Rehab (90899-17)

Rehab (short for psychsocial 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:

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

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

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

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 start-to-finish 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:  Not all listening is billable but when done at the right times, it is. Reflective listening conveys respect, helps establish trust, and can help clients collect their thoughts when they’re upset. Providing supportive listening when clients need to vent is one of the best interventions there is.

Praise:  Reinforcing desirable behavior with praise is a billable intervention that comes naturally to most of us. You can’t really do a rehab service that consists only of praise, but it’s definitely billable when given at the right time.

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.

The last two are more approaches than techniques, but the idea is, they can be used in a wide variety of situations.

 

 

 

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....

 

All PHI has been de-identified per HIPAA Privacy Rule