An appalling lack of standards exists as to what a child’s behavioral treatment plan should look like. As a result, parents are frequently at a loss to determine if the Plan proposed for their child is either adequate or appropriate. As an alternative to wishful thinking, misplaced trust in an unknown and untested service provider, and to raise the standards for treatment plans for children who are displaying challenging behavior, the internet resource ”Treatment Plans That Worked“ was created. Let’s define our terms, first of all.
A Treatment Plan should provide all of the information necessary for a conscientious person to deliver the correct treatment procedures, at the correct times, and with sufficient consistency to produce the changes in behavior that are described in the Plan — reducing or eliminating undesirable behavior and increasing or improving desired behavior, while providing a means to monitor progress on an ongoing basis that informs the process of treatment.
With that in mind, the “treatment plans that worked” on my website are offered as examples to guide professionals in the creation of age-appropriate behavioral treatment interventions for children, and as examples of successful treatment planning documents that parents may provide to professionals as a means of setting basic standards for treatment design and monitoring. These plans were all successful in that they all produced reduction or stabilization in the target (undesirable) behavior of children. Although these plans were successful in these cases, it is clear that all children are different, and that the exact same plan may or may not be effective for any other child, and that professional guidance should always be sought before and during the implementation of any treatment plan or program.
In this field, for every expert, there is an equal and opposite expert. Nevertheless, there are some basic standards on which everyone should agree. At a minimum for example, all behavioral treatment plans should provide the following information. The order of presentation isn’t as important as the level of understanding that it creates in the mind of the person who is to implement the plan, such as a mental health worker or a parent. A very simple plan, accompanied by a very high level of professional supervision, training and support, can achieve tremendous results. A highly complicated, lengthy, jargon-ridden treatment plan written by someone with impressive credentials obviously doesn’t guarantee success. The middle ground (where the treatment plan is complete in terms of its components, explicit in its directions to the person who will implement it, and which can be evaluated objectively as to its effectiveness) is ideal.
• Any behavioral treatment plan should specify the exact behavior that is “targeted” for improvement. The plan must say exactly what is to be reduced or eliminated. By the same token, the plan must say exactly what is to be taught in replacement of the “targeted” behavior. It is rarely helpful to tell a child what not to do; you always have to specify what he/she should do as well.
• A treatment plan should explain exactly what the treatment provider should be doing to accomplish the replacement of the “target” behavior. A treatment provider should be able to look at the treatment plan and know precisely which techniques are to be used, how often and in which circumstances. When terms like “contingency contracting” are used, a glossary of terms that is accessible to the treatment provider is essential. How else can the treatment provider know exactly what to do?
• A treatment plan should always contain a simple and easy means of measuring progress from the perspective of the treatment recipient, not the treatment provider. Outcome progress measurement should include a “baseline” measure, which is a starting point in the measurement of treatment outcomes that precedes the start of the treatment period. How else will you know how far you’ve come (or how far you’ve gone astray) if you don’t know where you started?
• Treatment plans must include a planned stop date, so that the treatment team can prepare to present information to funding authorities prior to that date in order for funding to be continued. Continued funding is necessary and therefore justifiable whenever the child is within the age served by the funding entity, the treatment plan is working, but the work has not yet been satisfactorily completed.
Steven Kossor is a licensed psychologist and certified school psychologist who founded the Institute for Behavior Change in 1996. He has been recognized by the US Congress, both houses of the Pennsylvania legislature and by the President’s New Freedom Commission on Mental Health for his leadership in the creation of a successful in-home and in-school treatment model for children with serious behavioral difficulties. Independent researchers at the University of North Carolina at Chapel Hill examined more than 300 treatment records and found a statistically significant association between delivery of treatment using Mr. Kossor’s model and reductions in physical aggression, noncompliance with adult prompts, socialization deficits and communication deficits in children between the ages of 2 and 17 with Autism, ADHD and other disabling conditions. This research was replicated by independent researchers at Thomas Jefferson University in Philadelphia, PA in 2010. Mr. Kossor teaches parents and professionals how to create excellent behavioral treatment plans, how Medicaid can be used to fund them (regardless of family income) and how to get and keep treatment funding, despite Managed Care and other obstacles.
The Institute for Behavior Change: www.ibc-pa.org