Mental health providers are constantly making decisions about care, often in rapid succession. Whether it is constructing a thorough case formulation, selecting evidence-based interventions that best fit a specific presenting problem, knowing when to shift those interventions in response to in-the-moment feedback, collaborating on how to best measure treatment progress, or using the data from those measurements to guide the next treatment step, there are so many decision points and each presents an opportunity to impact the trajectory of clients’ lives. Providers have a significant responsibility to make the most informed decisions they can and often need to act without the luxury of time.
Fortunately, PracticeWise has many tools—part of the Managing and Adapting Practice (MAP) system— that can help providers structure clinical decisions and feel secure that their treatment plans are based on the latest scientific evidence.
Here are some of the tools that help providers make more informed decisions and gain confidence in providing the highest quality care:
- The PWEBS application accesses a database with information coded from thousands of research trials in youth mental health and captures which treatments are effective for different types of participants and presenting problems. Providers can easily search features related to their clients like target problem(s), age, gender, ethnicity, and setting and receive a quick snapshot of the broader treatment families and interventions that have the most research support based on those specific features. The PWEBS tool takes the vast scientific research literature and boils it down to a brief menu of options that allows providers to more easily plan their treatment episodes.
- The Process Guides give providers a framework for thinking through several treatment decisions (e.g., choosing which practices to use in an episode of care, planning for a single session, adapting practices for specific clients) and come with easy-to-use fillable worksheets to help document decisions for individual clients or sessions.
- The Treatment Planner is a Process Guide that prompts providers to choose their client’s target problem as well as other areas that may need to be addressed in treatment (e.g., co-occurring target problems, major life events) and fill in the practice elements that are most likely to help the client with those concerns. The “Focus” section is divided into three phases of treatment so providers can think about how they plan to initially connect and build rapport with the youth and family, then move on to cultivating skills in the main part of treatment, before wrapping up by consolidating those skills.
- The Session Planner is another Process Guide that assists providers in structuring a single treatment session. It has checklists with reminder items for before session and after session and prompts providers to consider how to spend their time in the beginning, middle, and end parts of the session. In this way, it helps providers to be flexible and get back on track with their plan when things go off course.
- The Embracing Diversity Process Guide supports providers in making adaptations to their care. It invites providers to outline how they might change the content as well as how to they present their interventions to better fit specific individuals. It acknowledges that interventions are not intended to be one size fits all and that there are ways to adapt messaging and content while keeping true to the evidence base.
- Practice Guides are 2-page documents that give a high-level overview of specific evidence-based practice elements. They break those elements down into the main steps of the practice with bulleted guidance on how to complete those steps. Providers can use Practice Guides as a foundation from which to add their own expanded content.
- Clinical Dashboards are tools that allow providers to enter their progress measures as well as the practices they are using and includes a visual representation of how treatment is going. The Clinical Dashboard graphs the outcome measures over time and gives providers an important snapshot of how these measures changed as compared to when specific interventions were used. In this way, it helps providers decide when things are going well and the plan can move forward and when things might need to change course.
Let’s walk through a few examples of how providers might use these tools with clients in the early and then later parts of treatment.
Gabby – Early Stage of Treatment
Background and Initial Planning
Alysia recently started to work with Gabby, a 12-year-old girl experiencing social anxiety and depression. Gabby’s parents are also in the process of getting divorced and Gabby has been having trouble keeping up in school. Alysia decides to use MAP because she thinks that Gabby and her family would benefit from the model.
She starts by using the PWEBS database to search for Gabby’s primary focus area and looks over the treatment summary to find that the practice elements that are most common in effective treatment groups for anxiety in 12-year-olds are Exposure, Cognitive, and Psychoeducation for Child and for Caregivers.
Expanding the Plan
She also does a PWEBS search for Gabby’s secondary focus area of depression and sees that she may also want to consider covering Problem Solving, Activity Selection, Insight Building, and Goal Setting. Given that Gabby’s parents’ divorce is impacting her mood, she also thinks that Communication Skills and Problem Solving might be helpful skills for the whole family.
Organizing Tools and Session Details
Alysia thinks about when she might want to cover these different practices as she works with Gabby and adds them to the Treatment Planner. She then uses the Clinical Dashboard to add in the standardized outcome measures she plans to administer to Gabby to track her progress over time, namely, the Revised Child Anxiety and Depression Scale (RCADS), the Patient Health Questionnaire (PHQ-9), and the Pediatric Symptom Checklist (PSC-17). She will work with Gabby to identify a few other individualized measures that are specific to her goals (e.g., being more comfortable speaking to new people).
As Alysia is planning to see Gabby for the first time since her assessment, she wants to start with Psychoeducation about Anxiety. She opens the corresponding Practice Guide and decides that she wants to use a helpful interactive video to explain the link between thoughts, feelings, and actions. She adds this activity and a reminder to bookmark the video to the Session Planner and saves it to Gabby’s chart so she can remember to look at it before their meeting.
Jared – Later Stage of Treatment
Assessing Progress and Uncovering New Information
Eliott is a provider who has been working with a Jared, a 16-year-old male with substance use and disruptive behavior for about three months and is feeling stuck as Jared has not been making a lot of progress over their time together. He has been tracking Jared’s drinking and marijuana use using the Timeline Followback measure and his behavior by having his mother complete the Eyberg Child Behavior Inventory (ECBI) as well as parent report of lying and sneaking out and has seen little change.
He decides to have a conversation with Jared to review the data and other potential treatment options. During that time, Jared discloses that he experienced a significant traumatic event two years ago when he was assaulted by a group of other students. He has been having flashbacks of the event as well as trouble sleeping at night.
Adjusting Focus and Adapting the Plan
Eliott makes the decision to switch Jared’s primary target area to trauma to address these recent difficulties. He starts by searching the PWEBS database for trauma as a target area and updates his Treatment Planner to include Psychoeducation for Trauma, Cognitive, Narrative, Exposure, and Personal Safety Skills.
Incorporating New Measures and Diversity Considerations
He considers additional measures to track on the Clinical Dashboard like the UCLA PTSD Reaction Index for DSM-5 and the number of flashbacks Jared experiences per week. He also takes a look at the Embracing Diversity Guide because, given that Jared prefers not to talk about what happened and does not think of it as trauma, he wants to think through different ways to present Psychoeducation for Trauma.
Learn More About PracticeWise Tools
These are just a few examples of how providers can use PracticeWise tools to guide thoughtful decision-making and plan next steps throughout different phases of care. Whether it’s choosing the right intervention, adapting it for a specific client, or tracking progress over time, these tools offer flexible, evidence-informed support.
To learn more about PracticeWise tools and training opportunities, visit practicewise.com, or reach out to us at [email protected].
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About the Author
Jennifer Regan, Ph.D., serves in multiple roles on the Services and Products Development team for PracticeWise. Learn more about Dr. Regan on the PracticeWise team page.
