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 Please provide detailed response to each comment and provide feedback to include a reference. Please read the attached document for further instructions.

8 DQ 1 (Obj. 8.2):Why is it important to consider the first session the beginning of discharge planning? Why is it important to prepare an accurate and consistent discharge summary? Be sure to include ethical considerations and involvement of the client.

Discharge planning should commence upon client admission into a service and/or program and the discharge plan should continue to be updated during the course of the client’s treatment stay with the provider. The benefits of conducting discharge planning for clients with substance abuse, mental health or co-occurring issues are:

· to link clients to appropriate next step resources based on their needs;

· to minimize likelihood that client will “relapse” or have to return to care post successful completion of treatment;

· to prevent vulnerable clients from becoming homeless and/or criminalized; and

· to assist clients with re-entry to community.

Discharge planning is important in order to maintain gains achieved during the course of treatment the client has had in the inpatient, residential and/or outpatient care setting. Conversely, lack of discharge planning can cause an interruption in the care of the client, one of the most significant obstacles to establishing a stable recovery. Clients impacted by mental health, substance abuse or co-occurring disorders leaving a treatment program will most likely have a number of continuing health care issues that will need to be addressed. When it comes to ethical considerations and involvement of the client, the client may still be in need of self-help groups, relapse prevention groups, continued individual counseling, mental health services (especially important for clients who will continue to require medication), as well as intensive case management monitoring and support. A carefully developed discharge plan, produced in collaboration with the client, will identify and match client needs with community resources, providing the support needed to sustain the progress achieved during treatment. Developing positive peer networks is another important facet of discharge planning for continuing care. The provider seeks to develop a support network for the client that involves family, community, recovery groups, friends, and significant others. Where a client’s family of origin is not healthy and supportive, other networks can be accessed or developed that will support him. Programs also should encourage client participation in mutual self-help groups, particularly those that focus on co-occurring disorders. These groups can provide a continuing supportive network for the client, who usually can continue to participate in such programs even if he moves to a different community. Therefore, these groups are an important method of providing continuity of care. In the healthcare field “discharge planning” is one of the most important issues in our time, it is at once a methodology, a discipline, a function, a movement and a solution.

 

Reference:

Barry D, Rock D. Byond discharge summary. Hospital and Community Psychiatry. 2005; 38 (5)

  

My response:

Good afternoon Kim,

Re: Topic 8 DQ 1 (Obj. 8.2)

A discharge summary should begin at the time of admission in to services. This is for the purpose of identifying the client’s need/course of action and the supports in which they will use to achieve these desired outcomes (Alghzawi, 2012). Discharge will not only help in meeting the clients needs, but by the end of therapy the client will be able to see if the needs were met and how they were met. It will also assist in any further care that the client may need once they have left services. The lack of a discharge plan could result in a disturbance to the care of that client and establishment of their recovery (Alghzawi, 2012). Discharge plans are completed with the collaboration of the client, and will include the client’s needs, community resource, referrals for supports, and a plan to sustain the progress made (Alghzawi, 2012). This also will speak to the validity and consistency of care toward the client. The ACA code of ethics in section A discusses the ethical standards held by counselors when terminating services, and that such services should be terminated when the client no longer is in need of assistance.

American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA. Author

Alghzawi H. M. (2012). Psychiatric discharge process. ISRN psychiatry2012, 638943. doi:10.5402/2012/638943

My response:

Good afternoon Sydnee

Re: Topic 8 DQ 1 (Obj. 8.2)

Considering the end of treatment at the beginning is important for client and therapist expectations, successful outcomes, and client engagement. According to (Swift & Greenberg, 2015), “By talking about and planning for the end of therapy early on, patients are better able to commit to a full course of treatment and make the most of each and every session” (p. 94). When clients have a clear idea of what to expect, they can more easily envision what the end of treatment should look like. Have their goals been met? Were their needs and issues addressed? Was there a decrease or elimination of symptomology? If we are having this discussion in the beginning, when planning and co-creating treatment goals and objectives, clients will know what to expect for the final stages and ultimate outcome of treatment. Continuing treatment indefinitely can foster codependence between the client and therapist, so it is vital to know what will be addressed, what the desired outcome is, and how we will we get there.

An accurate and consistent discharge summary helps to ensure the continuity of treatment, shows the quality and consistency of care received, improves coordination of services following discharge, and demonstrates if goals and objectives were met. According to the ACA Code of Ethics, (2014) A.11.c., clinicians are ethically bound to terminate treatment “when it becomes reasonably apparent that the client no longer needs assistance, is not likely to benefit, or is being harmed by continued counseling” (p. 6), and I would add when the initially agreed upon goals have been met. Client input is as important to termination as it is to the treatment planning stage as it gives a clear road map of where we are beginning and where we will end or when we will know that desired treatment outcomes has been achieved. 

American Counseling Association (2014). ACA Code of Ethics. Alexandria, VA. Author

Swift, J. K., & Greenberg, R. P. (2015). Assist in planning for appropriate termination. In Premature termination in psychotherapy: Strategies for engaging clients and improving outcomes. (pp. 93–104). Washington, DC: American Psychological Association. https://doi-org.lopes.idm.oclc.org/10.1037/14469-005

My response:

Good afternoon Victoria


Re: Topic 8 DQ 2 (Obj. 8.2): How would you prepare a client for discharge? What information should be discussed in sessions leading up to termination?

Termination should be among a client’s treatment goals and therapy is a safe place to talk about ending relationships and wrapping things up (Howes, 2008). If a client has already been prepared for discharge this could help the process go a little smoother. If the client and the counselor do not prepare for termination this can create a sense of denial which can lead to an awkward, abrupt and destructive end to the overall treatment process (Howes, 2008). It can benefit the client to talk about their therapeutic future and when the therapist points out all their strengths, successes and achievements this can be healthy and a good thing for the client to be made aware of. Sometimes counseling can become mundane in a way and that is one of the many reasons that it is time to discharge a client. If they are doing well and not struggling with the issues that brought them into therapy then that is a good things and it should be acknowledged. Some ways to end therapy include making sure client’s basic needs are met, draw client’s attention to their original goals or make sure that the client is aware that therapy is infinite (Tyrrell, 2013). All three options are solid. I think I would go with pointing out to the client their original goals and presenting them with all the progress they have made. It would take multiple sessions but I would try to prepare the client with all th reasons I believe they are ready for discharge. Information I would include are, goals, strengths, major changes for the better, minor things that might still need work ad an overall review. I would also ask the client how they feel about discharge and see how they are reacting to the discharge process. Starting the client from day one is essential when it comes to healthy, productive and sensible discharge process.

Howes. (2008). Terminating therapy, Part IV: How to terminate. Retrieved from 
https://www.psychologytoday.com/us/blog/in-therapy/200810/terminating-therapy-part-iv-how-terminate

Tyrrell. (2013). How to end therapy with your clients. Retrieved from https://www.unk.com/blog/how-to-end-therapy-with-your-clients/

My response: