Faith Johnson CNS 786: Assignment 5.

Case Model Application

After the initial call from the QC outpatient center requesting my services, I chose to

apply a cognitive-behavioral consultee consultation model. Being that the disruptive behaviors of

clients was suspected to correlate with a multitude of factors, including socioeconomic status and

a lack of knowledge and confidence, I chose to focus on the internal and external events

influencing the behaviors of clients. Similarly, clinical staff will be trained on how to effectively

communicate with disruptive clients.

Description of Problem

In the initial stage of consultation, I sought to understand the problem through the eyes of

the consultee. During this stage, the consultee and I were able to clearly identify and defy the

problem. Once we identified the problem, we discussed key functions for my being there, one of

which was that I “help the consultee make positive changes in the client’s environment and in the

client’s behavior” (Dougherty, 2014, p. 216). Discussing this function with Mrs. Green, we were

then able to discuss contributing factors to the problem. Mrs. Green and I were able to come to

an agreement on defining the problem as communication barriers between clinical staff and

clients as well as misunderstandings between the clients’ internal and external controls, and

unawareness of how to cope with and manage disruptive behaviors.

Analyzing the Problem

Following the identification of the problem, the consultee and I worked to deeply analyze

the problem to prepare for the implementation of treatment. To begin, I asked the consultee to

conduct herself as she would on any given day. Over a span of 3 days, I was able to observe the

consultee demonstrate her skills with clinical staff and client’s. In order to properly implement a

set of behaviors, “the consultant observes the consultee’s current use of behavior changing
Faith Johnson CNS 786: Assignment 5.1

skills” (Russell, 1978, p. 348). By observing these skills, I was able to identify the effects of the

consultee’s behaviors on the actions of the clients. By doing so, this provided the consultee and I

with a clear analyzation of the problem, which lead us into implementing a treatment plan.

Solution Discourse

Once the problem was identified, defined, and analyzed, and before implementing a

treatment plan, I asked the client to think of and provide me with solutions she thinks would help

solve the problem. Before beginning, I asked her to consider the following: (1) behaviors of

herself that function as consequences problematic behaviors to clients, (2) behaviors of the

clients that function as consequences to herself, and (3) behaviors of others in the center (i.e.

peers, supervisors, etc.) that may function as reinforcement/punishment to herself in regard to the

new behaviors she will learn (Russell, 1978, p.348). After considering all of the above, the

consultee set the following solutions/goals:

1. Implement a skills workshop for all clinical staff to remain cognizant of mechanisms to

use with disruptive clients

2. Implement a clinical approach to increase attendance and openness to groups

3. Improve client behaviors by modifying outside environmental stressors

4. Increase personal knowledge of cognitive behavioral communication strategies to ensure

implementation and continued maintenance

Intervention

To select appropriate intervention methods, I researched methods of persuading clients to

seek services as well as responses to treatment and treatment duration. Making sure I took into

consideration the potential feelings of clients was important in developing a plan that caters to

them as much so the consultee. “Satisfied patients tend to take better advantage of services,
Faith Johnson CNS 786: Assignment 5.1

increasing treatment compliance and patient recovery” (Fortin, Cao, & Fleury, 2018). With this

in mind, I sought to increase satisfaction throughout the entire system (clinical staff,

administrative staff, clients, etc.). I also wanted to be culturally sensitive and cost-effective in my

intervention approaches. As I considered various components and contributing factors, we

collaborated to conclude that the following solutions may help increase client satisfaction and

participation:

1. Offer an incentive to all clients who participate in their assigned sessions without

disruption

2. Have clinical staff frequently check-in with uncooperative/disruptive clients via

telephone to build rapport (i.e. once per week outside of group)

3. Regulate treatment by offering clients flexibility in length of treatment; adding a sense of

control versus a sense of being controlled

In regard to the third solution, Barkham el al (2006) offers the following remark: “Level of

improvement and treatment duration are mutually regulated so that treatments tend to end when

clients have improved to a degree or a level that is good enough.” Giving clients a sense of

control over their care, while remaining clinically inclined to alter treatment as needed, could

positively impact the degree to which clients are voluntarily more inclined to continue treatment.

We also sought interventions to address any and all possibilities of barriers with all staff

members. The consultee felt that weekly staff meetings were allowing communication to flow

smoothly amongst staff, however, after reviewing qualitative data from staff, we were able to

reveal that clinical staff felt an urgency for additional communication and trainings. After

reviewing this information, we came up with the following interventions:

Faith Johnson CNS 786: Assignment 5.1

1. Implement an additional meeting for clinical staff only once per week to address any

additional clinical concerns

2. Additional trainings will be accessible on an as needed basis and will require, at

minimum, yearly re-certifications

3. All staff will be required to learn techniques on how to talk to and minimize disruption

amongst uncooperative clients

Offering resources and trainings to all staff members will assist in reducing the amount of

disruption to all clients. Clinical staff and administrative staff should be receptive to adding

techniques to improve the subsequent level of functioning of all clients (Toban, 1970).

Assessment

To follow the improvements and results of the intervention plan, I asked for updates

through weekly phone calls as well as a series of scaling questions. All progress was carefully

reviewed, and adjustments were made as necessary. To continue assessing progress, I suggested

that the consultee continue offering an open space for feedback, concerns, and suggestions from

staff. Continuing to allow staff members an opportunity to remain open and express areas of

improvement will not only keep all members in correlation with one another, but it will also

continue to construct a receptive, valued environment.

Termination

Throughout the consultation process, I fostered a consultant-consultee relationship that

encouraged the consultee to implement the process independently. During our remaining two

weeks together, I encouraged the consultee to share the proposed solutions with staff members

during the weekly all-staff meetings. I wanted to allow time for staff to process the proposed

solutions and present with any questions or concerns before the end of consultation. By modeling
Faith Johnson CNS 786: Assignment 5.1

this approach, I was able to create a sense of accountability and trustworthiness for the consultee.

Although there is a potential for these interventions to be unsuccessful, weekly staff meetings

over the next 6-12 months should help provide additional data to readjust.

Rationale

I chose to implement a cognitive-behavioral approach because it allowed me an

opportunity to focus on the behaviors of clients, define these behaviors, set concrete goals,

collect data, and develop a plan based upon the data collected and the suspected contributing

factors to the disruptive, uncooperative behaviors of clients. I also wanted to spend a large

amount of time on behavior change and the influences that can affect behaviors, since I feel that

it is crucial to acknowledge, understand, and work around restructuring the minds and behaviors

of these clients. Likewise, with a behavioral approach, I would be able to create approaches that

were client-centered and allow clients to partake in their own treatment.

Faith Johnson CNS 786: Assignment 5.1

References

Barkham, M., Connell, J., Stiles, W.B., J.N.V., Margison, F., Evans, C., & Mellor-Clark, J.

(2006). Dose-effect relations and responsive regulation of treatment duration: The good

enough level. Journal of Consulting and Clinical Psychology, 74(1), 160-167. https://doi-

org.go.libproxy.wakehealth.edu/10.1037/0022-006X.74.1.160

Dougherty, A.M. (2014). 6th edition. Psychological consultation and collaboration in school and

community settings. Belmont, CA: Brooks/Cole.

Fortlin, M., Cao, Z. & Fleury, M.J. (2018). A typology of satisfaction with mental health services

based on Andersen’s behavioral model. Social Psychiatry and Psychiatry Epidemiology,

53, 587-595. https://doi.org/10.1007/s00127-018-1498-x

Russell, M.L. (1978). Behavioral consultation: Theory and process. Personnel & Guidance

Journal, 56(6), 346. https://doi-org.go.libproxy.wakehealth.edu/10.1002/j.2164-

4918.1978.tb04645.x

Toban, E. (1970). Professional and nonprofessional mental health workers’ modes of persuading

clients to seek institutional services. Journal of Consulting and Clinical Psychology,

34(2), 177-180. https://doi-org.go.libproxy.wakehealth.edu/10.1037/h0029041