The idea behind the care2 is that people with multiple issues, complex problems, and high risk for acting out in ways that harm self or others, usually need interventions that are multi-modal and address their issues in a way that is more specific to each person’s individual needs. The more complex the issues, the more “multi-modal” the intervention needs to be. So, for example, a person with just a moderate depression could do very well with the combination of medication and (often) cognitive behavioral therapy (evidence based practice). 

Let’s suppose that you are seeing a child with depression and mom has depression. That means that there is probably a genetic base to the depression. Traditional therapy is good for this. This often means individual therapy and medication management. However, let’s suppose that mom’s depression is not treated and the child’s depression is due, in part, to mom’s untreated depression, domestic violence in the home or substance abuse by dad, in addition to a genetically based mood disorder. Then, the intervention needs to be more complex. Now you may need trauma therapy, skill building, family therapy and maybe mom needs her own therapy in addition to finding a way to stop the domestic violence at home. Maybe dad needs substance abuse treatment. Treatment is now very complicated. And yes, I do know that parents may not be willing to get their own treatment, but that is why you build a relationship with the parents around their child’s therapy before you tackle their own issues. As we all know, you will convince some and not others.

The CARE2 is intended to give you a way to organize the presenting problem(s) and treatment plan to meet the needs of the client and his family where appropriate. You don’t need it if your client is dealing with just regular old genetic depression (ADHD, adjustment disorder, etc) and nothing else is going on – probably half your caseload, depending on where you work. Now, what about the other half of your caseload? You need an organized way to assess the types of problems the client (and often his/her family) is having and what interventions are going to be applied. I have tried to save you some time and trouble by giving you an easy way to organize your assessment of need and plan of action by giving you the CARE2. It is based on my 30 years of experience and research. I have also tried to save you time and trouble by researching evidence based practice for the majority of problems we generally see. I certainly think many of you know most of the information I have gathered. But just in case you missed something, the CARE2 provides a way to find information, handouts, etc. that can help you do your job. We are adding to the intervention list and it can only get better and better.

Additionally, clients with more complex treatment needs require more services per week. The CARe2 gives you a way to determine which clients should be receiving a higher level of care. You do this by using the chart at the end that indicates the level of care that is needed.

As for risk of violence and sexual offending, you need to know who is at risk for offending in the community and what level of services will keep them at lower risk for re-offending. That is another function of the CARE2. When your client has a risk of harming others in the community and especially if he has been referred by the legal system, community safety is also your client. This means those at risk MUST have the appropriate type and level of treatment to reduce their risk of offending in the community. You must know what level of care is needed for community safety and then apply it. The CARE2 has the highest rate of correctly differentiating those who are dangerous to the community from those who are not (90% accuracy). Clinical judgment of the therapist of a client has the lowest rate for correctly classifying who is dangerous to the community and who is not (48% accuracy). This has been proven in years of research.