Professionals’ Treatment Plan and Contract Beliefs and Practices

Author: 

Allen, Bruce

Abstract: 

Treatment plans with so-called “contracts” are either theoretically irrelevant or antithetical to the Client-Centered approach. However, in the mental health field, they are fairly ubiquitous, especially for Medicaid work. Because of this, I surveyed mental health professionals in one state to see how they used treatment plans with contracts and what they thought of them. I intended to: (a) discover whether these were, indeed, a professionally accepted standard of care (b) compare and contrast Client-Centered respondents with professionals of other orientations. Overall, belief that two of the contract requirements (specifying what goals would be accomplished and how this would be done) were helpful fell between “neutral” and “agree somewhat” on a five-point Likert scale. A third (specifying the time when a goal would be accomplished) fell between “neutral” and “disagree somewhat.” Thus the contract did not appear to be an accepted standard of care. Nor did the plan as a whole: Fifty-one percent of the Medicaid providers said it was related to what they did only “marginally” or “not at all” and 75% said they used it because of legal or clinic regulations. There weren’t enough Client-Centered professionals to allow them to be examined separately, so respondents were combined in two groups, those whose approaches were supposed friendly to the plans and those that were skeptical of them. Statistically, the skeptical and friendly groups differed on how helpful they thought the contract requirements were, although the Friendly group’s means for each of the three requirements still only fell between “Neutral” and Agree Somewhat.” The groups did not differ, however, on how much the plan affected their behavior or why they used it. The results suggest that to make clinical requirements more conducive to Client-Centered practice it would be more helpful to focus on what professionals actually do and what they believe about what they do rather than on theoretical issues. 

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