What articles have 140,000 of your colleagues read to improve their practice?


Each week, I upload articles to the web about how to improve effectiveness. There are a lot to choose from, but here are the top ones read by behavioral health professionals around the world:

This is the latest version of the most widely-read upload on the site. It summarizes all of the available research about using feedback to improve retention in and outcome of care, including studies using the ORS and SRS.

A short, fun article that highlights the evidence-based steps for improving one’s effectiveness as a behavioral health provider. Feedback, it turns out, is not enough. This article reviews the crucial step that makes all the difference.

Finally, here’s a link to a simple-to-use tool for interpreting scores on the ORS:

That’s it for now. Best wishes in your work. Stay in touch.

Scott Miller (Evolution 2014)
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

Advanced FIT Training (2015)
Registration is open for the Advanced Training in Feedback-Informed Treatment (FIT). Learn how to integrate this SAMHSA certified evidence-based practice into your work or agency. We promise you three comprehensive, yet fun-filled days of learning together with colleagues from around the world.


Something New

something new ICCE

Actually, it’s more accurate to say, “Everything is new!”  The International Center for Clinical Excellence is coming up on its fifth birthday!   Since its launch in 2010, the ICCE has become the largest, online community of behavioral health practitioners and researchers in the world.  To celebrate, we are launching an entirely new web platform.   All the features you’ve come to expect remain—the discussions with colleagues, the document library, the commercial free atmosphere.   At the same time, everything has been streamlined, made faster, easier, and more intuitive.  Log in today!   Join a forum.  Start a conversation.  Share a presentation or paper with others. As you can see my own website has been completely redone.  The “Top Performance” blog is now front and center.  Plug in your email address and you’ll get regular updates regarding how to improve your effectiveness.   As always, my articles, books, video and audio materials are available with the click of a button.  You can also find an up-to-date schedule of workshops and intensive trainings in feedback informed treatment (FIT).

PCOMS Speaking of FIT, have you visited the www.whatispcoms.com website?  It’s the official website for ICCE’s Partners for Change Outcome Management System.  Here you can learn everything you need to know to get started using the feedback process documented to improve effectiveness and approved by SAMHSA as an evidence-based practice.  What’s new?  Thanks to ICCE members around the world, the site is available in five different languages, including: English, Dutch, Swedish, Norwegian, and Danish.   Until next time!

Using Feedback Informed Treatment to Improve Medication Adherence and Reduce Healthcare Costs


Medication adherence is a BIG problem.  According to recent research, nearly one-third of the prescriptions written are never filled.  Other data document that more than 60% of people who actually go the pharmacy and get the drug, do not take it as prescribed.

What’s the problem, you may ask?  Inefficiency aside, the health risks are staggering.  Consider, for example, that the prescriptions least likely to be filled are those aimed at treating headache (51 percent), heart disease (51.3 percent), and depression (36.8)percent).

medication adherence

When cost is factored into the equation, the impact of the problem on an already overburdened healthcare system becomes even more obvious.  Research indicates that not taking the medicines costs an estimated $290 billion dollars per year–or nearly $1000 for every man, woman, and child living in the United States.  It’s not hard to imagine more useful ways such money could be spent.

What can be done?

Pringle_Photo 2013

Enter Dr. Jan Pringle, director of the Program Evaluation Research Unit, and Professor of Pharmacy and Therapeutics at the University of Pittsburgh. As I blogged about back in 2009, Jan and I met at a workshop I did on feedback-informed treatment (FIT) in Pittsburgh.  Shortly thereafter, she went to work training pharmacists working in a community pharmacy to use the Session Rating Scale ([SRS] a four-item measure of the therapeutic alliance) in their encounters with customers.

It wasn’t long before Jan had results.  Her first study found that administering and discussing the SRS at the time medications were dispensed resulted in significantly improved adherence (you can read the complete study below).

She didn’t stop there, however.


Just a few weeks ago, Jan forwarded the results from a much larger study, one involving 600 pharmacists and nearly 60,000 patients (via a special arrangement with the publisher, the entire study is available by clicking the link on her publications page of the University website).

Suffice it to say that using the measures, in combination with a brief interview between pharmacist and patient, significantly improved adherence across five medication classes aimed at treating chronic health conditions (e.g., calcium channel blockers, oral diabetes medications, beta-blockers, statins, and renin angiotemsin system antagonists).  In addition to the obvious health benefits, the study also documented significant cost reductions.  She estimates that using the brief, easy-to-use tools would result in an annual savings of $1.4 million for any insurer/payer covering at least 10,000 lives!

Prior to Jan’s research, the evidence-base for the ORS and SRS was focused exclusively on behavioral health services.  These two studies point to exciting possibilities for using feedback to improve the effectiveness and efficiency of healthcare in general.

The tools used in the pharmacy research have been reviewed and deemed evidence-based by the Substance Abuse and Mental Health Services Administration.

PCOMSLogoKnown as PCOMS, detailed information about the measures and feedback process can be found at www.whatispcoms.com.  It’s easy to get started and the measures are free for individual healthcare practitioners!


Applying Feedback-Informed Treatment in Diverse Settings around the World

FIT TOT 2014 Liz and SusanneIMG-20110801-00045Norwegian friends at AI 2014

Honestly, I don’t know why I hadn’t noticed it before.  It’s not the first time it happened.  Last week, the ICCE held the “Training of Trainers” and “FIT Implementation” intensive trainings in Chicago, Illinois (USA).  Participants came from all around the world–from the northern-most parts of Alaska to the southern tip of New Zealand.  Geographic diversity aside, what really struck me was the many different clinical settings and populations where feedback-informed treatment (FIT) was being used to improve the quality and outcome of behavioral health services.

Practitioners are applying FIT with adults, adolescents, children, and families being treated in inpatient, outpatient, residential, in-home, and outreach settings for problems ranging from anxiety to early psychosis intervention.  Together with my co-teachers, Danish psychologist Susanne Bargmann, Dutch psychologist Liz Pluut, and ICCE Community Manager Cynthia Maeschalck, we worked, played hard, and learned a great deal.  I’ve pulled together a brief video to give you a sense of the energy and excitement.  I think you’ll be surprised…

Need more information about FIT?  Visit the official website: www.whatispcoms.com.  There you’ll find everything you need: brief video introduction, the empirical support, and a download link for the measures and additional resources.

By the way, registration is now open for the March 2015 “Advanced FIT” and “FIT Supervision” Intensives.  Feel free to e-mail me at info@scottdmiller.com with any questions.  As indicated in the video, the trainings fill up about 3 months in advance so register as soon as possible.

See you in March.

Scott Miller Headshot


P.S.:  Want to watch something fun?  Take a look at this video about improving one’s skills in listening, influence, and suggestion.  Be sure and leave a comment!

Want to be more effective? Point North!

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In June, I spent several days in the air traveling to and from Perth, Australia for a conference.  Too tired to read anymore, I turned on the video system and began watching a program from the Discovery Channel about the North American red fox. 

red fox

The furry little creatures were shown hunting rodents hidden under three feet of snow.  Three feet!  Up in the air the foxes would hop, thrusting their noses deep into the drifts.  Most of the time, they came up with nothing.  That is, unless they were facing north.  Then the odds changed considerably.  Seventy-five percent of the time, the fox was guaranteed a meal.  Scientists believe the animal uses the planet’s magnetic field to more accurately calculate and plot it’s trajectory–the same principle as the GPS in your car.  Watch the video.  It’s incredible.

In a similar way, the odds of successful treatment increase considerably when clinicians incorporate feedback into their work.  Asking consumers to assess their progress and the quality of the therapeutic relationship is the “North Pole” of behavioral health services.  Available evidence documents that when providers ask for and accommodate such feedback, dropout and deterioration rates plummet, and effectiveness doubles.  Without it, the same body of evidence shows that likelihood of recovery for consumers is about 15-20%, roughly equivalent to foxes who hunt pointing in the wrong direction.

The process, known as Feedback-Informed Treatment (FIT), is being used around the globe to improve the quality and outcome of therapy.  It’s also listed on SAMHSA’s National Registry of Evidence-Based Programs and Practices.

I have a brand new DVD demonstrating how to introduce, administer, and deal effectively with the feedback consumers provide.  It was filmed live at the most recent Evolution of Psychotherapy Conference.  Thanks to the Erickson Foundation, for a limited time, you can get it here for 29.95 (that’s 50% off the regular price).

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More information about FIT is available at: www.whatispcoms.com.  You can also access the free outcome and alliance tools there.  Gotta go.  I’m re-arranging my office furniture…