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Child Planning: A Treatment Planning Overview for Problems with Children

A Treatment Overview for Parenting Problems with Children

Duration: 3 hours

Learning Objectives:

Obtain a basic understanding of how to identifying, causes, symptoms of children with lying problems or history, and learn different options to complete a treatment plan that includes:

a. Behavioral Definitions

b. Long Term Goals

c. Short Term Goals

d. Strategies to Achieve Goals

e. DSM V diagnosis Recommendations

***For a full list of 15 short term goals with dozens strategies listed next to each goal check the Child Treatment App for Windows or Apple PC and Android Devices, under our main menu Windows-Apple Apps. Download the Free Demo to Evaluate***

Course Syllabus:

Introduction

Conventional Models of Parenting

Modern and Other Models of Parenting

Planning Decisions and Parenting

Parenting Stages

Symptoms

Diagnosis

Steps to Develop a Treatment Plan that includes Behavioral Descriptors, Long Term Goals, Short Term Goals, Interventions/Strategies and DSM V CODE Paired with ICD_9 and 10-CM Codes for ODD

Sample Treatment Plan

Introduction:

Parenting is the process of promoting and supporting the physical, emotional, social, and intellectual development of a child from infancy to adulthood. Parenting refers to the activity of raising a child rather than the biological relationship. In the case of humans, it is usually done by the biological of the child in question, although governments and society take a role as well. In many cases, orphaned or abandoned children receive parental care from non- blood relations. Others may be adopted, raised by , or be placed in an orphanage.

The goals of human parenting are debated. Usually, parental figures provide for a child's physical needs, protect them from harm, and impart in them skills and cultural values until they reach legal adulthood, usually after adolescence. Among non-human species, parenting is usually less lengthy and complicated, though mammals tend to nurture their young extensively. The degree of attention parents invest in their offspring is largely inversely proportional to the number of offspring the average adult in the species produces.

Conventional Models of Parenting:

Rules of Traffic Model – an instructional approach to upbringing. Parents explain to their children how to behave, assuming that they taught the rules of behavior as they did the rules of traffic. What you try to teach a child doesn’t necessarily mean it’ll get through to them. For example, a teenager was told "a thousand times" that stealing was wrong yet the teen continued to do so. The problem of parenting, in this case, is not that they tried to teach him/her the right thing, but that they considered parenting as a single, narrow minded method of parenting, without fulfilling the range of parental duties.

Fine Gardening Model – a model in which parents believe that children have positive and negative qualities, the latter of which parents should "weed out" or "prune" into an appropriate shape. The problem in this parenting method is that parents fight with the faults of their child rather than appreciate their current achievements and/or capabilities; a method which may continue through their whole life without success.

Reward and Punishment Model – "RaP" is a model of parenting based on logic: for a good action - a reward/praise and for a bad action - a punishment/scolding/reprimand. To teach a child by this logic is relatively easy and can even be effective, especially if it is done consistently. It is because it forms a sense of justice in a child's mind that it works. But, simultaneously, it imparts the child's universal image of the reward and punishment and when real life doesn't prove to be just it undermines the child's faith in justice. This model can be considered dangerous for the future of children. It may happen that a man, grown up by this model, facing the first serious failure or first trouble, would lift his arms and ask, 'Why me?'"

Modern Models of Parenting:

Reward and Punishment Method: Parenting typically utilizes tools of reward and punishment method, but most experts now agree that corporal punishment is not an effective behavior modification tool. In some jurisdictions corporal punishment (e.g., spanking or whipping) has been prohibited by law. Many parents have adopted non-physical approaches to , for example time-out. The other "civilized" forms of discipline behavioral control, structure, accountability, Parental supervision, etc.

: The philosophy of Parenting For Everyone, which stem from the book by the same name, considers parenting from the ethical point of view. It analyses parenting goals, conditions and means of childrearing. It offers to look at a child's internal world (emotions, intelligence and spirit) and derive the sources of parenting success from there. The concept of heart implies the child's sense of being loved and their ability to others. The concept of intelligence implies the child's morals. And the concept of spirit implies the child's desire to do good actions and avoid bad behavior, avoid encroaching upon anybody's dignity. The core concept of the philosophy of Parenting For Everyone is the concept of dignity, the child's sense of worthiness and justice.

Christian parenting: In the United States, disparate models explicitly termed "Christian parenting" are popular among some parents who claim to apply biblical principles to parenting. Information on Christian parenting is found in publications, Christian parenting websites, and in seminars devoted to helping parents apply Christian principles to parenting.

While some Christian parenting models are strict and authoritarian, others are "grace-based" and share methods advocated in and positive parenting theories. Particularly influential on opposite sides have been James Dobson and his book Dare to Discipline, and William Sears who has written several parenting books including The Complete Book of Christian Parenting & and The Discipline Book.

In a study of Christian parents done by Christian Parenting Today in 2000, 39% of the surveyed have family devotions once a week or more, and 69% of parents consider Sunday school, youth and children's programs extremely important.

Other Modern Parenting Models include:

. – A family model where children are expected to explore their surroundings with protection from their parents.

. – Places a strong value on discipline as a means to survive and thrive in a harsh world.

. Attachment parenting – Seeks to create strong emotional bonds, avoiding physical punishment and accomplishing discipline through interactions recognizing a child's emotional needs all while focusing on holistic understanding of the child.

. Taking Children Seriously – Sees both praise and punishment as manipulative and harmful to children and advocates other methods to reach agreement with them. Planning and pre-pregnancy.

Family Planning Decisions and Parenting:

Reproductive health and preconception care affect pregnancy, reproductive success and maternal and child health. During pregnancy the unborn child is affected by many decisions his or her parents make, particularly choices linked to their lifestyle. The health and diet decisions of the mother can have either a positive or negative impact on the child during prenatal parenting.

Many people believe that parenting begins with birth, but the mother begins raising and nurturing a child well before birth. Scientific evidence indicates that from the fifth month on, the unborn baby is able to hear sound, be aware of motion, and possibly exhibit short-term memory. Several studies show evidence that the unborn baby can become familiar with his or her parents' voices. Other research indicates that by the seventh month, external schedule cues influence the unborn baby's sleep habits. Based on this evidence, parenting actually begins well before birth.

Depending on how many children the mother carries also determines the amount of care needed during prenatal and post-natal periods.

Parenting Stages:

Infants: Infant Parenting is where many of the responsibilities of parents begin. They need to attend to their infant's needs by providing special food, to adapt to the infant's erratic sleep cycle and to comfort their child at all times. Additionally, they should love their child constantly and become very sensitive to anything that scares the infant or makes it sad. Mothers should breastfeed their infants at this stage if they can, and sufficient exposure to language will be important for the infant when it begins speaking later on.

Toddlerhood: When the infant becomes a toddler, (generally 1 year after birth) the parents must begin to provide basic training of different types. Of the skills the child learns at this stage, many of them are motor skills and coordination. The child must learn to crawl, sit up, and eventually walk. They must develop their hand-eye coordination from pre-basic levels to higher levels of sophistication. Most speaking ability also develops at this stage, and parents must encourage lingual development by attempting to talk with the child, get them to understand basic gestures and emotional displays, and in most developed countries, eventually teach them to read and write. (This skill overlaps with the next stage of development.)

As the child develops and they learn to speak and move on their own, their curiosity sometimes "drives them like a motor." They will be able to crawl off staircases and swallow dangerous objects all on their own at this point, and parents will have to protect their child by protecting them, and in turn, showing them how some things (swallowing objects, falling off stairs) are dangerous.

Childhood: Parents are expected to make important decisions about preschool education and early childhood education. Parents have to love and care for their preschoolers doing all that they can to keep them safe. It is important not to keep things laying around that is dangerous to small children and items that say keep out of reach of children. Children at this age are very likely to put things in their mouths and eat and drink things that are dangerous to their health.

Adolescents: During adolescence children are beginning to form their identity and are testing and developing the interpersonal and occupational roles that they will assume as adults. Although adolescents look to peers and adults outside of the family for guidance and models for how to behave, parents remain influential in their development. Parents often feel isolated and alone in parenting adolescents, but they should still make efforts to be aware of their adolescents activities, provide guidance, direction, and consultation. Adolescence can be a time of high risk for children, where newfound freedoms can result in decisions that drastically open up or close off life opportunities. Parental issues at this stage of parenting include dealing with "rebellious" teenagers, who didn't know freedom while they were smaller.

Young Adults: As children become young adults their personalities show the result of successful or unsuccessful parenting. Especially it is noticeable when young adults make their independent life decisions about their education, work and choosing mates for friendship or .

Middle Age and Old Age: Parenting doesn't stop when children grow up and age. Parents always remain to be parents for old children. Their relationship continues developing if both parties want to keep it or improve. The parenting issues may include the relationship with grandchildren and stepchildren.

Symptoms and Causes:

The experiences of families with parent-child conflict may vary significantly from family to family. Parent-child conflict is not a formal diagnosis that is made by a healthcare provider or mental health professional. It is a “V-code” in DSM-5, meaning that it is not a mental disorder. However, some of the behaviors that may contribute to the conflict could be associated with other psychiatric conditions may include:

Parent becomes easily frustrated by children demands

Parent is having personal problems

Parent is having marital problems

Parent is having financial problems

Parent is unable to discipline children appropriately

Parent maintains no rules at home

Parent maintains no structure at home

Parent ignores reasonable demands made by children Parent give no attention to student needs at home

Parent give no attention to student needs at school

Pattern of emotional abuse evident

Pattern of physical abuse evident

Parent projects very low self esteem

Poor parenting skills are evident

Parent is socially isolated

Parent has no emotional support

Parent is isolated

Parent has no social supports

Parent lacks confidence

Parent lacks knowledge of resources

Steps to Develop a Treatment Plan:

The foundation of a good treatment plan is based on the gathering of the correct data. This involves following logical steps the built-in each other to help give a correct picture of the problem presented by the client or patient:

The mental health clinician must be able to listen, to understand what are the struggles the client faces. this may include:

issues with family of origin,

current stressors,

present and past emotional status,

present and past social networks,

present and past coping skills,

present and past physical health, self-esteem,

interpersonal conflicts

financial issues

cultural issues

There are different sources of data that may be obtained from a:

clinical interview,

Gathering of social history,

physical exam,

psychological testing,

contact with client’s or patient’s significant others at home, school, or work

The integration of all this data is very critical for the clinician’s effect in treatment. It is important to understand the client’s or patient’s present awareness and the basis of the client's struggle, to assure that the treatment plan reflects the present status and needs of the client or patient.

There 5 basic steps to follow that help assure the development of an effective treatment plan based on the collection of assessment data.

Step 1, Problem Selection and Definition:

Even though the client may present different issues during the assessment process is up to the clinician to discern the most significant problems on which to focus during treatment. The primary concern or problem will surface and secondary problems will be evident as the treatment process continues. The clinician may must be able to plan accordingly and set some secondary problems aside, as not urgent enough to require treatment at this time. It is important to remember that an effective treatment plan can only deal with one or a few problems at a time. Focusing in too many problems can lead to the lost of direction and focus in the treatment.

It is important to be clear with the client or patient and include the client’s or patient’s own prioritization of the problems presented. The client’s or patient’s cooperation and motivation to participate in the treatment process is critical. Not aligning the client to participate my exclude some of the client’s or patient’s needs needing immediate attention.

Every individual is unique in how he or she presents behaviorally as to how the problem affects their daily functioning. Any problems selected for treatment will require a clear definition how the problem affects the client or patient.

It is important to identify the symptom patterns as presented by the DSM-5 or Diagnostic and Statistical Manual or the International Classification of Diseases (ICD).

PARENTING PROBLEMS BEHAVIORAL DESCRIPTORS:

1. Parent becomes easily frustrated by children demands.

2. Parent is having personal or marital problems.

3. Parent is unable to discipline children appropriately.

4. Parent maintains no rules or structure at home.

5. Parent ignores reasonable demands made by children.

6. Parent give no attention to student needs at home or school.

7. Pattern of physical or emotional abuse evident.

8. Parent projects very low self esteem.

9. Poor parenting skills are evident.

10. Parent is socially isolated and has no emotional support.

Step 2, Long Term Goal Development:

This step requires that the treatment plan includes at least one broad goal that targets the problem and the resolution the problem. These long term goals must be stated in non-measurable terms but instead indicate a desired positive outcome at the end of treatment.

LONG TERM GOALS for PARENTING PROBLEMS:

1. Accomplish effective parenting skills.

2. Teach parent the child's developmental level as it relates to parenting.

3. End ineffective or abusive parenting.

4. Implement positive, effective parenting techniques.

5. Resolve marital conflicts that may affect parenting.

6. Establish a functioning parental team or unit.

7. Explore any childhood issues that impact on effective parenting.

8. Reduce the level of stress on parents, children, and the family.

9. Increase degree of family connectedness.

Step 3, Objective or Short Term Goal Construction:

Objectives or short term goals must be stated in measurable terms or language. They must clearly specify when the client or patient can achieve the established objectives. The use of subjective or vague objectives or short term goals is not acceptable. Most or all insurance companies or mental health clinics require measurables objectives or short term goals.

It is important to include the patient’s or client’s input to which objectives are most appropriate for the target problems. Short term goals or objectives must be defined as a number of steps that when completed will help achieve the long-term goal previously stated in non measurable terms. There should be at least two or three objectives or short-term goals for each target problem. This helps assure that the treatment plan remains dynamic and adaptable. It is important to include Target dates. A Target day must be listed for each objective or short-term goal.

If needed, new objectives or short-term goals may be added or modified as treatment progresses. Any changes or modifications must include the client’s or patient’s input. When all the necessary steps required to accomplish the short-term goals or objectives are achieved the client or patient should be able to resolve the target problem or problems.

If required all short term goals or objectives can be easily modify to show evidence based treatment objectives. The goal of evidence based treatment objectives (EBT) is to encourage the use of safe and effective treatments likely to achieve results and lessen the use of unproven, potentially unsafe treatments. To use EBT in treatment planning state restate short term goals in a way that steps to complete that goal and achieve results. For example, the short term goal “13. Increase positive self-descriptive statements.” Can be restated as; “By the end of the session the patient or client will list at least 5 positive self descriptions of himself or herself, and assess how they can help alleviate the presenting problem” Remember, that it must be stated in a way one can measure effectiveness.

It is important to note that traditional therapies usually rely more heavily on the relationship between therapist and patient and less on scientific evidence of proven practices.

EXAMPLES OF SHORT TERM GOALS FOR PARENTING PROBLEMS:

1. Stop negative discipline techniques and implement positive techniques.

2. Probe child behavior expectations, and parenting style.

3. Probe for any marital conflicts that affect parenting.

4. Identify and end any perfectionist expectations.

5. Implement openness to discuss parenting and discipline effectively with their children.

Step 4, Strategies or Interventions:

Strategies or interventions are the steps required to help complete the short-term goals and long-term goals. Every short term goal should have at least one strategy. In case, short term goals are not met, new short term goals should be implemented with new strategies or interventions. Interventions should be planned taking into account the client’s needs and presenting problem

INTERVENTIONS FOR PARENTING PROBLEMS:

1. Explore parents struggles with parenting, marital relationship, child expectations, and parenting style.

2. Establish or rule out the presence of marital conflicts, and resolve each conflict. 3. Identify child's personality/temperament type and how may clash with parents, and develop specific strategies to better deal with personality types.

4. Explore each parent's childhood and identify any unresolved conflicts.

5. Increase parents' awareness of how unresolved childhood issues are affect their ability to parent effectively.

Step 5, Diagnosis:

The diagnosis is based on the evaluation of the clients present clinical presentation. When completing diagnosis the clinician must take into account and compare cognitive, behavioral, interpersonal, and emotional symptoms as described on the DSM-5 Diagnostic Manual. A diagnosis is required in order to get reimbursement from a third-party provider. Integrating the information presented by the DSM-5 diagnostic manual and the current client’s assessment data will contribute to a more reliable diagnosis. it is important to note that when completing a diagnosis the clinician must have a very clear picture all behavioral indicators as they relate to the DSM-5 diagnostic manual.

Diagnosis of Parenting Problems:

DSM V CODE Paired with ICD_9-CM Codes (Parenthesis Represents ICD-10-CM Codes Effective 10-2014):

Possible Diagnostic Suggestions for Children with Parenting Problems:

Adjustment Disorders Specify whether:

309.0 (F43.21) With depressed mood

309.24 (F43.22) With anxiety

309.28 (F43.23) With mixed anxiety and depressed mood

309.3 (F43.24) With disturbance of conduct

309.4 (F43.25) With mixed disturbance of emotions and conduct

309.9 (F43.20) Unspecified

313.81 (F91.3) Oppositional Defiant Disorder

Specify current severity: Mild, Moderate, Severe

312.34 (F6381) Intermittent Explosive Disorder

Conduct Disorder - Specify whether:

312.81 (F91.1) Childhood-onset type

312.32 (F91.2) Adolescent-onset type

312.89 (F91.9) Unspecified onset

Specify if: With limited prosocial emotions

Specify current severity: Mild, Moderate, Severe

301.7 (F60.2) Antisocial Personality Disorder

312.33 (F63.1) Pyromania

312.32 (F63.3) Kleptomania

312.89 (F91.8) Other Specified Disruptive, Impulse-Control, and Conduct Disorder

312.9 (F91.9) Unspecified Disruptive, Impulse-Control, and Conduct Disorder

Attention-Deficit/Hyperactivity Disorder Specify whether:

314.01 (F90.2) Combined presentation

314.00 (F90.0) Predominantly inattentive presentation

314.01 (F90.1) Predominantly hyperactive/impulsive presentation

Specify if: In partial remission

Specify current severity: Mild, Moderate, Severe

314.01 (F90.8) Other Specified Attention-Deficit/Hyperactivity Disorder

314.01 (F90.9) Unspecified Attention-Deficit/Hyperactivity Disorder

Problems Related to Family Upbringing

V611.20 (Z62.820) Parent-Child Relational Problem

V61.8 (Z62.891) Sibling Relational Problem

V61.8 (Z62.29) Upbringing Away From Parents

V611.29 (Z62.898) Child Affected by Parental Relationship Distress

Other Problems Related to Primary Support Group

V611.03 (Z63.5) Disruption of Family by Separation or Divorce

V61.8 (Z63.8) High Expressed Emotion Level Within Family

Child Physical Abuse, Confirmed

995.54 (T74.1 2XA) Initial encounter

995.54 (T74.1 2XD) Subsequent encounter

Child Physical Abuse, Suspected

995.54 (T76.12XA) Initial encounter

995.54 (T76.1 2XD) Subsequent encounter

Child Sexual Abuse

Child Sexual Abuse, Confirmed

995.53 (T74.22XA) Initial encounter

995.53 (T74.22XD) Subsequent encounter

Child Sexual Abuse, Suspected

995.53 (T76.22)(A) Initial encounter

995.53 (T76.22XD) Subsequent encounter

, Suspected

995.52 (T76.02XA) Initial encounter

995.52 (T76.02XD) Subsequent encounter

Child Psychological Abuse

Child Psychological Abuse, Confirmed

995.51 (T74.32XA) Initial encounter

995.51 (T74.32XD) Subsequent encounter

Child Psychological Abuse, Suspected

995.51 (T76.32XA) Initial encounter

995.51 (T76.32XD) Subsequent encounter

Overall Integration of a Treatment Plan:

Choose one presenting problem. This problem must be identified through the assessment process. Select at least 1 to 3 behavioral definitions for the presenting problem. if a behavior definition is not listed feel free to define your own behavioral definition. Select at least long-term goal for the presenting problem. Select at least two short-term goals or objectives. Add a Target Date or the number of sessions required to meet this sure term goals. If none is listed feel free to include your own. Based on the short-term goals selected previously choose relevant strategies or interventions related to each short term goal. If no strategy or intervention is listed feel free to include your own. Review the recommended diagnosis listed. Remember, these are only suggestions. Complete the diagnosis based on the client's assessment data.

Sample Treatment Plan:

Present Behavioral Descriptors of Problem:

Parent is unable to discipline children appropriately. Parent maintains no rules or structure at home.

Long Term Goals:

Implement positive, effective parenting techniques Establish a functioning parental team or unit.

Short Term Goals Objectives:

Increase parents self confidence. Increase parent support of each other in the parenting.

Strategy or Intervention for Goal 1:

Refer parents to training in effective parenting. Monitor and reinforce parents' efforts to employ new techniques and approaches. Educate the parents on the differences between boys and girls development and perspectives.

Strategy or Intervention for Goal 2:

Identify areas of parenting strength and identify weaknesses that need to be improved. Identify and implementing specific ways parents can support each other to improve parenting. Teach parents how children can stop parents from cooperating with each other in order to get their way.

DSM V Diagnosis:

313.81 (F91.3) Oppositional Defiant Disorder - Moderate

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