CLINICAL HANDBOOK OF SCHIZOPHRENIA

CHAPTER 15TREATMENT PLANNINGALEXANDER L. MILLERDAWN I. VELLIGANMuch of this chapter is devoted to discussion of specifics of treatment planning. By wayof introduction, however, we pose a series of questions that consider the rationale for andelements of treatment planning.WHAT IS A TREATMENT PLAN?A treatment plan is a document that relates treatments to desired outcomes (goals). To beoperationally useful, the plan should specify how progress toward goals will be measured.For example, the goal of competitive employment might have days worked perquarter as a measure of progress. The treatment plan needs to cover all the areas thattreatments are intended to affect. Goals should be specific and, where necessary, sequentiallystaged.WHY HAVE A TREATMENT PLAN?Schizophrenia is a chronic, multifaceted illness. Treatment responsibilities are typicallydivided among multiple providers, and priorities shift according to phase of illness. Treatmentsinteract with one another and with life events (e.g., loss of stable housing likelyimpacts medication adherence). Providers come and go. Patients change treatment locations.Without a written record that pulls together the totality of treatments, theirpurposes, and their results, each provider tends to operate in a silo, attending to only oneaspect of the illness, unaware of how that aspect fits and interacts with the rest of the picture.Thus, a dynamic treatment plan should be a mechanism for providing integrated,coordinated treatment over time.145