Mentorship Model

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Medication Compliance

Medication Compliance

Week 1: Initial Assessment

Defining Objectives

What do you want the client to reflect on in this first session? 

  • Client will be able to recognize the relationship between his current use or misuse of medication and its impacts on key areas of functioning in his life
  • Client  will learn about the importance of his medication to his overall well being 
  • Client will identify and agree upon a method for tracking their compliance over the next week to report back on in the next session

Taking Action

How will you support reflection and goal-setting as they relate to medication?

  • Provider will assess the client’s motivation through the stages of change model and work to understand the client’s existing relationship with medication. Provider will tailor the psychoeducation provided to better align with the client’s current understanding
  • Provider will use motivational interviewing techniques like open ended questions, decisional balance and scaling questions to gauge client’s awareness of how his current use or misuse of medication is related to his satisfaction (or lack thereof) in other areas of his life
  • Provider will stay mindful of potentially stressful associations the client may have with a diagnosis or prescription, engage in strengths-based assessment, and offer unconditional positive regard and affirmation when addressing client’s current patterns
  • Provider will offer psychoeducation around the benefits of complying with clinical recommendations. Provider will be prepared to speak to the importance of the client’s medication in treating the symptoms he is experiencing and will provide psychoeducation to client around the risks and rewards of taking medication 
  • Provider will assess for barriers to medication compliance and identify one or more behavioral interventions that could help support medication compliance
Questions to Consider Resistant Client Corner
  • How does the client view and relate to his medication? Are there any underlying feelings of shame or embarrassment that may be contributing to avoidance?
  • Does the client’s medication come with any side effects that may explain behaviors in other areas? Have the side effects impacted the client in any other areas of his life?
  • How long has the client been taking (or not taking) prescribed medication?

Pro Tip: Don’t feel as though you are expected to overcome all resistance to taking a proper course of medication in the first session. In fact, this might discourage the client from sharing.

Instead, give the client space to share his feelings towards the medication he is taking, not taking, or misusing and validate his experience. Building trust will give you more credibility as you invite the client to make small changes

When to Check In

As you gather information about the client’s relationship to his medication regimen and treatment plan, keep an eye out for these signs that more support will be required before moving on in this domain:

  • Client reports significant disruptions in his daily life due to the side effects of prescribed medication
  • Client exhibits signs of intoxication or altered mental state during the session
  • Client appears to have easy or regular access to unprescribed medication

Week 2: Data Analysis

Defining Objectives

What data should the client be reporting? What changes have they noticed?

  • Client will report on his current medication compliance, observing the efficacy of what he had been asked to do by his provider in the previous week 
  • Client will fully assess existing barriers and be open to working collaboratively with provider to develop strategies for overcoming them  
  • Client will feel more confident in how adhering to his prescribed medication can improve the reported negative symptoms he is experiencing and drive positive changes in the areas in which he feels motivated

Taking Action

How can you help the client learn and adapt from the data they have gathered?

  • Provider will create the space for a discussion on the client’s current medication compliance and assess the efficacy of previous efforts to make changes or intervene in this area
  • Provider will develop a more comprehensive understanding of the barriers to medication compliance and will use MI to promote a collaborative approach to improving compliance through behavioral change in the coming week(s)
  • Provider will remain mindful of client’s state of change and use MI to continue to connect these proposed behavioral interventions to client’s reported motivations or desire to decrease negative symptoms
Questions to Consider Resistant Client Corner
  • How does the client’s reported compliance in the previous session line up with the data they are reporting?
  • Are there any changes you are noticing in the client’s attitude towards their medication?
  • What support(s) might this client need in order to adhere to their prescription guidelines more consistently?

To continue building trust, continue to emphasize data collection over behavioral changes. Share with the client that the goal is to get an accurate picture, not necessarily to change things right away.

If the client is reluctant to share any information about his medication habits, affirm that he has his right to privacy, ask more generalized questions like: how they make him feel, how well they seem to be working, and how well he is able to manage them.

When to Check In

Medication can be a sore subject for many people. As the client opens up and shares more about his relationship to his medication, he may reveal more about why he avoids or misuses the medication he has been prescribed. Watch out for these signs that a deeper examination might be beneficial:

  • Client displays a significant negative change in their affect or mood after taking their medication more consistently or any symptoms of withdrawal
  • Your client might be very direct about not following his prescription, not speaking to his psychiatrist, or not liking his psychiatrist.  Don’t get caught up in debating or challenging this behavior.  Believe that there is probably a “good reason” for him to be doing what he is doing, be curious, and seek to understand, even when it doesn’t seem like he’s making the right decision

Week 3: Making Adjustments

Defining Objectives

What changes can the client most readily implement in his medication compliance?

  • Client will continue to report on his current medication compliance, reflecting on what went well and what he hopes to improve upon
  • Client will be able to identify one tangible roadblock or obstacle that impacted his compliance over the preceding week as well as an action that he can take in the upcoming week to mitigate it 
  • Client will express greater openness to intervention and behavioral change in this area

Taking Action

  • Provider will continue to assess the efficacy of previous interventions, adjusting as needed
  • Provider will directly engage in supporting client’s medication compliance, including prompting in-home interventions in collaboration with provider when warranted or as a result of previous weeks ambivalence to comply
  • Provider will remain mindful of client’s state of change and use MI to continue to connect these proposed behavioral interventions to client’s reported motivations or desire to decrease negative symptoms
Questions to Consider Resistant Client Corner
  • What sorts of structures can you help the client implement to improve their compliance?
  • What is the primary driver of avoidance or misuse that you are noticing? For instance, is the client struggling with time management and missing doses or deliberately avoiding their medication?

Pro Tip: if you haven’t already, you should work to get a release of information signed so that you can freely speak with the client’s psychiatrist or prescribing physician

When to Check In

By this point, you and the client should hopefully be seeing progress. This could mean increased adherence, but it might also look like greater consistency in data collection or more openness to medication as a tool rather than a hindrance. Lack of forward progress of any kind is likely a sign that more support or adjustments will be required. Consider checking in if the client:

  • Refuses to track or attempt to improve their compliance in this area
  • Seems unable to identify any causes for their lack of compliance or recall previous efforts

Week 4: Lessons Learned

Defining Objectives

  • Client will continue to report on his current medication compliance, reflecting on what went well and what he hopes to improve upon
  • Client will be able to report on the importance of medication compliance as it relates to mitigating negative symptoms or accomplishing his desired goal or outcome. Client will be be able to summarize his past behaviors and the changes he is working to implement in order to solidify learning and demonstrate greater self-awareness

Taking Action

  • Provider will encourage the client to step back and consider the broader story of his diagnosis, treatment history, and plan for the future
  • Provider will engage client in reflective discussion around growth and changes, taking time to spotlight any connections to the client’s stated goal or motivation
  • Provider will elicit change talk and commitment from the client by engaging in MI to challenge client to build future plans based on previous results
  • Provider will ask the client to summarize the interventions that have taken place, the challenges he has overcome, and the successes he has experienced to ensure comprehension
Questions to Consider
  • How well has the client understood the work he has engaged in? Is the client internalizing lessons around medication compliance in a way that will allow him to apply those lessons on his own?
  • How does the client think about their own efforts and ability to change?
  • How will you and the client respond to a slip-up or regression in his medication compliance? What factors in the client’s life are most likely to trigger a step back?

When to Check In

If the client reaches session 4 having made little meaningful progress, this is a great juncture to re-assess the client’s capacity for self-initiated changes outside of session time. The following indicators may be signs that the client’s overall treatment goals may need to be revisited in concert with your supervisor and any other members of the client’s team:

  • If the client continues to display opposition to discussing or addressing medication as a part of his treatment
  • If the client’s mental health stability seems to continue to fluctuate and it is presumed that medication adherence or lack thereof is contributing to this fluctuation 
  • If you’ve struggled to gain consent to speak with the client’s psychiatrist and/or have struggled to connect with the psychiatrist upon gaining consent.