When behavioral health clinicians develop treatment plans, they usually work from the diagnosis. This clinical finding comes from the assessment of the client, their symptoms, and what the group of behaviors appears to display. However, in many cases the clinician’s diagnosis is inaccurate, leading to improper treatment. While the diagnosis is valuable for billing and documentation purposes, it should be in sync with the client’s behaviors. And this process can be difficult. For example, in a list of the top 12 diagnoses for children and adolescents, the symptom “irritability” is listed for anxiety, bipolar disorder, eating disorder, oppositional defiant disorder, post-traumatic stress disorder, and reactive attachment.
Here are some reasons a client’s diagnosis are inaccurate:
1. The clinician falls in love with a diagnosis and makes the client’s behavior stick to their clinical conclusion. For example, if a therapist specializes in anxiety in the treatment of adolescents, they may see every child through a closed lens. Many children experience difficulty in fears and worries, but other factors can impact their symptoms besides anxiety, such as depression, substance use, or trauma.
2. Lack of knowledge. In a study published in 2008, a psychiatrist reviewed over 200 psychiatric consultations and found that the “accuracy of psychiatric diagnosis was the highest for cognitive disorders 60%, followed by depression 50% and anxiety disorders 46%, whereas the accuracy of diagnosing psychosis was 0%.” Not knowing the proper symptoms or signs of a condition can lead to misdiagnosis.
3. The diagnosis of the decade. Every 10 years it seems that clinicians find a diagnosis and stick with it rather than objectively see if it applies to a client. A real case example illustrates this problem. A child born in the 1980s was first diagnosed at age 5 with attention deficit disorder and given Ritalin to help them with their inattention. Later in the 1990s as an adolescent, they continued with behavior problems and then were diagnosed with bipolar disorder. Finally in the 2000s, with prolonged problems, the now-adult was diagnosed with intermittent explosive disorder.
4. Lack of understanding of differential diagnoses. For example, trauma and attention deficit hyperactivity disorder (ADHD) have several symptoms that overlap. Concentration, distraction, lack of listening, restlessness, and difficulty sleeping are behaviors clients with either condition have. Yet ADHD is a disorder of organization because the client lacks the internal structure to keep their lives manageable. But trauma is a disorder of stress because the client’s stress response does not function properly, causing their behaviors to range from withdrawal to rage.
When clinicians decide on a diagnosis, it has to be based on the cluster of behaviors that occur and how to differentiate between different conclusions.
Praxes offers treatment intervention software, Apogee. Coming in 2022, it will have a diagnostic decision tree for its users.
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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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