From Evidence-based Practice to Cultural Change: Steps to Successful Implementation

July 11, 2017 By scottdm Leave a Comment

Chances are your are carrying a smartphone–maybe you’re even reading this post on your Android or Iphone! One thing I’m almost certain of is that the device you own–can’t live without–is not a Nokia.

The nearly complete absence of the brand is strange. Not long ago, the company dominated the mobile phone market. At one time, seventy percent of phones in consumers’ hands were made by Nokia.

“And then,” to quote Agathe Christie, “there were none!”

Today, Nokia’s global market share is an anemic 3 %.

What happened? Here, the answer is no mystery. It was not a lack of position, talent, innovative ideas, or know-how. Rather, the company failed at implementation. Instead of rapidly adapting to changing conditions, it banked on its brand name and past success to carry it through. Vague considerations trumped concrete goals. Spreadsheets and speeches replaced communication, consensus-building, and commitment. The moral of the story? No matter how successful the brand or popular the product, implementation is hard.

Nowhere is this truer than in healthcare. Change is not only constant but accelerating. Each week, hundreds of research findings are published. Just as frequently, new technologies come online. All have the potential to do good, to improve the quality and outcome of treatment.

Research to date, for example, documents that seeking ongoing, formal feedback from those receiving behavioral health services as much as triples the effectiveness of the care offered, while simultaneously cutting the rate of drop out by 50%, and decreasing the risk of deterioration by 33%. Enough evidence has amassed to warrant the approach–known as, “Feedback Informed Treatment”–being listed on the National Registry of Evidence-Based Programs and Practices.

Any yet, despite the massive amount of time and resources, agencies and practitioners devote to staying “up-to-date,” most implementation efforts struggle, and far too many fail–according to the available evidence, about 70-95% (a figure equivalent to the number of start-up businesses in the United States that belly up annually).

In their chapter in the new book, Feedback Informed Treatment in Clinical Practice, Randy Moss and Vanessa Mousavizadeh, provide step-by-step instructions, based on the latest research and real-world experience, for creating an organizational culture that supports implementation success. Recently, I had a chance to talk with Randy about the chpater. Whether you’ve got the book or not, I think you’ll find the knowledge and experience in the video below, helpful:

In the meantime, while on the subject of implementation, here’s a cool, electronic version of a tool you can use to track the progress of your efforts. Known as the “Fidelity Readiness Index and Fidelity Measure” or FRIFM, it helps identify where you and your organization are in the process as well as identify and set goals in order to remain on track (it’s one of the reasons reviewers at SAMHSA gave our application perfect marks for implementation support). Thanks to my Danish colleague, Rasmus Kern for developing and making it available. By the way, the program contains both English and Danish versions. Click here to download.

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

More Deliberate Practice Resources…

May 30, 2017 By scottdm 1 Comment

Last week, I blogged about a free, online resource aimed at helping therapists improve their outcomes via deliberate practice. As the web-based system was doubling as a randomized controlled trial (RCT), participants would not only be accessing a cutting-edge, evidence-based protocol but also contributing to the field’s growing knowledge in this area.

To say interest was high, doesn’t even come close. Within 45 minutes of the first social media blast, every available spot was filled–including those on the waiting list! Lead researchers Daryl Chow and Sharon Lu managed to open a few additional spots, and yet demand still far exceeded supply.

I soon started getting emails. Their content was strikingly similar–like the one I received from Kathy Hardie-Williams, an MFT from Forest Grove, Oregon, “I’m interested in deliberate practice! Are there other materials, measures, tools that I can access and start using in my practice?”

The answer is, “YES!” Here they are:

Resource #1. Written for practicing therapists, supervisors, and supervisees, this volume brings together leading researchers and supervisors to teach practical methods for using deliberate practice to improve the effectiveness of psychotherapy.

Written for practicing therapists, supervisors, and supervisees, this volume brings together leading researchers and supervisors to teach practical methods for using deliberate practice to improve the effectiveness of psychotherapy.

Twelve chapters split into four sections covering: (1) the science of expertise and professional development; (2) practical, evidence-based methods for tracking individual performance; (3) step-by-step applications for integrating deliberate practice into clinical practice and supervision; and (4) recommendations for making psychotherapist expertise development routine and expected.

“This book offers a challenge and a roadmap for addressing a fundamental issue in mental health: How can therapists improve and become experts? Our goal,” the editors of this new volume state, ” is to bring the science of expertise to the field of mental health. We do this by proposing a model for using the ‘Cycle of Excellence’ throughout therapists’ careers, from supervised training to independent practice.”

The book is due out June 1st. Order today by clicking here: The Cycle of Excellence: Using Deliberate Practice to Improve Supervision and Training

Resource #2: The MyOutcomes E-Learning Platform

The folks at MyOutcomes have just added a new module on deliberate practice to their already extensive e-learning platform. The information is cutting edge, and the production values simply fantastic. More, MyOutcomes is offering free access to the system for the first 25 people who email to support@myoutcomes.com. Put the words, “Responding to Scott’s Blogpost” in the subject line. Meanwhile, here’s a taste of the course:

Resource #3:

Last but not least, the FIT Professional Development Intensive. There simply is no better way to learn about deliberate practice than to attend the upcoming intensive in Chicago. It’s the only such training available. Together with my colleague, Tony Rousmaniere–author of the new book, Deliberate Practice for Psychotherapists: A Guide to Improving Clinical Effectiveness, we will help you develop an individualized plan for improving your effectiveness based on the latest scientific evidence on expert performance.

We’ve got a few spaces left. Those already registered are coming from spots all around globe, so you’ll be in good company. Click here to register today!

OK, that’s it for now. Wishing you all the best for the Summer,

Scott D. Miller, Ph.D.

Can you tell me what I’m supposed to do? A free deliberate practice resource

May 17, 2017 By scottdm 5 Comments

You’ve read the studies. Maybe you’ve even attended a training.

Deliberate practice is the key to improving your effectiveness as a psychotherapist. Top performing therapists devote twice as much time to the process. More, when employed purposefully and mindfully, the outcomes of average practitioners steadily rise over time.

But what exactly is a therapist supposed to practice in order to improve? It’s a question that comes up within minutes of introducing the subject at my workshops–one my colleagues, Daryl Chow, Sharon Lu, Geoffrey Tan, and I have been working on answering.

Just over three years ago, we published preliminary results of a study documenting the impact of individualized feedback and rehearsal on mastering difficult conversations in psychotherapy. Therapists not only improved their ability to respond empathically under especially challenging circumstances, but were able to generalize what they learned to new and different situations.

Now, the entire deliberate practice program has gone online. In light of the research, it’s been both expanded and refined. There’s no need to leave the comfort of your home or office and, best of all, it’s free.

Sign up to participate and you will learn what to practice as well as receive feedback specifically tailored to your professional development. You will also be helping the field as the program is part of a research study on deliberate practice.

****UPDATE! UPDATE! UPDATE! UPDATE!****

Response to the above post has been overwhelming! Despite the size of the study, all of the available spots filled within 45 minutes. I’ve been corresponding with the chief researcher, Daryl Chow, Ph.D.. He tells me 15 more spots have just been added. If you want to participate, click here. The password is: DCT. If all of the spots are taken, please add your name to the wait list.

One more opportunity: join me in Chicago for the upcoming two-day intensive on deliberate practice. For more information or to register, click on the icon below my name. As with the online program, we are nearly full, so register today.

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence