At Praxes, we just finished conducting training for an organization in Southern California on conceptualizing and formulating documentation. In doing so, we helped the attendees improve the ways they viewed a case, how they perceived the problems, goals, and interventions, and what goes into a clinical record.
Along the way, we explored what should or should not be done in a treatment intervention. This goes to the old adage, “Do the ends justify the means?” In other words, can a practitioner do anything they want with a client during a treatment session and still bill it as a service?
The answer is yes (with one notable exception), as long as the outcome of the session is to cover a client goal originating from their assessment and treatment plan. To justify medical necessity, the practitioner must show that they are working to a) improve the client’s functioning, b) prevent deterioration of the functioning or c) help the client progress developmentally. This comes from the Los Angeles County Department of Mental Health’s Provider Manual of 2020.
Let’s give an example of two options:
Option A: Andrew takes Josh to the park where they play soccer.
Option B: Andrew wants to improve Josh’s frustration level. He stands about ten feet away and kicks the ball to Josh, who has to kick it back. Every third or fourth time, Andrew kicks the ball away from Josh, so Josh has to move to get it (within a reasonable distance). Josh learns how to move and improve his frustration level.
Is either of these billable services and why?
The answer is that Option A is not billable and Option B is. Although they are engaged in physical activity, Andrew the practitioner has a goal in mind. He wants to decrease Josh’s (the client’s) frustration level. Perhaps since Josh learns by moving around and likes to play soccer, Andrew is using a soccer ball as the means to help Josh tolerate being annoyed and irritated. He kicks the ball to Josh a couple of times, then mixes it up where Josh has to move around or chase the ball to retrieve it. This maneuver is Andrew’s intervention. Then Andrew observes what Josh does when he has to get the ball. If he gets angry, how does he manage that anger? Hopefully, over time, Josh will not be as upset and calmer, knowing that things don’t always go his way (literally). When done, Andrew sees if the approach works, and can even count the number of times Josh is upset or the intensity of these events. He evaluates the intervention and can use it again or try something else.
Kicking a ball, playing a game, any sort of activity (except watching a movie or television show) can be an intervention, as long as it is conducted with a purpose or goal to reduce or increase specific behaviors. Being creative with treatment strategies can improve client engagement and treatment outcomes.
Praxes provides training in Documentation. For more information about our training courses, please contact us.
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PRAXES is a nationwide behavioral health software, consulting, and training company. No one in the behavioral health industry has a better reputation, and if you give us the chance, we’ll show you why! At PRAXES, our services improve the efficiency and structure of behavioral health agencies serving children and families nationwide. PRAXES brings over 45 years of administrative and clinical expertise. With more than 100 client companies nationwide, we offer the expertise to advance the quality of behavioral health services. We accomplish these goals through our new clinical decision software, our training of best practices, and helping companies meet regulatory standards. At PRAXES, we believe in being creative and fostering new ways to serve children and their families. Our vision is to empower the families our agencies serve with skills that not only improve their functioning, but help them to thrive in their everyday lives. When you give us the chance, you’ll be connected directly to our friendly staff, so you can expect immediate attention to your inquiry. So, don’t wait, call now!
Dan Thorne has unique perspectives on the field of mental health. As a clinician, he has had over 40 years of experience working with clients in the Southern California area. After obtaining his Bachelor’s degree from the University of California at Irvine, he worked with children in the Orange County Juvenile Hall. Here he honed his earliest techniques on at-risk children. After that, he obtained his Master’s degree in Counseling from California State University, Fullerton.
In the 1990’s, Dan turned his attention to the clinical and administrative side of behavioral health organizations. For three years, he was the Assistant Administrator of Starting Point, a chemical dependency facility in Costa Mesa, CA. In 2001, he took an opportunity to be the Director of Harbor View Community Services Center in Long Beach. When he arrived, the Center had only 80 clients and 13 staff. When he left, there were over 400 clients and 75 staff. Dan created several programs through their contract with the Los Angeles County Departments of Mental Health and Child and Family Services. Under his guidance, Harbor View became one of the leading providers of children’s services in Los Angeles County.
While improving the results of the client’s parents at the Center, Dan reflected on his experiences as a parent. His children themselves had special needs such as mental and intellectual challenges, and Dan knew the toll it takes on the parent. In order to help the child, the parent has to be healthy. From this concept, he created his parenting program. After years of refining it, teaching it to his staff at the Center, and then taking the results and comments from these efforts, he became the developer of the current PRAXES program. It is a culmination of Dan’s personal trials and tribulations as a parent along with empirical results and research of over 40 parenting programs.
Our vision at PRAXES is to advance the strength of parents and caregivers of children with special needs (mental health, intellectual, or physical) through education, support, and empowerment. Thus, they can live healthy and functional lives while caring for the child.
Apogee is a clinical decision software designed to help behavioral health practitioners with their treatment and patient engagement. It provides evidence-based and research-based components. Not only do they consist of elements from such practices as Cognitive Behavior Therapy, Seeking Safety, Dialectical Behavior Therapy, Motivational Interviewing, Functional Behavior Analysis, but also the Intensive Models for Parents, Youth, and Children.
PRAXES has over 30 years of accreditation experience. We know what it takes to get your organization accredited. Whether it’s Joint Commission, CARF, or COA, our team can provide an evaluation of your current status and review the standards which need improvements. We will assist you with the policies, documentation, and training required to be accredited.
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