15 Refer to Outpatient Systematic Care Team (15)The client was referred to an outpatient Systematic Care team to help manage medications and provide support services.The client has followed through with the referral to an outpatient Systematic Care team and support services have begun.The client has not engaged with the outpatient Systematic Care team and was redirected to follow through on this recommendation.
16 Monitor Medication Reaction (16)The client's reaction to the medication in terms of side effects and effectiveness were monitored.The client reported that the medication has been effective at reducing energy levels, flight of ideas, and the decreased need for sleep; he/she/they were urged to continue this medication regimen.The client has been reluctant to take the prescribed medication for his/her/their manic state, but was urged to follow through on the prescription.As the client has taken his/her/their medication, which has been successful in reducing the intensity of the mania, he/she/they have begun to feel that it is no longer necessary and have indicated a desire to stop taking it; he/she/they were urged to continue the medication as prescribed.
17 Monitor Ability to Participate in Psychotherapy (17)The client's pattern of symptom improvement was monitored, with a focus on how stable he/she/they are in regard to participation in psychotherapy.The client was judged to be significantly improved and capable of participating in psychotherapy.The client was judged to still be too manic to allow helpful participation in psychotherapy.
18 Educate About Mood Episodes (18)A variety of modalities were used to teach the family about signs and symptoms of the client's mood episodes.The phasic relapsing nature of the client's mood episodes was emphasized.The client's mood episode concerns were normalized.The client's mood episodes were destigmatized.
19 Teach Stress Diathesis Model (19)The client was taught a stress diathesis model of bipolar disorder.The biological predisposition to mood episodes was emphasized.The client was taught about how stress can make him/her/them more vulnerable to mood episodes.The manageability of mood episodes was emphasized.The client was reinforced for his/her/their clear understanding of the stress diathesis model of bipolar disorder.The client struggled to display a clear understanding of the stress diathesis model of bipolar disorder and was provided with additional remedial information in this area.
20 Provide Rationale for Treatment (20)The client was provided with the rationale for treatment involving ongoing medication and psychosocial treatment.The focus of treatment was emphasized, including recognizing, managing, and reducing biological and psychological vulnerabilities that could precipitate relapse.A discussion was held about the rationale for treatment.The client was reinforced for his/her/their understanding of the appropriate rationale for treatment.The client was redirected when he/she/they displayed a poor understanding of the rationale for treatment.
21 Educate About Medication Adherence (21)The client was educated about the importance of medication adherence.The client was taught about the risk for relapse that occurs when medication is discontinued.The client was asked to make a commitment to prescription adherence.The client was reinforced for his/her/their understanding and commitment to prescription adherence.The client was redirected when he/she/they displayed poor understanding or commitment to prescription adherence.
22 Assess Prescription Nonadherence Factors (22)Factors that have precipitated the client's prescription nonadherence were assessed.The client was checked for specific thoughts, feelings, and stressors that might contribute to his/her/their prescription nonadherence.The client was assigned “Why I Dislike Taking My Medication” from the Adult Psychotherapy Homework Planner (Jongsma).A plan was developed for recognizing and addressing the factors that have precipitated the client's prescription nonadherence.
23 Coordinate Group Psychoeducational Program (23)The client was admitted to a group psychoeducational program that teaches clients the psychological, biological, and social influences in the development of BPD.The client's involvement in the group psychoeducational program focused on the bio- logical and psychological treatment of his/her/their disorder.The client has followed through on his/her/their involvement in a group psychoeducational program and key topics were reviewed.The client has not followed through on his/her/their involvement in a group psychoeducational program and was redirected to do so.
24 Teach Illness Management Skills (24)The client was taught about illness management skills.The client was taught about identifying early warning signs, common triggers, and coping strategies.The client was taught about problem solving regarding life goals, and development of a personal care plan.The client was assigned “Identifying and Handling Triggers” in the Adult Psychotherapy Homework Planner (Jongsma).The client was assigned “Recognizing the Negative Consequence of Impulsive Behavior” in the Adult Psychotherapy Homework Planner (Jongsma).
25 Use Cognitive Therapy Techniques (25)Cognitive therapy techniques were used to identify, challenge and, change cognitive appraisals that may trigger his/her/their elevated or depressive mood.The client was reinforced for his/her/their greater insight into his/her/their cognitive appraisals.
26 Assign Homework on Cognitive Biases (26)The client was assigned homework exercises in which he/she/they identified cognitive biases in appraising self, others, and the environment.The client was assigned “Journal and Replace Self-Defeating Thoughts” in the Adult Psychotherapy Homework Planner (Jongsma).The client was assisted in reviewing his/her/their insight regarding cognitive biases, and his/her/their successes were reinforced.The client was provided with corrective feedback toward improvement of his/her/their understanding of cognitive biases and alternatives.
27 Teach Coping and Relapse Prevention Skills (27)The client was taught coping and relapse prevention skills via cognitive-behavioral techniques.The client was taught about delaying impulsive actions, structuring and scheduling daily activities, keeping a regular sleep routine, avoiding unrealistic goals striving, and using relaxation procedures.The client was taught about identifying and avoiding episode triggers.
28 Conduct Family-Focused Treatment (28)The client and significant others were included in the treatment model.Family-Focused Treatment was used with the client and significant others as indicated in Bipolar Disorder: A Family-Focused Approach (Miklowitz and Goldstein).As family members were not available to participate in therapy, the Family-Focused Treatment model was adapted to individual therapy.
29 Assess and Educate About Aversive Communication (29)The family was assessed for the role of aversive communication in family distress and in the risk for the client's manic relapse.The family was educated about the role of aversive communication (e.g. highly expressed emotion) in developing greater family stress and in increasing the client's risk for manic relapse.The family displayed a clear understanding of the effects of aversive communication, and this was reinforced.The family was provided with remedial feedback, as they did not display a clear under- standing of the risk for relapse due to aversive communication.
30 Teach Communication Skills (30)Behavioral techniques were used to teach communication skills.Communication skills such as offering positive feedback, active listening, making positive requests for behavioral change, and giving negative feedback in an honest, respectful manner were taught to the client and family.Behavioral techniques were used to teach the family healthy communication skills.Education, modeling, role-playing, corrective feedback, and positive reinforcement were used to teach communication skills.
31 Teach Problem-Solving Skills (31)Behavioral techniques such as education, modeling, role-playing, corrective feedback, and positive reinforcement were used to teach the client and family problem-solving skills.Specific problem-solving skills were taught to the family, including defining the problem constructively and specifically, brainstorming options, evaluating options, choosing options, implementing a plan, evaluating the results, and reevaluating the plan.Family members were asked to use the problem-solving skills on specific situations.The family was reinforced for positive use of problem-solving skills.The family was redirected for failures to properly use problem-solving skills.
32 Assign Problem-Solving Homework (32)The client and family were