S02 - Attachment E Mental Health Treatment Plan.pdf

Mental Health Treatment Plan

Date of Admission:

Stage of Case Management:

Treatment Plan Type: Initial or Update

Needs and Preferences (Veteran’s own words):

Strengths and Abilities (Veteran’s own words):

Barriers to Care (Veteran’s own words):

Risk Factors (If risk factors are indicated, please use boxes below to further explore and refer to medical or mental health provider if needed)

• Tips: Please review various tips to take in to consideration. (high fall risk, suicidal ideation, suicidal attempts, homicidal ideation, paranoia, delusional auditory hallucinations, visual hallucinations, combat exposure, traumatic brain injury, dementia, pain, recent substance use, medication noncompliance, [ ] No Identified Risks at the time of plan creation

[ ] Medical/Physical Health

[ ] Mental Health

[ ] Substance Abuse/Use

[ ] Access to Weapons

[ ] Other

Suicide Risk Assessment Review:

a. Does veteran have a Columbia Suicide Risk Assessment in chart during past year?

[ ] Yes [ ] No

If no, complete CSRE and additional suicide risk assessments as applicable

b. What is veteran’s risk level?

Pain Screening:

Are you currently experiencing any pain? [ ] Yes [ ] No

Please describe your pain: (Veteran’s own words)

Do you want assistance to address your pain? [ ] Yes [ ] No (If yes Please refer to PCP for further assistance)

Trauma Screening: indicate any past or present traumas

a. Have you been a victim of physical, sexual abuse, neglect, or exploitation? [ ] Yes [ ] No

If yes, is there a way we can help connect you with needed services?

Nutritional Screening (if any are checked, please refer veteran to PCP):

a. Over the last year, have you had any concerns about weight loss, weight gain, eating disorders, or food allergies? [ ] Yes [ ] No

If so, have you lost or gained 10 pounds within the last 3 months without wanting to?

[ ] Yes [ ] No

b. Have you changed the kind or amount of food you eat due to illness or dental problems?

[ ] Yes [ ] No If yes, please describe these changes

c. Have you or do you binge eat and/or induce vomiting? [ ] Yes [ ] No

If yes, please specify frequency, last occurrence, and if you have had any physical issues brought on by this:

d. Please describe how we can help you with any of the above concerns:

Primary Care Visit:

a. Have you seen your Primary Care Provider within the last year? [ ] Yes [ ] No

If no, please advise veteran to schedule an appointment with his/her PCP

Areas of concern to be Addressed

(in CPRS, Click on problem areas to be worked on)

1) Date Identified:

New [ ] Update [ ] Resolved [ ]

Concern: Housing

Goal: (veteran’s own words)

Objective 1:

Intervention:

Barriers:

Target Date:

Responsible Person:

Frequency of Occurrence:

Progress Made:

Objective 2:

Intervention:

Barriers:

Target Date:

2) Date Identified:

Concern: Finances

Goal: (veteran’s own words)

Objective 1:

Barriers:

Target Date:

Barriers:

Target Date:

Frequency of Occurrence :

3) Date Identified:

Concern: Physical Health

Barriers:

Target Date:

Barriers:

Target Date:

4) Date Identified:

Concern: Mental Health

Barriers:

Barriers:

Target Date:

5) Date Identified:

Concern: Employment/Job Training

Barriers:

Target Date:

Barriers:

Target Date:

6) Date Identified:

Concern: Education

Barriers:

Barriers:

Target Date:

7) Date Identified:

Concern: Suicidal Ideation/Intent

Barriers:

Target Date:

Barriers:

Target Date:

Progress Made

8) Date Identified:

Concern: Legal Issues

Barriers:

Target Date:

Barriers:

Target Date:

Progress Made

9) Date Identified:

Concern: Transportation

Barriers:

Target Date:

Barriers:

Target Date:

10) Date Identified:

Concern: Social Support

Barriers:

Target Date:

Barriers:

Target Date:

11) Date Identified:

Concern: Substance Use/Abuse

Barriers:

Target Date:

Barriers:

Target Date:

12) Date Identified:

Problem: Sustained Recovery

Barriers:

Target Date:

Barriers:

Target Date:

13) Date Identified:

Concern: Other Addictive behaviors.

Barriers:

Target Date:

Barriers:

Target Date:

14) Date Identified:

Concern: (Other problem areas not listed)

Barriers:

Target Date:

Barriers:

Target Date:

Concerns Deferred and why:

Veteran’s thoughts and feelings towards his/her treatment plan:

Next Treatment Plan Update:

Veteran was provided with a signed copy of the plan: [ ] Yes [ ] No If No, then reason:

Educational Plan

The new HUD VASH Mental Health Treatment Plan will be added to CPRS with a hopeful

“roll-out” by August 1. Once this occurs, all HUD-VASH Supervisors will first be trained. Next, there will be weekly to bi-weekly training sessions (dependent upon availability of training room) with the possibility of individual team training days. Once all HUD-VASH staff have been trained, the trainings will continue once month for newly hired staff and for a re-fresher course.