Treatment Plan? What’s a Treatment Plan?

So there is no inter-rater reliability or validity to child custody evaluations, there is no knowledge of attachment or family systems therapy or personalty pathology in the mental heath people treating your families, and there is no treatment plan guiding treatment.  As a clinical psychologist, my head is exploding.

The very first question a clinical psychologist asks about an assessment procedure is, “What’s the reliability?”  The next question is, “What’s the research on validity?”  Third question, “What are the possible cultural issues and limitations?” boom-boom-boom all clinical psychologists ask these same first three questions about an assessment procedure, and in that order – reliability, validity, culture.

The answers with child custody evaluations are, zero, there is none, and we don’t know.  Done.  There is not a clinical psychologist alive that accepts those three answers.  Done.

Basic to professional practice, and I mean obvious-fundamental duh-level basic to professional practice, is that you’re expected to know about the pathology you are treating (Standard 2.01a).  That is simply a no-brainer.  If you’re treating autism… you know about autism.  If you’re treating eating disorders… you know about eating disorders.  You know about that pathology you’re treating.  Obvious no-brainer, right?

So if you’re treating attachment pathology you know about the attachment system, right?  No.  Not in the alternate reality of forensic psychology.  You don’t need to know anything about the attachment system if you’re treating attachment pathology in forensic psychology.  Something about working for the court means you don’t need to know stuff anymore.  You’re exempt from knowing anything if it’s a court-involved family.

What about if you’re treating families, you would need to know about family therapy right?  You’d think so, but no.  Not in this alternate reality of forensic psychology.  You don’t even need to know about family systems therapy to treat families.  No knowledge necessary, just dive right in.

My head is exploding.

And in forensic psychology there’s no such thing as a treatment plan. A what?

I know.  That’s exactly what I’m saying.  What’s a treatment plan?  <sigh>

Look at a school IEP.  There it is.  That’s it.  That’s a treatment plan.

Do the same thing except for pathology problems rather than educational problems, and that’s a treatment plan in clinical psychology.

The public school system is slightly more formal in how they handle their treatment plans than is clinical psychology, but we in clinical psychology still have the full structure of the treatment plan in our intake assessment notes and our treatment progress notes.

So what do we notice right off the bat about a standard of practice routine school treatment plan for the child’s educational problems… it’s written.

You don’t even have to ask.  The IEP is written.  If you asked the school NOT to do a written treatment plan, they’d say no.  It’s a written treatment plan.

The educational treatment plan of an IEP is explained to parents fully, and parents have to agree to the proposed plan before the school has permission to enact the treatment plan described to the parent and documented in the written treatment plan.  In clinical psychology, this is called informed consent to treatment (Standard 10.01 of the APA ethics code).

A written treatment plan and full explanation and informed consent of the parent is standard-of-practice routine in the public schools.

As a parent in the public school system, you are provided with a written educational treatment plan for your child.  That plan comprehensively addresses each aspect of your child’s educational challenges, identifying goals, specific interventions, and ways that progress toward achieving those goals will be measured.

School system – routine standard of practice – written treatment plan.

And the professional standards of practice in forensic psychology require you to get a court order to learn what symptoms the child has.  I am writing letters for parents supporting their attorney’s efforts to get a court order to find out what the child’s symptoms are.  Far cry from an IEP standard of practice, wouldn’t you say?

Have you ever been given a written treatment plan for your therapy with your child?

What about for your child’s individual therapy, have you ever seen the therapy IEP for your child’s individual therapy?

My head is exploding.  We are going to ask… strongly suggest… expect… that all mental health professionals working with your children practice at least at the level of our public schools for when they develop educational assessments and interventions for your children’s educational problems.

Is that too much to ask forensic psychology?  That you practice at least at the level of the public school system when they assess and intervene with educational problems?

Because if that’s too much to handle forensic psychology, if you can’t make it up that hill to the standards that are routine for our public school system, then step aside please, because clinical psychology does treatment plans routinely, and we in clinical psychology can actually elevate the IEP plan process.  So we’re comfortable with written treatment plans ala IEP in clinical psychology.

AB-PA represents the return of clinical psychology to court-involved practice.

Parents, compare your treatment plans to the school IEP.  Oh my god, look how beneath professional standards of practice we are.  We should routinely be at school IEP documented treatment plan level… today…. right now…. yikes, yikes, yikes.  That’s seriously deficient where we’re at.

Forensic psychology, you’re going to need to up your game substantially and quickly.  IEP level written treatment plans.  Standards of practice at LEAST at the level provided by the public school system for the child’s educational needs.

No?  Well that’s a curious response, forensic psychology.  Because I suspect that may be a legal right of this parent.  At the level of the public school system.  You’re saying no to “at the level of the public schools”?  That may be actionable.  It’d be actionable in the public school system if the school didn’t do a written IEP level treatment plan for the child’s educational problems.

Oh, and if you’re saying no to practice at least at the level of our public school system… why?

Don’t these parents deserve the same respect and treatment that they receive from our schools?  Why don’t these parents deserve the same respect and treatment from professional psychology that the receive routinely as a standard of practice in the educational system.

Soooo, forensic psychology… you may have a problem saying that you are NOT going to provide standard of care in treatment planning that is at LEAST at the level mandated for treatment of educational problems in the public school system?

Treatment plans.  Expected standard of practice.

Craig Childress, Psy.D.
Clinical Psychologist, PSY 18857

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