Before you can create a plan that will take you to where you want to go, you have to know where you are now. Whether the plan is for a trip to San Francisco or to Bipolar In Order, you don't know what path to take or what direction to travel without knowing your starting point. Along the way, you may find yourself off track, so it is equally important to periodically reassess where you are and make adjustments as necessary.
The practice of a fifteen minute assessment and a prescription needs to be relegated to the history books along with drowning women to see if they are witches. You cannot determine in fifteen minutes where you are psychologically any better than finding your location by spinning a globe and poking it with your finger.
It takes a thorough assessment to determine the starting point for getting any mental condition "in order." Thorough means both a deep and wide look at the whole person from several points of view. It is important to examine the physical, mental, emotional, spiritual, relationship, and career/financial aspects to get a complete perspective. Each assessment should be at least one hour and the psychiatrist should optimally spend three hours or more before suggesting treatment approaches.
Communication between all of the assessment team members is a critical part of any thorough approach. Having assessments from many points of view may be substantially better than a single approach, but without sharing the insights they could lead to conflicting conclusions.
Our approach is to use a database that is accessible to all team members; including the client, family, and all of the experts involved. We also have group meetings with the entire team. While the database needs to be HIPAA1 compliant, the most crucial element is that the client needs to legally approve the information sharing between team members.
The process is to meet with the various team members individually and then assemble the team so that they can share their unique perspectives. For example, the psychiatrist may suggest the need to start a jogging program, but the medical or fitness evaluation might have determined that jogging is not the best approach and suggest swimming instead.
The first use of the thorough assessment is help in creating the Life Plan as detailed in the next chapter. Based on knowing where the client is currently and what the client desires to accomplish, the Life Plan is a critical part of the overall strategy.
Assessments are not a static process. Every time a team member meets with a client for treatment, they are doing an assessment and taking notes about the current conditions. The notes are shared with all team members, including the client. The client's own introspection is a form of assessment also. The client even has the opportunity to comment and self-assess as part of the database.
The Life Plan includes clear and measurable milestones toward achieving our goals. It is important for the team to reassess the client's condition at each of the milestone dates and make adjustments to the plan. The reassessments are more formal than the ongoing assessments that happen at each meeting. They are geared toward setting the current point of progress and are used as the starting point for changes in the Life Plan as well as treatment regimens.
The assessment process is an integral part of a successful program. It is used as the reference point in developing the Life Plan as well as for making periodic scheduled adjustments. Ongoing assessments are a crucial component in getting any mental condition "in order."
Details of how assessments are done from each point of view are included in the next section - Advantage Program Components. While not everyone has the resources or inclination to have such a thorough assessment, this book is about what is ultimately possible. Just as not everyone is interested in achieving equanimity or even the highest level of self-mastery, the assessment should be commensurate with the intended outcomes.
- http://www.hhs.gov/ocr/privacy/hipaa/understanding/index.html The Privacy Rule provides federal protections for personal health information held by covered entities and gives patients an array of rights with respect to that information. At the same time, the Privacy Rule is balanced so that it permits the disclosure of personal health information needed for patient care and other important purposes.
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