Social/Communication

 

26. Member will increase the number of anger management techniques he knows how to use, from a baseline of 0 to a goal of 6, as measured by member's description or demonstration of skills to CM.

Rehab: CM will use skill-building workbooks, modeling, role-play, and rehearsal to help member develop skills for managing anger and frustration. Will help member learn to identify situations that trigger anger, physical signs of anger, and factors that contribute to angry outbursts such as suppressing his feelings.

Group:  Group facilitator will conduct RCCS group to help participants improve their ability to manage strong emotions such as anger, frustration, and disappointment.

Member will attend RCCS group, practice using the anger management skills he learns, begin applying them to real-life situations, and discuss the results with treatment team on a weekly basis.

27. Member will reduce anger outbursts (as described in Dx Symptoms and CFS 3) from 5 times per week to a goal of 0 times per week and sustain this change for 6 months as measured by report of R&B manager.

Rehab:  CM will teach member coping skills to manage strong emotions and feelings of anger, such as deep breathing, progressive relaxation, meditation, visualization, and exercise. Will help member learn to identify situations that trigger anger, physical signs of anger, and factors that contribute to angry outbursts such as suppressing his feelings.

CMS: CM will conduct regular visits to member’s R&B to monitor progress, consult with housing manager, and identify any issues that need to be addressed.

Therapy: Clinician will use CBT to help member identify cognitive distortions (inaccurate thoughts and assumptions) that contribute to his anger, and teach him how to challenge and replace them with more accurate ones.

Medication: MD/NP will provide psychoeducation and prescribe/monitor psychiatric medications to stabilize mood and reduce symptoms of depression and irritability. Nurse will assist with medication management to help member overcome impairments related to lack of med adherence (see CFS 8).

Medication: Nurse will conduct annual nursing assessments to assist physician with ruling-out organic causes of mental health symptoms and to identify physical conditions neglected as a result of mental illness that may warrant referral.

Member will practice using the coping skills he learns and begin applying them to real-life situations. He will discuss the results with his CM during their weekly meetings.

28. Member will increase the number of situational triggers to anger he can identify, from a baseline of 0 to a goal of at least 3, then develop a plan for what to do when he encounters them, as measured by member's description of situations and plan.

Rehab: CM will use skill-building workbooks to help member identify situations that trigger anger. Will help member develop a plan for avoiding anger-provoking situations when possible, limiting his exposure to them when they cannot be avoided (e.g., saying he needs to think and excusing himself temporarily), and using skills such as deep breathing, venting to a trusted friend, and journaling to de-escalate and regain control of his emotions.

Therapy: Clinician will provide therapeutic interventions such as CBT and Mindfulness to help member recognize links between symptoms, behaviors, and impairments; develop insight and understanding of his illness; and overcome negative thoughts and feelings.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce depression and mood lability. Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Group: Group facilitator will conduct RCCS group to help participants improve their ability to manage strong emotions such as anger and frustration.

Member will attend RCCS group, maintain and awareness of his triggers, and follow the agreed-upon plan when he encounters them.

29. Member will increase the number of hours per day he spends outside his room, from a baseline of <1 to a goal of 4 or more, and sustain this change for 6 months, as measured by collateral and member self-report.

Rehab: CM will use modeling, role-play, and rehearsal to help member develop more effective social skills, with the goal of making social interactions more productive and rewarding.

CMS: CM will facilitate linkage to groups and activities in member’s community.

Therapy: Clinician will provide therapeutic interventions such as CBT to help member identify and correct self-defeating thoughts that may be contributing to his feelings of depression.

Group:  Group Facilitator(s) will conduct Moving Forward, Sports Talk, and similar groups with the goal of encouraging social interaction, practicing conversation skills, developing insight into the process of recovering from adversity, and the value of support from peers.

Member will attend at least 4 sessions of one of the above groups or participate in a weekly social or group activity in his community.

30. Member will reduce isolative episodes (as described in CFS 3) from 7 times per week to a goal of less than 2 times per week and sustain for 3 months as measured by self-report and caregiver report.

Rehab: CM will teach member skills to manage anger and anxiety, such as deep breathing, progressive relaxation, meditation, positive mental imagery, and exercise. Will use modeling, role-play, and rehearsal to help member develop more effective social skills, with the goal of making social interactions more productive and rewarding.

CMS: CM will facilitate linkage to groups and activities in member’s community.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of depression, anxiety, and anger.

Medication: Nurse will assist with medication management to help member overcome impairments related to lack of consistent med adherence.

Therapy: Clinician will provide therapeutic interventions such as CBT to help member identify and correct self-defeating thoughts that may be contributing to his feelings of anger and anxiety.

Group: Group Facilitator(s) will conduct Coping Skills and DBSA (Depression and Bipolar Support Alliance) Groups to help participants form connections with peers, recognize they are not alone, share experiences, and celebrate accomplishments.

Member will attend at least 1 series of one of the above groups.

31. Member will develop greater comfort in social situations as evidenced by attending at least one group or social function in his community per week (from a baseline of 0 per week), and sustain this change for 3 consecutive months, as measured by member self-report.

Rehab: CM will provide MHS (skill-building through role-play, modeling, and rehearsal) to help member improve social/interpersonal skills. Will teach anxiety-reduction techniques such as deep breathing that member can implement in real-time, without attracting attention or shifting his attention away from the conversation.

CMS: CM will provide linkage to groups and social activities in member's community.

Group: Group Facilitator(s) will conduct Moving Forward, Sports Talk, and similar groups with the goal of encouraging social interaction, practicing conversation skills, improving listening skills, and learning how to express interest in others.

Member will attend at least 1 series of one of the above groups and practice using the skills he learns with his CM.

32. Member will identify an activity he and his son enjoy doing together, then engage in that activity with his son at least once a month for a period of 6 months.  Baseline:  Desires closer relationship with son but has not taken steps to achieve it.

Rehab: CM will teach member skills for reducing his symptoms, such as remembering to take his medications in the right amounts, at the right times; identifying and eliminating unnecessary sources of stress, and learning self-calming techniques. Will model communication skills such as active listening and verbal/non-verbal expressions of interest, then role-play with member to increase self-confidence.

Therapy: Clinician will use CBT to help member identify negative patterns of thinking that are interfering with his relationships (e.g., guilt, negative self-image, negative labels) and replace them with more accurate ones.

Group:  Group Facilitator(s) will conduct Moving Forward, Sports Talk, and similar groups with the goal of encouraging social interaction, practicing conversation skills, improving listening skills, and learning to demonstrate interest in others.

Member will adhere to med regimen, implement coping skills he learns from his treatment team, and attend at least one series of groups to practice having conversations.

33. Member will increase the number of conversations to which she makes a significant contribution, from a baseline of 0 per week to a goal of 5 per week, and sustain this change for at least 6 months as measured by collateral, member self-report, and CM observation.

Rehab:  CM will use role-play, modeling, and relaxation training to help member develop skills for managing the anxiety she experiences in social/performance situations that causes her to avoid them. Will help member learn to distinguish between passive, assertive, and aggressive styles of communication.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of depression and anxiety.

Medication: Nurse will assist with medication management to help member overcome impairments related to lack of med adherence (see CFS 8).

Member will practice using the anxiety-reduction techniques she learns and begin applying them in real-life situations. She will discuss the results with her CM during their weekly meetings.

34. Member will initiate and maintain a 5-minute conversation with a member of his treatment team at least once a week, and sustain this change for a period of 6 months.  Baseline:  Conversations usually last less than a minute and are rarely initiated by member.

Rehab: CM will use modeling, role-play, practice, and feedback to help member develop more effective communication skills. Will stress the importance of taking medications as prescribed, eliminating unnecessary sources of stress, initiating conversations in quiet areas with minimal distractions, and tactfully disengaging if symptoms or surroundings make conversations too difficult.

Collateral: CM will educate member’s family on the potential benefits of maintaining a low-stress environment, keeping volume levels down, using active/reflective listening, using non-judgmental language, having only one person speaking at a time, avoiding arguments, and acknowledging that member’s beliefs are real without supporting the actual delusions.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of thought disorder.

Medication: Nurse will assist with medication management to help member overcome impairments related to lack of med adherence as described in CFS 8.

Member will observe conversations between other people and make a note of the patterns he observes.

35. Member will initiate and maintain a 10-minute conversation with someone he is not already well acquainted with, at least 1x/week for a period of 6 months, as evidenced by member self-report and CM observation.  Baseline:  Sometimes initiates conversations but loses focus and disengages within 2 minutes.

Rehab: CM will provide MHS (skill-building through role-play, modeling, and rehearsal) to help member improve social/interpersonal skills. Will teach anxiety-reduction techniques such as deep breathing that member can implement in real-time, without attracting attention or shifting his attention away from the conversation.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce anxiety and depression. Nurse will assist with medication management to help member overcome impairments related to lack of med adherence.

Medication: Nurse will conduct annual nursing assessments to rule-out organic causes of mental health symptoms and identify physical conditions neglected as a result of mental illness that may warrant referral.

Group:  Group Facilitator(s) will conduct Moving Forward, Sports Talk, Let’s Vent, and similar groups with the goal of encouraging social interaction, practicing “give and take” conversation (balancing speaking with listening), and learning how to express interest in what others are saying without interrupting them.

Member will practice using the skills he learns and attend at least one series of groups to practice having conversations.

36. Member will be able to describe the process of reflective listening to his CM, explain how it benefits both speaker and listener, and demonstrate it in-vivo.  Baseline:  Displays minimal interest in, and retention of, things others say during conversations.

Rehab:  CM will teach member to use reflective listening through modeling, role-play, role reversal, and feedback. Will help member recognize and avoid blocks to active listening, such as daydreaming, rehearsing (thinking about what he is going to say next instead of listening), filtering (listening only to parts of a conversation), judging, and distractions.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of mood lability. 

Medication: Nurse will assist with medication management to help member overcome impairments related to inconsistent use of prescribed medications (see CFS 8).

Member will observe conversations between other people and make a note of the patterns he observes.

37. Member will increase the number of minutes he is able to sit in a crowded waiting room without experiencing significant emotional distress, from a baseline of 0 to a goal of 30, and sustain this change for 6 months, as measured by member self-report and CM observation.

Rehab: CM will teach member anxiety-reduction skills such as focusing on breathing, progressive muscle relaxation, calming mental imagery, positive self-affirmations, meditation, and exercise. Will help member practice techniques such as deep breathing that he can implement in real-time, as needed, without attracting the attention of others.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of anxiety and thought disorder.

Medication: Nurse will assist with medication management to help member overcome impairments related to lack of med adherence.

Group:  Group Facilitator(s) will conduct Moving Forward, Sports Talk, and similar groups to encourage peer-to-peer interaction, allow participants to become acclimated to group settings, and help develop greater self-confidence in social situations.

Member will attend at least 1 series of one of the above groups and practice using the anxiety-reduction skills he learns with his CM.

38. Member will be able to identify basic body-language signals and accurately describe their meaning, as measured by statements he makes to his CM.  Baseline:  Has difficulty interpreting non-verbal cues, unable to recognize common body-language signals.

Rehab:  CM will use skill-building workbooks and pictures to increase member’s awareness of non-verbal forms of communication such as facial expressions, touching, gestures, posture, body language and spatial distance between himself and others. Will use modeling, role play, and role reversal to help member internalize this awareness and incorporate it into his everyday interactions.

Group:  Group Facilitator(s) will conduct Moving Forward, Sports Talk, Let’s Vent, and similar groups with the goal of encouraging social interaction, practicing “give and take” conversation (balancing speaking with listening), and learning to recognize and interpret non-verbal communication by others in the group.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of thought disorder.

Medication: Nurse will assist with medication management to help member overcome impairments related to lack of med adherence.

Member will observe conversations between others and make a note of patterns he observes (e.g., eye contact, posture, body positioning, facial expressions, use of gestures, etc.).

39. Member will increase the number of exchanges he initiates with an appropriate verbal greeting, from baseline of 0x/week to a goal of 7x/week, and sustain this change for at least 6 months, as measured by collateral, member self-report and CM observation.

Rehab: CM will provide MHS (skill-building through modeling and role-play) to help member improve social/interpersonal skills. Will work with member on appropriate conversation starters, tones of voice, and facial expressions for a variety of different situations.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to control positive symptoms of schizophrenia. Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Medication: Nurse will conduct annual nursing assessments to assist physician with ruling-out organic causes of mental health symptoms and to identify physical conditions neglected as a result of mental illness that may warrant referral.

Member will make note of how others respond to his greetings and discuss it with his CM during their weekly meetings.

40. Member will increase the number of times he responds to verbal greetings by others (e.g., by smiling, nodding, or offering a similar greeting), from a baseline of 0x/week to a goal of 7x/week, and sustain this change for at least 6 months, as measured by collateral, member self-report and CM observation.

Rehab: CM will provide MHS (skill-building through modeling and role-play) to help member develop more effective social/interpersonal skills. Will work with member on appropriate conversation starters, tones of voice, and facial expressions for a variety of different situations.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to control positive symptoms of schizophrenia.  Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Medication: Nurse will conduct annual nursing assessments to rule-out organic causes of mental health symptoms and identify physical conditions neglected as a result of mental illness that may warrant referral.

Member will make note of how others respond to his greetings and discuss it with his CM during their weekly meetings.

41. Member will increase the number of minutes per day she spends in conversation with others, from a baseline of 3 minutes to a goal of 30 minutes, and sustain this change for 6 months, as evidenced by collateral and member self-report.

Rehab: CM will use modeling, role-play, practice, and feedback to help member develop more effective communication skills. Will stress the importance of taking medications as prescribed and reducing/eliminating unnecessary sources of stress.

CMS: CM will facilitate linkage to groups and social activities in member’s community and make regular visits to member’s R&B to monitor progress, consult with housing manager, and identify any issues that need to be addressed.

Collateral: CM will educate member’s R&B manager on the benefits of using active listening, using non-judgmental language, and avoiding arguments.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of thought disorder.

Medication: Nurse will assist with medication management to help member overcome impairments related to lack of med adherence (see CFS 8).

Member will practice using the communication skills she learns and begin applying them in real-life situations. She will discuss the results with her CM during their weekly meetings.

42. Member will improve his ability to manage depression as evidenced by spending at least 2 days a week in the company of others, away from his apartment.  Baseline:  0 days a week.

Rehab: CM will use RCCS skill-building exercises such as "My Hopes and Dreams", "My Spirituality", and "My Resilience" to inspire hope, increase motivation, and help member envision positive outcomes. Will use modeling and role-play to help member improve social/interpersonal skills. Will encourage member to focus on his strengths and achievements.

CMS: CM will facilitate linkage to groups and social activities in member’s community.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of depression.  Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Group:  Group Facilitator(s) will conduct Moving Forward, Sports Talk, and similar groups to encourage peer-to-peer interaction, allow participants to become acclimated to group settings, and help develop greater self-confidence in social situations.

Member will attend at least 1 series of one of the above groups.

43. Member will spend at least 2 days a week doing gardening at the Common Ground Community Garden in West Anaheim, and sustain this change for 3 months, as measured by member self-report.  Baseline:  Has identified gardening as something he enjoys; currently engages in no activities that he finds meaningful or fulfilling.

Rehab: CM will use RCCS skill-building exercises such as "My Hopes and Dreams", "My Spirituality", and "My Resilience" to inspire hope, increase motivation, and help member envision positive outcomes. Will provide MHS (skill-building through role-play, modeling, and rehearsal) to help member improve social/interpersonal skills.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to control positive symptoms of schizophrenia.

Medication: Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Member will practice using the skills he learns and inform his CM of any barriers he encounters in using the community gardens.

44. Member will increase instances in which anger management techniques are successfully used, from a baseline of 0x/month to a goal of at least 4x/month, and sustain this change for the remainder of the cycle, as measured by member's description of situation and how techniques were used.

Rehab:  CM will use skill-building workbooks to help member identify situations that trigger his anger. Will help member develop a plan for avoiding anger-provoking situations when possible, limiting his exposure to them when they cannot be avoided (e.g., saying he needs to think and excusing himself temporarily), and using skills such as deep breathing, venting to a trusted friend, and journaling to stay in control of his emotions.

Therapy: Clinician will provide therapeutic interventions such as CBT and Mindfulness to help member recognize links between symptoms, behaviors, and impairments; develop insight and understanding of his illness; and overcome negative thoughts and feelings.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce depression and mood lability.  Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Group: Group facilitator will conduct RCCS group to help participants improve their ability to manage strong emotions such as anger and frustration.

Member will attend RCCS group, practice using the anger-management skills he learns, maintain and awareness of his triggers, and follow the agreed-upon plan when he encounters them.

45. Member will be able to describe 2 instances per week (from a baseline of 0 per week) in which he used a de-escalation technique to remain calm in a situation where he would normally have lost his temper, and sustain this change for 6 months, as measured by CM report.

Rehab:  CM will use skill-building workbooks to help member identify situations that trigger his anger, and help him develop a plan for avoiding and/or limiting his exposure to these situations. Will teach anger management skills such as deep breathing and counting to ten, and use modeling to help him distinguish between assertive and aggressive styles of communication.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce depression and mood lability. Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Medication: Nurse will conduct annual nursing assessments to rule-out organic causes of mental health symptoms and identify physical conditions neglected as a result of mental illness that may warrant referral.

Group: Group facilitator will conduct RCCS group to help participants improve their ability to manage strong emotions such as anger and frustration.

Member will attend RCCS group, practice using the anger-management skills he learns, maintain and awareness of his triggers, and follow the agreed-upon plan when he encounters them.

46. Within 3 months, member will be able to describe or demonstrate 5 anger management techniques; over the following 9 months (7-12) she will be able to describe at least one situation per month in which she has successfully applied these techniques.  Baseline:  Knows of 1 technique (counting to ten) but doesn't use it in real-life situations.

Rehab:  CM will teach member coping skills to manage strong emotions that precipitate her angry outbursts, such as deep breathing, progressive relaxation, meditation, visualization, and exercise. Will help member learn to identify situations that are likely to trigger her anger (based on past patterns), physical signs of anger, and factors that contribute to angry outbursts such as suppressing her feelings.

Group: Group facilitator will conduct RCCS and COEG (Co-Occurring Education Group) to help participants improve their ability to manage strong emotions and learn about the relationship between substance abuse and recovery from mental illness.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of anger, mood lability, and depression. 

Medication: Nurse will assist with medication management to help member overcome impairments related to inconsistent use of prescribed medications (see CFS 8).

Member will attend RCCS and COEG group, practice using the anger-management skills she learns, maintain and awareness of her triggers, and follow the agreed-upon plan when she encounters them.

47. Member will express disagreement without 1) raising his voice excessively, and 2) walking away without resolving the issue, for a period of 6 months, as measured by collateral and member self-report.  Baseline:  Shouts and walks away during disagreements about 1x/2 weeks.

Rehab: CM will help member look for patterns in her behavior and assist her in identifying precursors to angry outbursts, with the goal of helping her intervene before she loses her temper. Will teach member techniques for disengaging without giving in, such as asking for more time to think and temporarily excusing herself, and skills such as deep breathing, journaling, and venting to a trusted friend to regain control of her behavior.

Therapy: Clinician will provide therapeutic interventions such as CBT and Mindfulness to help member recognize links between symptoms, behaviors, and impairments; develop insight and understanding of his illness; and overcome negative thoughts and feelings.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce depression and mood lability.  Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Medication: Nurse will conduct annual nursing assessments to assist physician with ruling-out organic causes of mental health symptoms and to identify physical conditions neglected as a result of mental illness that may warrant referral.

Member will practice using the anger-management skills he learns, maintain and awareness of his triggers, and follow the agreed-upon plan when he encounters them.

48. Member will analyze 5 instances in which she became extremely angry and come up with at least 2 alternative explanations for the triggering event in each situation, as evidenced by statements she makes to her CM.  Baseline:  Member jumps to conclusions without considering alternative explanations.

Rehab: CM will teach self-calming techniques such as deep breathing to facilitate the exploration of past events and willingness to consider alternative explanations for what happened.
 
Therapy: Clinician will use CBT to help member identify “automatic thoughts” that are most closely linked to her fears of abandonment and episodes of anger (e.g., "If people are late, it means they don't respect me"). Will help member challenge these thoughts and replace them with more accurate beliefs.

Group: Group facilitator will conduct RCCS group to help participants improve their ability to manage strong emotions such as anger and anxiety.

Member will attend RCCS group and work collaboratively with her CM and therapist to gain insight into her thoughts and behaviors.

49. Member will choose to disengage from heated conversations within one minute and use an anger management technique to calm down before resuming the discussion, as evidenced by collateral and member self-report.  Baseline:  Unable to disengage and prevent escalation of arguments.

Rehab: CM will use skill-building workbooks to help member identify situations associated with angry outbursts he has had. Will help member develop a plan for avoiding anger-provoking situations when possible, limiting his exposure to them when they cannot be avoided (e.g., saying he needs time to think and excusing himself temporarily), and using skills such as deep breathing, venting to a trusted friend, and journaling to regain control of his behavior.

Collateral: CM will educate member’s R&B manager on the use of active listening and non-judgmental language, and explain how this can help improve communication.

Therapy: Clinician will help member identify cognitive distortions (inaccurate thoughts and assumptions) that contribute to his anger, and teach him to challenge and replace them with more accurate ones.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of depression, anger, and impulsivity. 

Medication: Nurse will assist with medication management to help member overcome impairments related to inconsistent use of prescribed medications.

Member will consider past incidents in which he lost his temper and look for similarities in the events leading up to these episodes.

50. Member will be able to explain the difference between passive, assertive, and aggressive communication styles, and give 1 example per week of a situation in which he has used an assertive style effectively, for a period of 6 months, as measured by report of CM.

Rehab: CM will teach anger management skills such as deep breathing and counting to ten, and use modeling to help member distinguish between passive, assertive, and aggressive styles of communication. Will role-play mock disagreements with member to give him the opportunity to practice appropriate assertive responses.

Rehab: CM will work to increase member’s awareness of how inappropriate responses affect his relationships with others and interfere with his ability to get his short- and long-term needs met.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce depression and mood lability.  Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Group:  Group Facilitator(s) will conduct Coping Skills and DBSA (Depression and Bipolar Support Alliance) Groups to help participants form connections with peers, recognize they are not alone, share experiences, and celebrate accomplishments.

Member will attend groups, practice using the communication skills she learns, and begin applying them in real-life situations. She will discuss the results with her CM during their weekly meetings.

51. Member will be free of panic attacks for 3 consecutive months, as measured by member self-report.  Baseline:  Member has never gone longer than 2 months without having a severe panic attack.

Rehab: CM will teach member anxiety-reduction skills including deep breathing techniques to prevent hyperventilation, and encourage her to avoid substances like caffeine that may be making her attacks worse. Will accompany member into the community and provide support as she gradually exposes herself to situations she is afraid of.

CMS: PCS will provide educational materials about panic disorder to help member understand that she is not "going crazy" or having a heart attack when symptoms occur. Will show member how to use the Common Ground library to find more information about panic disorder and stories of people who have successfully overcome it.

Therapy: Clinician will help member explore thinking patterns and behaviors that are sustaining or triggering her panic attacks.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of anxiety and depression. 

Medication:  Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Member will practice using the coping skills she learns and use positive self-talk to reassure herself of her ability to endure anxiety symptoms without serious consequences (e.g., "This has happened many times before and I was fine once it passed.").

52. Member will have a social support network composed of at least 3 friends or family members who are actively supporting him in his recovery.  Baseline:  Member is able to identify one friend but says they aren't always supportive or available when he needs to talk.

Rehab: CM will work to reduce member’s isolation & social withdrawal by helping him learn to safely communicate his own needs and show that he understands the needs of others. Will model appropriate conversation starters and role-play conversations for him to have with others.

CMS: CM will link member with social groups in his area, where he can meet people with similar interests and life experiences.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of anxiety and depression. Nurse will assist with medication management to help member overcome impairments related to lack of consistent med adherence.

Group: Group Facilitator(s) will conduct Moving Forward, Sports Talk, and similar groups to encourage peer-to-peer interaction, allow participants to become acclimated to group settings, and help develop greater self-confidence in social situations.

Member will attend at least 1 series of one of the above groups and practice using the communication skills he learns.

53. Member will increase the number of people he trusts and feels comfortable turning to for support, from a baseline of 1 to a goal of at least 5, and sustain this change for the remainder of the cycle, as measured by member self-report.

Rehab: CM will use modeling, role-play, practice, and feedback to help member develop more effective communication skills. Will stress the importance of taking medications as prescribed and reducing/eliminating unnecessary sources of stress. Will encourage member to focus on his strengths and achievements.

CMS: CM will link member with groups and social activities in his area, where he can meet people with similar interests and life experiences.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of thought disorder. Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Medication: Nurse will conduct annual nursing assessments to rule-out organic causes of mental health symptoms and identify physical conditions neglected as a result of mental illness that may warrant referral.

Group: Group Facilitator(s) will conduct Moving Forward, Sports Talk, and similar groups to encourage peer-to-peer interaction, allow participants to become acclimated to group settings, and help develop greater self-confidence in social situations.

Member will attend at least 1 series of one of the above groups and practice using the communication skills he learns.

54. Member will have a well-defined social support network consisting of at least 4 close friends or family members and will be involved with at least one group that meets on a regular basis.  Baseline:  Member has 2 friends he can turn to for support but isn't involved in any social or group activities.

Rehab: CM will help member identify new strategies and coping skills to increase his social participation, then model, role-play and practice these skills with him in the community on a monthly basis. Will provide feedback and positive reinforcement when member engages in pro-social behaviors.

CMS: CM will facilitate linkage to groups and social activities in member’s community where he can meet new people and practice using the skills he learns.

Therapy: Clinician will assist member in identifying thoughts that are most closely linked to his anxiety (e.g., "People won’t like me" or "Everyone can tell there’s something wrong with me") then then help him challenge those thoughts and replace them with more accurate beliefs about himself and the people around him.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of thought disorder and anxiety.  Nurse will assist with medication management to help member overcome impairments related to lack of med adherence.

Member will practice using the communication skills he learns and use positive self-statements to increase self-confidence.

55. Member will reduce instances of shouting and making threats during visits to the clinic, from a baseline of 1x/2 visits to a goal of 1x/6 visits, and sustain this change for 6 months, as measured by report of clinic staff.

Rehab: CM will teach member anger management skills such as deep breathing, progressive relaxation, counting to ten, and buying time. Will help member learn to identify physical signs increasing anger and factors that contribute to angry outbursts, and help him develop a plan for what to do when he feels his anger escalating.

Group: Group facilitator will conduct COEG (Co-Occurring Education Group) to help participants improve their ability to manage strong emotions and learn about the relationship between substance abuse and recovery from mental illness.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of anger, mood lability, and depression.

Medication: Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Member will attend COEG group, practice using the anger-management skills he learns, maintain and awareness of his triggers, and follow the agreed-upon plan when he encounters them.

56. Member will have at least 4 "just me" days per week in which she focuses on improving herself and refrains from offering advice, passing judgment, or admonishing others for doing things she feels are wrong.  Baseline: Limits focus to self 0 days per week.

Rehab:  CM will use skill-building exercises from the Relationships and Conflict Management workbooks to help member learn to set limits and boundaries, and to increase her awareness of how inappropriate responses impact her relationships with others. Will teach member to use journaling as a way of expressing her feelings, and “I” statements for occasions she feels she must express her opinions directly to another person.

Therapy: Clinician will use therapeutic interventions such as DBT and CBT to help member recognize links between symptoms, behaviors, and impairments; develop insight and understanding into her illness; and overcome negative thoughts and feelings.

Medication: MD/NP will provide psychoeducation and prescribe and monitor psychiatric medications to reduce symptoms of anger, mood lability, and depression.

Medication: Nurse will assist with medication management to help member overcome impairments related to inconsistent adherence to med regimen.

Member will begin using a journal to express at least some of her thoughts and feelings about others, and to make note of things she wants to work towards in her own life.

All PHI has been de-identified per HIPAA Privacy Rule