CLINICAL HANDBOOK OF SCHIZOPHRENIA

15. Treatment Planning 149TABLE 15.3. Matching Practices with Problem Areas in Treating SchizophreniaProblem area Proven efficacy Possible efficacy Not efficaciousPositive symptoms Antipsychotic, CBT (added) IndividualpsychodynamicpsychotherapyNegative symptomsAntipsychotic, socialskills trainingCognitive deficitsCognitive remediation,antipsychoticSocial/familyFamily therapies, socialskills trainingOccupational/school Supported employment ShelteredworkshopsActivities of dailyliving (ADLs)HousingSubstance abuseCAT, independent livingskills trainingSupported housingIntegrated dual diagnosistreatment, medicationsspecific to category of abusedsubstance (e.g., methadone)Antidepressants, CBTDepressionAnxiety Antianxiety medications AntipsychoticMedication adherence Behavioral tailoring CAT, compliance therapy/motivational interviewing/shared decision making/regimen simplificationRelapses/rehospitalizationsACT, CAT, family therapies,antipsychoticRelapse preventiontrainingstances. Documentation needs to be detailed enough that a reviewer can determinewhether the recommendations are being followed. Documentation in over half of medicalrecords that are not structured to capture the elements being rated has repeatedly beenfound to be inadequate to rate prescriber adherence to medication guidelines. Thus,guideline implementation includes restructuring medical records to prompt recording ofthe necessary information to judge whether the guideline is being used. Examples of documentationgeared to implementation of a specific guideline or algorithm can be found inthe appendices at www.dshs.state.tx.us/mhprograms/timasczman.pdf.Medication algorithms and guidelines should not be confused with standards ofcare. They are recommendations for typical patients. Individual patient characteristicsand clinical judgment ultimately determine whether it is appropriate to apply the algorithmor guideline in individual situations.PLANNING PSYCHOSOCIAL INTERVENTIONSConsumer-Centered PlanOne of the most important aspects of planning successful psychosocial treatment is to ensurethat the goals and objectives of the consumer lie at the center of the plan. Each spe-