OPTIMAL OUTCOME OF TREATMENT
The client learns to manage his/her own illness, developing awareness of the illness and learning skills which enable him/her to overcome or accommodate symptom fluctuations. The optimal outcome is for the client to live independently and engage in productive activities with minimal need for support or treatment.
ASSESSMENT GUIDELINES (See Assessment Guidelines for Adults)
All staff will provide services which are perceived as non-threatening and affirming of the client's rights and personhood. Staff will provide the services needed with extreme sensitivity and patience, especially during periods of confusion and disorientation.
1. Clients with psychotic disorders should be carefully evaluated and prioritized regarding their need for center services. This shall include evaluation of danger to self or others and need for involuntary hospitalization.
2. The assessment should include a determination of current living conditions and circumstances to specifically address housing, health care access, relationships, daily life activities, finances, transportation, etc. If the client has dependent children, appropriate referral for evaluation or services should be made. As client needs are identified, refer to appropriate services, e.g., case management.
3. Clients will be encouraged, where appropriate, to sign a release of information form so that the family and/or support system can be contacted and offered information about the client's psychotic disorder. If a release is signed, the family/support system will be invited to be actively involved in treatment and relapse prevention. Information about psychotic disorders and the Utah Alliance for the Mentally Ill may be provided to the families without a release of information.
4. If there is evidence that the individual is dependent upon and/or under the influence of a chemical substance, an evaluation for the need for medical detoxification should be made. Inquiring about substance abuse is an essential part of the initial assessment. Because substance abuse often coexists with psychotic conditions, therapists will continually assess for substance abuse and encourage appropriate treatment as needed.
TREATMENT GUIDELINES (See Treatment Guidelines for Adults)
"Modern treatment includes not only pharmacotherapy to alter the neurochemical aspects of vulnerability, but also flexible individual and group psychotherapies, psychoeducation, and assertive case management to mitigate the impact of stress; rehabilitation to promote the development of resources; and social, cognitive, and vocational skills and learning strategies to enhance coping capacity" (APA 1995). Particular attention should be given to the stability and sufficiency of the client's living arrangements. All of these services must incorporate the client's life history and experiences, values and interests.
1. The chronic nature of many psychotic disorders may require varying level intensity of services over the course of an individual's lifetime. This will require diligence on the part of the treatment team to keep the client involved in appropriate services.
2. Therapists will assess the client's understanding or interpretation of their symptoms. Therapists will provide or assure that education about the psychotic disorder is available and is complimentary with the client's own personal understanding of his/her symptoms whenever possible. The therapist will assist in providing current information about symptom management.
3. Medication is critical in the treatment of psychotic disorders. Medication arrangements should be made in accordance with the client's assessed needs. Medical staff have primary responsibility to periodically review medication use with the client. Therapists should review medication use and refer concerns to the medical staff as indicated.
4. The therapist will engage the client in relapse prevention. This may include discussion with the client regarding preferences for people to contact, with whom he/she feels the safest, and alternatives to hospitalization in times of crisis to include the use of the Mental Health Advanced Directive (UCA-62A-12-504 Forms available from the State Division of Mental Health.)
5. A collaborative team approach to treatment is essential. The team includes the client, therapist, case manager, other psychosocial rehabilitation team staff, and medical staff. Involvement of family and other community/social supports is also highly recommended when appropriate. Cooperation, coordination, and communication are critical for good care and treatment.
6. Therapy with clients with psychotic disorders will include assisting the client to address issues of loss, previous treatment experiences, relationship issues, parenting skills, self-image, and depression as appropriate. Therapy need not focus solely on psychotic symptoms unless that is the client's choice.
7. Because of the often unpredictable and/or slow process of recovery, staff will communicate hope to clients, and assess progress by improved quality of life (as measured in family/friend relationships, living situation, work, health status) as well as remission of symptoms.
8. Clients with psychotic disorders will be given appointments which are flexible in duration and frequency which meet the needs of the client.
9. Medical providers are responsible for providing information to the client about medication, including potential benefits and side effects, both short and long term. Medical providers will conduct a yearly assessment for involuntary movement, i.e., AIMS or DISCUS, with all clients receiving neuroleptics for longer than six months.
10. When substance abuse co-exists with a psychotic condition, attention needs to be paid to the treatment of the substance abuse problem. Concurrent treatment provides the most effective approach. Substance abuse treatment should be specifically tailored for the individual with a psychotic disorder and documented in the clinical record.
THESE GUIDELINES
HAVE BEEN DEVELOPED BY:
THE UTAH PREFERRED PRACTICE CONSENSUS PANEL
UNDER
THE AUSPICES OF THE UTAH DIVISION OF MENTAL HEALTH
APPROVED NOVEMBER 1, 1996