CLINICAL HANDBOOK OF SCHIZOPHRENIA

15. Treatment Planning 147WHAT DOES A TREATMENT PLAN LOOK LIKE?There is no standard treatment plan format, but if a treatment plan is to be a useful toolfor communication, then it should contain key elements of information in visually accessibleform. Table 15.1 presents a suggested template with two examples of problems andinterventions. Even in systems without electronic medical records, we suggest creatingand storing the treatment plan electronically and designating one person to be responsiblefor keeping it current and putting the latest version in the medical record.TREATMENT PLAN DEVELOPMENTAppropriate use of evidence-based and promising practices is at the core of treatmentplanning. That is to say, practices supported by good scientific evidence are key tools oftreatment plan implementation. The potential value of each practice for an individual patienttends to change over time, with the exception of antipsychotic medication, whichshould be consistently maintained as treatment for chronic schizophrenia. A list of practiceswith one or more controlled trials is in Table 15.2. Evidence-based practices arethose for which two or more independent randomized controlled trials have shown evidenceof efficacy. Other practices that show promise have not yet attained this level of evidence.Other chapters in this book review the evidence for many of these practices.Cognitive adaptation training (CAT) is a relatively new treatment that promotes desiredbehaviors by restructuring the patient’s living environment and by providing externalprompts and cues (e.g., to take medication).It is useful to characterize treatment goals in terms of the applicable practices. Table15.3 lists problem areas frequently encountered in schizophrenia treatment and practicesthat have evidence for effectiveness in each area. Proven efficacy means that there is at leastone randomized controlled trial and that results are unambiguous. In a couple of instances,ineffective treatments are listed because they have historically been widely used, but controlledtrials have shown them to not be useful compared to the effective treatments listed.The choice of which practice to use, when there is more than one choice, is determinedby the patient’s condition and local availability of the intervention. Not every patientcare setting is able to make all these practices available to all patients for whom theyare suitable. Under these circumstances we suggest that it is preferable to include thepractice in the treatment plan and document its lack of availability. This illustrates aware-TABLE 15.1. Treatment Plan ExampleProblem Intervention(s) Measure GoalPsychosis Drug A BriefPositiveSymptomScaleRepeatedhospitalizationsAssertivecommunitytreatmentDays inhospitalper yearReductionto no morethan mildsymptomsStartdateExpected goalachievementdateResponsiblepersonContactinformation2-14-07 5-10-07 Dr. Jones 555-5555Reductionof > 50%compared toprior year1-15-07 4-14-07 Ms. Smith 123-4567