September 7, 2010
Chicago, Illinois USA

I can't believe it. Summer is over. Kids are back in school. And the International Center for Clinical Excellence (ICCE) is celebrating its one year anniversary!  Time passes so quickly.

On August 24th, 2009, I blogged about the creation of a web-based community of clinicians using the latest Web2.0 technology where participants could learn from and share with each other.  The ICCE website and community was officially launched the following December at the Evolution of Psychotherapy conference.  In a few short months, ICCE had become the largest, international online community of professionals, researchers, and policy makers working to improve the quality and outcome of behavioral health services.

So much more has happened over the last year, including the development and standardization of a training package for clinicians and agencies interested in streamlining the implementation of CDOI, the annual "training of trainers" conference, and much more.  Take a look at the video and see for yourself, and if you are not already a member, join us online today at: www.centerforclinicalexcellence.com. 

A few days ago, I received an email from Shirley Galdys, the Associate Director of the Crawford-Marion Alcohol and Drug/Mental Health Services Board in Marion, Ohio.  Back in January, I blogged about the steps the group had taken to deal with the cutbacks, shortfalls, and all around tough economic circumstances facing agencies in Ohio.  At that time, I noted that the dedicated adminsitrators and clinicians had improved the effectiveness and efficiency of treatment so much by their systematic use of CDOI that they were able to absorb cuts in funding and loss of staff without having to cut services to their consumers. 

Anyway, Shirley was writing because she wanted to share some additional good news.  She'd just seen an advance copy of the group's annual report.  "Since we began using CDOI over two years ago," she wrote, "board level compaints and grievances have decreased!" 

In the past, the majority of such complaints have centered on client rights.  "Because of CDOI," she continued, "we are making more of an effort to explain to people what we can and cannot do for them as part of the 'culture of feedback'....we took a lot for granted about what people understaood about behavioral health care prior to CDOI."

The Crawford-Marion Alcohol and Drug/Mental Health Services Board is now into the second full year of implementation.  They are not merely surviving, they are thriving!  In the video below, directors Shirley Galdys, Bob Moneysmith, and Elaine Ring talk about the steps for a successful implementation. 

"Hope Transcends" was the theme of the 39th Annual Summer Institute on Substance Abuse and Mental Health held in Newark, Delaware this last week.  I had the honor of working with 60+ clinicians, agency managers, peer supports, and consumers of mental health services presenting a two-day, intensive training on "feedback-informed clinical work."  I met so many talented and dedicated people over the two days and even had a chance to reconnect with a number of folks I'd met at previous trainings-- both at the Institute and elsewhere.

One person I knew but never had the privlege of meeting before was psychologist Ronald Bassman.  A few years back, he'd written a chapter that was included in my book, The Heroic Client.  His topic at the Summer Institute was similar to what he'd written for the book: harmful treatment.  Research dating back decades documents that approximately 10% of people detriorate while in psychotherapy.  The same body of evidence shows that clinicians are not adept at identifying: (a) people who are likely to drop out of care; or (b) people who are deteriorating while in care.

Anyway, you can read about Ron on his website or pick up his gripping book A Fight to Be.  Briefly, at age 22 Ron was committed to a psychiatric hospital.  Over the next several years, he was diagnosed with paranoid schizophrenia and forcefully subjected to a series of humiliating, painful, degrading and ultimately unhelpful "treatments."  Eventually, he escaped his own and the systems' madness and became a passionate advocate for improving mental health services.  His message is simple: "we can and must do better."  And, he argues persuasively, the process begins with building better partnerships with consumers.

One way to build bridges with consumers is routinely seeking their feedback regarding the status of the therapeutic relationship and progress of any services offered.  Indeed, the definition of "evidence-based practice" formally adopted by the American Psychological Association mandates that the clinician "monitor...progress...[and] If progress is not proceeding adequately...alters or addresses problematic aspects of the treatment (e.g., problems in the therapeutic relationship or the implementation of the goals of treatment)" (pp. 276-277, APA, 2006).  Research reviewed in detail on this blog documents significant improvement in both retention and outcome when clinicians use the Outcome and Session Rating Scales to solicit feedback from consumers.  Hope really does transcend.  Thank you Ron and thank you clinicians and organizers at the Institute.

And now, just for fun.  Check out these two new videos:

It's an idea that makes intuitive sense but is simultanesouly unappealing to most people. I, for one, don't like it.  What's more, it flies in the face of the "self-esteem" orientation that has dominated much of educational theory and practice over the last several decades.  And yet, research summarized in a recent issue of Scientific American Mind is clear: people learn the most when conditions are arranged so that they have to make mistakes.   Testing prior to learning, for example, improves recall of information learned after failing the pre-test regarding that same information.  As is well known, frequent testing following learning and/or skill acquisition significantly enhances retention of knowledge and abilities.  In short, getting it wrong can help you get it right more often in the future. 

So, despite the short term risk to my self-esteem, "error-centric learning" is an evidence-based practice that I'm taking to heart.  I'm not only applying the approach in the trainings I offer to mental health professionals--beginning all of my workshop with a fun, fact-filled quiz--but in my attempts to master two completely new skills in my personal life: magic and learning to play the ukelele.  And if the number of mistakes I routinely make in these pursuits is a reliable predictor of future success, well...I should be a master ukelele-playing magician in little more than a few days.

Enough for now--back to practicing.  Tonight, in my hotel room in Buffalo, New York, I'm working on a couple of new card tricks.  Take a look at the videos of two new effects I recorded over the weekend.  Also, don't miss the interview with Cindy Voelker and John Catalino on the implementation of CDOI at Spectrum Human Services here in Buffalo. 

    Brendan Madden   Scott D. Miller   Jeffrey K. Zeig

A little over month ago, I blogged about how the outcome and session rating scales were originally conceived of and developed.  A few days prior to that, I wrote about where the whole idea of using measures to solicit feedback had started.  In both instances, my teachers and supervisors played a significant role. Immediately following a two day workshop I'd given in Israel, psychologist Haim Omer suggested developing a visual analog scale that could be used in lieu of the longer Outcome Questionnaire 45.2--an idea that literally changed the entire arc of my professional career.  Drs. Lynn Johnson and Michael Lambert--a supervisor and professor I met and worked with as a graduate student--were the first to pioneer feedback-informed treatment (FIT).  Some twenty plus years into my career, I remain in contact with both, calling, seeking input, discussing ideas, and soliciting feedback. 

"Professional coaches," says the noted "expert on experts" K. Anders Erickson, "...play an essential role in guiding...future experts in a safe and effective manner" (p. 698).   Needless to say, I've been very fortunate to have such visionary mentors.  One more story.

In 1984, I wrote a letter to Dr. Jeffrey K. Zeig, the director of the Milton H. Erickson Institute.  I was in my second year of a Ph.D. program in psychology and, like many graduate students, dead broke.  While taking a course on hypnosis as part of my studies, I'd become interested in the work of Milton Erickson. 

"I'd like to learn more," I wrote at the time, "Would it be possible for me to visit the Institute, watch some videos and have a chance to talk with you?"  I wasn't too far away.  I could drive to Phoenix where the Institute was located.  I could even arrange to stay with friends to save money.  "Dr. Zeig," I continued, "I'm a graduate student and don't have much money, but I'd be willing to do some work in kind."  I'd pasted mailing labels on thousands of brochures for the local hypnosis and therapy organizations, for example, in exchange for being able to attend professional continuing education events.  "I'll vacuum and clean the office, wash vehicles, do filing.  Whatever might be helpful to you or the Institute."
 
Within a couple of weeks, an envelop from the Milton H. Erickson Institute arrived.  In it was a letter that was brief and to the point.  "Please call me," it said, and was signed Jeffrey K. Zeig, Ph.D.  Needless to say, I called straight away.  We chatted for a few minutes.  He told me that I was welcome to visit the Institute, watch videos, talk with some of the staff and even spend some time with him.  And then he asked, "Do you think you could afford five dollars?"  I was floored. 

Ever since meeting him on that hot summer day in Phoenix, he's been an important teacher and mentor.  It's particularly noteworthy that whenever we talk--by phone, email, or in chance meetings on airplanes while criss-crossing the globe--he invariably asks, "What are you learning?"  And then he listens, intently.  

Last week, we were catching up on the phone and Jeff told me that his long-held desire to open an international psychotherapy training and reseach facility had finally been fulfilled.  Briefly, The Institute for Applied Therapeutic Change is a real clinic where professionals and students can learn the latest in behavioral healthcare from leading experts in the field and while working with real clients (click on the text above for the complete press release).  

"I can hardly wait to attend some of the events," I said.  "And when are you available to teach?" he responded.   Stunned again.  I'm so fortunate and can hardly wait to participate in the Institute activities as both a presenter and student.  Stay tuned to the Foundation website for more details!