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Documentation – The Ends Justify the Means

Dan Thorne • Oct 07, 2021

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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