Using feedback to guide and improve the quality and outcome of behavioral health services is growing in popularity. The number of systems available for measuring, aggregating, and interpreting the feedback provided by consumers is increasing. The question, of course, is, “which is best?” And the answer is, “it depends on the algorithms being used.”
Over a decade ago, my colleagues and I developed a set of mathematic equations that enabled us to plot the “expected treatment response” or ETR of a client based on their first session Outcome Rating Scale (ORS) score. Although the math was complicated, the idea was not: therapists and clients could compare outcomes from session to session to the benchmark provided by the ETR. If too much or too little progress were being made, client and therapist could discuss what changes might be made to the services being offered in order to insure more effective or durable progress. It was a bold idea and definately “cutting edge” at the time–after all, 10 years ago, few people were even measuring outcomes let alone trying to provide benchmarks for guiding clinical practice. The formulas developed at that time for plotting change in treatmentare still being used by many around the world with great effect. At the same time, it was merely a first attempt.
I am proud and excited to be able to announce the development and launch of a new set of algorithms–the largest and most sophisticated to date–based on a sample of 427,744 administrations of the ORS, in 95,478 unique episodes of care, provided by 2,354 different clinicians. Unlike the prior formulas–which plotted the average progress of all consumers successful and not–the new equations provide benchmarks for comparing individual consumer progress to both successful and unsuccessful treatment episodes. Consider an analogy to the field of medicine. No one would be interested in a test for the effectiveness of a particular cancer treatment that compared an individual’s progress to to the average of all patients whether they lived or died. People want to know, “will I live?” And in order to answer that question, the ETR of both successful and ultimately unsuccessful treatments must be determined and the individual clients progress compared to both benchmarks. Adjustments can be made to the services offered when the client’s session by session outcomes fit the ETR of treatments that ended unsuccessfully.
An example of the type of feedback provided by the new algorithms is found below. The graph displays three zones of potential progress (or ETR’s) for a client scoring 15 on the ORS at intake. Scores falling in the “green” area from session to session are similar to treatments that ended successfully. As might be expected, those in the “red” zone, ended unsuccessfully. Finally, scores in the “yellow” zone had mixed results. In each instance, both the client and therapist are provided with instant feedback: green = on track, red = off track, yellow = concern.
The new algorithms will be a major focus of the upcoming “Advanced Intensive in Feedback-Informed Treatment (FIT)” scheduled for March 19th-22nd, 2012. All those subscribing to the event also receive the newly released series of FIT treatment manuals. Space is limited, as always, to 35 people and we are filling fast so please don’t wait. So many exciting developments!
Now, if you haven’t already done so, click on the video at the start of this post. I was floored by these satellite images. In some way, I hope that the new algorithms, FIT training manuals, and the ICCE community can inspire a similar sense of perspective!