Key Takeaways
- SMART goals are Specific, Measurable, Achievable, Relevant, and Time-bound
- Treatment planning should be a collaborative process between the social worker and client
- Evidence-based treatment selection matches interventions to the client's specific diagnosis and needs
- Levels of care range from outpatient to inpatient hospitalization, with several intermediate levels
- Discharge planning should begin at the time of admission to ensure continuity of care
- Treatment plans should be reviewed and updated regularly based on client progress
- Cultural considerations must be integrated into treatment planning
Treatment Planning
Treatment planning is the process of translating assessment findings and diagnostic impressions into a structured plan of action for clinical intervention. An effective treatment plan serves as a roadmap for both the social worker and the client, providing clear goals, measurable objectives, and specific interventions.
SMART Goals
Treatment plan goals should follow the SMART framework:
| Letter | Meaning | Example |
|---|---|---|
| S | Specific | "Reduce panic attack frequency" (not "feel better") |
| M | Measurable | "From 5 per week to 1 or fewer per week" |
| A | Achievable | Realistic given the client's current functioning and resources |
| R | Relevant | Addresses the client's stated concerns and clinical needs |
| T | Time-bound | "Within 12 weeks of treatment" |
Example SMART Goal: "Client will reduce panic attacks from 5 per week to 1 or fewer per week within 12 weeks by learning and applying cognitive-behavioral coping strategies."
Treatment Plan Components
A comprehensive treatment plan typically includes:
- Identifying information: Client demographics, diagnosis, and relevant history
- Problem list: Prioritized clinical issues identified in the assessment
- Goals: Broad statements of desired outcomes (what the client wants to achieve)
- Objectives: Specific, measurable steps toward achieving each goal
- Interventions: Specific therapeutic techniques and strategies the clinician will use
- Responsible parties: Who will do what (client, therapist, family, other providers)
- Timeline: Expected timeframe for achieving each objective
- Review date: When the plan will be evaluated and updated
Evidence-Based Treatment Selection
Clinical social workers should select interventions that have demonstrated effectiveness for the client's specific diagnosis and presenting concerns. Key evidence-based treatment pairings include:
| Diagnosis | Evidence-Based Treatments |
|---|---|
| Major Depression | CBT, Behavioral Activation, IPT, antidepressant medication |
| Generalized Anxiety | CBT, relaxation training, mindfulness-based approaches |
| PTSD | CPT (Cognitive Processing Therapy), PE (Prolonged Exposure), EMDR |
| Borderline PD | DBT (Dialectical Behavior Therapy), mentalization-based therapy |
| Substance Use | Motivational Interviewing, CBT, contingency management, 12-step facilitation |
| Panic Disorder | CBT with interoceptive exposure, panic-focused psychodynamic psychotherapy |
| Social Anxiety | CBT with exposure, social skills training |
| OCD | ERP (Exposure and Response Prevention), CBT |
Collaborative Treatment Planning
Effective treatment planning is a collaborative process that:
- Centers the client's voice, preferences, and cultural values
- Incorporates the client's definition of the problem and desired outcomes
- Respects the client's right to self-determination (making their own choices)
- Builds on the client's strengths and existing resources
- Considers practical barriers (transportation, childcare, finances, insurance)
- Involves other members of the treatment team when appropriate
- Is documented clearly and shared with the client
Which of the following is the BEST example of a SMART treatment goal?
Levels of Care
Clinical social workers must understand the full continuum of care to make appropriate placement and referral decisions. Levels of care are determined by the client's acuity, safety risk, and functional impairment.
| Level of Care | Description | Typical Duration | Best For |
|---|---|---|---|
| Inpatient Hospitalization | 24-hour psychiatric care in a locked or unlocked hospital unit | 3-10 days | Active suicidality, psychosis, severe withdrawal, inability to maintain safety |
| Residential Treatment | 24-hour structured therapeutic environment | 30-90+ days | Severe substance use, eating disorders, trauma requiring extended stabilization |
| Partial Hospitalization Program (PHP) | Structured programming 5-7 days/week, 6+ hours/day; return home evenings | 2-4 weeks | Step-down from inpatient, need for intensive structure but can maintain safety at home |
| Intensive Outpatient Program (IOP) | Structured programming 3-5 days/week, 3-4 hours/day | 4-8 weeks | Moderate symptoms, need for more than weekly therapy but can function at home |
| Standard Outpatient | Individual, group, or family therapy 1-2 times per week | Ongoing | Mild to moderate symptoms, stable functioning, maintenance |
| Community Support | Peer support, case management, vocational services | Ongoing | Long-term recovery support, social integration |
Discharge Planning
Discharge planning should begin at the time of admission, not at the end of treatment. Effective discharge planning ensures continuity of care and reduces the risk of relapse or crisis. Key components include:
- Aftercare referrals: Connecting the client with ongoing outpatient services, support groups, and community resources
- Medication management: Ensuring the client has prescriptions, understands their medications, and has a follow-up appointment with a prescriber
- Safety plan: A written plan identifying warning signs, coping strategies, support contacts, and emergency resources
- Relapse prevention plan: Identifying triggers, high-risk situations, and coping strategies specific to the client's diagnosis
- Natural supports: Connecting the client with family, friends, faith communities, and other natural support systems
- Practical needs: Addressing housing, transportation, employment, insurance, and financial stability
- Follow-up contact: Scheduling a post-discharge check-in to assess adjustment and address emerging needs
Arrange these levels of care from MOST intensive to LEAST intensive:
Arrange the items in the correct order
When should discharge planning ideally begin?
Which evidence-based treatment is MOST strongly supported for Borderline Personality Disorder?
A client in an intensive outpatient program (IOP) attends structured programming how many days per week?
SMART treatment goals must be Specific, Measurable, Achievable, Relevant, and __________.
Type your answer below