Rehab (90899-17)

Rehab (short for psychosocial rehabilitation) involves teaching people things. A defining characterstic of rehab is that clients come away from it with knowledge or skills they can apply in other situations, when you aren't around.

 

Rehab interventions can be divided into 4 categories:

1. Psychoeducation - Helping clients understand the mental health issues that are creating problems in their lives.

2. Coping skills - Helping clients learn to be in control of themselves and their symptoms.

3. Social skills - Once clients start getting their symptoms under control, they can shift their focus to improving their ability to interact with other people.

4. Independent living skills (IADLs) - The ability to interact effectively with other people opens the door to regaining daily living skills and making a full recovery.

Examples of progress notes documenting interventions in each of these categories can be found through the links on the left.

 

 

 

Techniques often used in rehab:

Modeling:  You can model almost anything – how to ask for help in a store, how to talk to people on the phone, how to deal with frustration. Modeling calm behavior can help your clients stay calm, even when they’re not consciously aware of what you’re doing. Calling attention to how other people are behaving is modeling, too. Practicing and role-play are common.

Pros and cons:  The goal here is helping clients learn to make good decisions themselves, rather than relying on you or somebody else. You do that by helping them identify all the possible costs and benefits involved with a given choice, or at least as many as you can think of, then weighing them out.

Reframing:  When you reframe something, you help clients see it a different way. Getting kicked out of a room and board, for example, can be reframed as a chance to make a fresh start and learn from past mistakes. If “reframing” sounds too much like therapy, you can say something like “redefined the situation” instead.

Listening:  Active and reflective listening convey respect, help establish trust, and can help clients collect their thoughts when they’re upset.

Praise:  Reinforcing desirable behavior with praise is an important part of nearly all rehab services.

Skill building:  You can teach clients coping skills for managing their symptoms, like deep breathing for anxiety and exercise for depression. Or you can teach them basic life skills like budgeting their money, applying for a job, making an appointment, riding the bus, or renting an apartment.

Psychoeducation: Helping clients learn about themselves – their illness, their strengths, their warning signs, how their environment affects them, what their needs are and how they can get them met, how they can avoid relapses and crises, etc.

 

 

 

Words and phrases commonly used in rehab notes:

Coached; problem-solved; provided feedback; engaged in skill-building; used reminders and redirection; taught client how to; helped client identify precursors to; helped client identify consequences of; modeled appropriate behavior; helped client modify behavior by; reframed situation as an opportunity to; normalized client’s experience by; engaged in reflective listening; actively listened; helped client practice de-escalation techniques; role-played; practiced; rehearsed; worked with client to identify strengths; explored alternative ways of handling the situation; helped client search for patterns in his behavior; developed a plan for dealing with; worked to increase client’s awareness of; developed more effective coping strategies for....

 

 

 

Theoretical approaches

Some approaches from the world of psychotherapy can be adapted for use in rehab work. They can serve as a general guide or framework for structuring a group of interventions over time.

Solution-Focused: The idea here is that every person is a vast repository of information about themselves. They’ve been collecting information about what works and doesn’t work their whole lives. They know more about themselves than anyone else. They may already have solutions to many of their problems. Your job is to help them sift through all the information they have to uncover solutions that are already there.

Problem-Solving:  When people are faced with too many problems too quickly, they shut down. They give up and stop trying. Helping them break their problems down into smaller parts that can be solved one-by-one allows them to start having small successes again. Each success increases hope and self-confidence, and in this way the tide can be turned. The goal here is to increase successes and minimize failures, so you want to establish small objectives your client has a good chance of accomplishing. A long string of successes is what you're shooting for, even if they're very small ones.

Behavioral Activation: The idea here is that the symptoms of depression, such as isolating and reducing interaction with others, are what sustain it and make it worse. The solution for people is forcing themselves to do things they did before they got depressed – behaving in ways that are contrary to how they feel. It may sound simplistic, but research shows it’s sometimes as effective as CBT and antidepressants.

 

All PHI has been de-identified per HIPAA Privacy Rule