symptoms, stability, and client insight.
We'll also be looking at ethical and managed care practices
that require measurable outcomes, evidence based interventions and documentation of progress,
and practice based evidence integrating real world clinical data. So
first things first, functional analysis. What is it? It's a
systematic behavioral assessment that dissects the environmental and internal factors
maintaining a target behavior and identifies antecedents, events preceding the behavior,
the behavior itself, and consequences through the whole staging process,
right to systematic case conceptualization. Refers to the clinician's integrative
synthesis of a client's history, symptoms, personality, traits, developmental stage,
relational patterns, and cultural context into a coherent working theory
that explains the origins and maintenance of the presenting problem.
Next is smart goal setting. We talked about it a
minute ago. It stands for specific, measurable, achievable, relevant, and
time bound. Smart goal setting is a structure for a
framework for formula treatment objectives. For illustration, considering a client
experiencing panic attacks and functional analysis might reveal at the
end of secedent, there's crowded public spaces, the behavior is
rapid breathing and avoidance, and the consequence is temporary relief
from anxiety through escape guiding an intervention such as gradual exposure.
The corresponding smart goal could be the client will practice
diaphragmic breathing and progressively crowded settings for at least through
fifteen minutes three times per week over the next four weeks,
as measured by a self monitoring log. Good therapy doesn't
happen by accident. Behind every meaningful session is a map
built not just from the client's story, but from the
science of change. THEE triple P expects you to know
how to draw that map, follow it, and revise it
and outcoming Evaluation isn't just about paperwork, it's how you
know what's working when to pivot. Evidence based treatment planning
goal is to create a plan that's individualized, measurable, and grounded.
In research, the functional analysis is the behavioral tool that
identifies antecedents. What happens before behavior, what exactly is the problem,
behavior and consequences, what form reinforces or maintains it. Example
is a teen skip school, that's the behavior after waking
up to parents arguing that's the antecedent and is allowed
to stay home without consequences. That's the consequence. This pattern
guides the intervention case. Conceptualization synthesizes client history, symptoms, personality,
and context into a working theory. It integrates diagnosis, developmental factors.
Relational patterns can be framed through theoretical lenses like cbt's
psychodynamic systems family. A strong conceptualization answers why is this
happening now and what maintains it? Goal setting, smart frameworks,
civic clear and focus. The measurable is observable or quantifiable
achievable is realistic for clients, context relevant connected to client's
core values of distress, and then time bound includes a
target time frame. Instead of improved communication, A smart goal
becomes client will use eye statements with partner doing your
disagreements at least three times per week over the next month.
Selecting interventions chosen based on diagnosis, client preference, empirical support
and cultural fit reference empirically supported treatments evidence based practices.
Treatments should reflect ongoing formulation, not just protocol. Empirically supported
treatments or interventions that have demonstrated efficacy and control research
studies meeting rigorous scientific criteria. Now, evidence based practice integrates
the best available research with clinical expertise in client preferences.
For example, for a client with major depressive disorder who
values family involvement and cultural traditions emphasizing collectivism, a clinician
might select behavior activation. This is an eest while adapting
to incorporate family supported activity, scheduling and showing cultural fit,
and all going ref formulation based on session feedback. Another
part is outcome monitoring methods. You don't just plan your measure.
Outcome evaluations track progress, so some standardized measures include PHQ
nine for instance assessments, a GAT seven, the OQ forty
five for overall functioning, administered, pre mative, post treatment or
session by session benefits, easy to score tracks, twin track
trends over time compare against norms. Limitations may not capture
nuance change or context specific issues. In addition, let's see
here we look at I lost my sorry, folks, I
lost my place where I was discussing some of the
techniques we were doing. So we're eest now we're back
over here. So behavioral assessment is the other one for
outcoming valuations. Behavioral assessment frequency, duration or intensity of target
behaviors like panic, attacks, sleep hours, substance use often done
via behavior logs or therapists. Observation especially help when CBT, exposure, therapy,
or parent management. Client self report is valuable when clients
reflect on subjective experience, quality of life, therapeutic satisfaction. You
can use it. You can use journals, bood trackers, and
weekly check in. Self report may fluctuate with emotional state,
clinical judgment, therapists. Impressions based on session content, affect, engagement, insight,
and relational shifts must be used again alongside objective data.
Though factors that influence treatment outcome we talked about it.
Therapeutic alliance is the strongest predictor of outcome across all modalities.
Includes agreement on goals, task collaboration, emotional bond Ruptures should
be dressed directly, addressed directly. Repair predicts greater long term success.
Client variables motivation, readiness for change, psychological mindedness and incsycopacity,
social support, co recurring disorders, substance use and trauma history.
Therapists variables empathy, authenticity and flexibility, cultural humility, adherence. The
treatment model tracking progress and making adjustments. Treatment isn't static,
it evolves. Therapists must monitor progress towards goals and adjust
techniques accordingly. Trates use for tracking use a treatment progress
note template, tie to smart goals, readminister measures like PHQ
nine or the GAD seven reviewed goal attainment state. Galing
is the client closer to their own definition of success,
went to a just treatment plateau in progress, use, symptoms, emerge,
goals no longer feel relevant, client resistance, life events, shift priorities,
and some of the intervention adjustments might include switching where
to modalities, tightening focus, or different skills. The therapeutic alliance
is the collaborative relationship between therapists and client, encompassing bond
agreement on goals agreement on tasks. Meta analytic research consistently
identifies it as one of the most robust predictors of
positive outcomes. Cultural humility evolves a lifelong commitment of self
reflection openness to the client's cultural world view. For instance,
the therapist notices a plateau and client's anxiety reduction after
six sessions using clinical judgment alongside behavioral logs showing persistent avoidance,
the therapist identifies a recent life event, job loss, shifting priorities.
Treatment is adjusted by incorporating solving skills from CBT and
scheduling a booster session. Focus on relapse prevention, readiness retermination.
Termination is about the absence of symptoms, its about sufficiency
of change and readiness to maintain gains. Indicators of readiness
include client has met the key treatment goals, increased use
of coping strategies outside greater autonomy, insider relational functioning, symptoms
stable for a certain for sustained period, client can reflect
on growth and anticipate few future challenges. Therapists should plan
for termination, collaboratively, allow reflection on the process, ethical and
systemic considerations. APA Ethics Code ten point zero one. Treatment
must be planned collaboratively and based on best available evidence.
Inform consent includes goals, methods and alternatives. Outcome valuation insurreans
we're doing no harm in delivering beneficial care. Manage care
and documentation and sure as require measurable goals. Progress tracking
and justification for continued treatment must document medical necessity using
functional impairment and diagnosis. Failure to demonstrate progress can lead
to denial coverage. Empirically supported treatments must be used appropriately,
not rigidly. Adaptations must be clinically justified and culturally responsive.
Practice based evidence collecting and analyzing your own outcome data
in real time support continuous improvement, Therapist accountability and contact
specific insight. Treatment planning transcends mere documentation. So that's it
for now, folks. Hopefully you enjoyed the podcast and we
will catch you next time.