What’s in an Acronym? CDOI, FIT, PCOMS, ORS, SRS … all BS?

June 7, 2014 By scottdm Leave a Comment

“What’s in a name?”

–William Shakespeare

A little over a week ago, I received an email from Anna Graham Anderson, a graduate student in psychology at Aarhus University in Denmark. “I’m writing,” she said, “in hopes of receiving some clarifications.”

Anna Graham Anderson

Without reading any further, I knew exactly where Anna was going. I’d fielded the same question before. As interest in measurement and feedback has expanded, it comes up more and more frequently.

Anna continued, “I cannot find any literature on the difference between CDOI, FIT, PCOMS, ORS, and SRS. No matter where I search, I cannot find any satisfying clues. Is it safe to say they are the same?” Or, as another asked more pointedly, “Are all these acronyms just a bunch of branding B.S.?”

I answered, “B.S.? No. Confusing? Absolutely. So, what is the difference?”

As spelled out in each of the six treatment and training manuals, FIT, or feedback-informed treatment, is, “a panetheoretical approach for evaluating and improving the quality and effectiveness of behavioral health services. It involves routinely and formally soliciting feedback from consumers regarding the therapeutic relationship and outcome of care and using the resulting information to inform and tailor service deliver.”

Importantly, FIT is agnostic regarding both the method of treatment and the particular measures a practitioner may employ. Some practitioners use the ORS and SRS, two brief, simple-to-use, and free measures of progress and the therapeutic relationship–but any other valid and reliable scales could be used.

Of all the acronyms associated with my work, CDOI is the one I no longer use. For me, it had always problematic as it came precariously close to being a treatment model, a way of doing therapy. I wasn’t interested in creating a new therapeutic approach. My work and writing on the common factors had long ago convinced me the field needed no more therapeutic schools. The phrase, “client-directed, outcome-informed” described the team’s position at the time, with one foot in the past (how to do therapy), the other in the future (feedback).

And PCOMS? A long time ago, my colleagues and I had a dream of launching a web-based “system for both monitoring and improving the effectiveness of treatment” (Miller et. al, 2005). We did some testing at an employee assistance program in located in Texas, formed a corporation called PCOMS (Partners for Change Outcome Management System), and even hired a developer to build the site. In the end, nothing happened. Overtime, the acronym, PCOMS, began to be used as an overall term referring to the ORS, SRS, and norms for interpreting the scores. In February 2013, the Substance Abuse and Mental Health Service Adminstration (SAMHSA) formally recognized PCOMS as an evidence-based practice. You can read more about PCOMS at: www.whatispcoms.com.

I expect there will be new names and acronyms as the work evolves. While some remain, others, like fossils, are left behind; evidence of what has come before, their sum total a record of development over time.

How not to be among the 70-95% of practitioners and agencies that fail

April 20, 2014 By scottdm Leave a Comment

Our field is full of good ideas, strategies that work. Each year, practitioners and agencies devote considerable time and resources to staying current with new developments. What does the research say about such efforts? When it comes to the implementation of new, evidence-based practices, traditional training strategies routinely produce only 5% to 30% success rates. Said another way, 70-95% of training fails (Fixsen, Blase, Van Dyke, & Metz, 2013).

In 2013, Feedback Informed Treatment (FIT)–that is, formally using measures of progress and the therapeutic alliance to guide care–was deemed an evidence-based practice by SAMHSA, and listed on the official NREPP website. It’s one of those good ideas. Research to date shows that FIT as much as doubles the effectiveness of behavioral health services, while decreasing costs, deterioration and dropout rates.

As effective as FIT has proven to be in scientific studies, the bigger challenge is helping clinicians and agencies implement the approach in real world clinical settings. Simply put, it’s not enough to know “what works.” You have to be able to put “what works” to work. On this subject, researchers have identified five, evidence-based steps associated with the successful implementation of any evidence-based practice. The evidence is summarized in a free, manual available online. You can avoid the 70-95% failure rate by reading it before attending another training, buying that new software, or hiring the latest consultant.

At the International Center for Clinical Excellence, we’ve integrated the research on implementation into all training events, including a special, two-day intensive workshop on implementing Feedback-Informed Treatment (FIT). Based on the five, scientifically-established steps, clinicians, supervisors, and agency directors will learn how to both plan and execute a successful implementation of this potent evidence-based practice.

You can register today by clicking on the link above or the “FIT for Management” icon below. Feel free to e-mail me with any questions. In the meantime, hope to see you this summer in Chicago!

Psychotherapy Training: Is it Worth the Bother?

October 29, 2012 By scottdm 2 Comments

Big bucks. That’s what training in psychotherapy costs. Take graduate school in psychology as an example. According to the US Department of Education’s National Center (NCES), a typical doctoral program takes five years to complete and costs between US$ 240,000-300,000.00.

Who has that kind of money laying around after completing four years of college? The solution? Why, borrow the money, of course! And students do. In 2009, the average amount of debt of those doctoral students in psychology who borrowed was a whopping US$ 88,000–an amount nearly double that of the prior decade. Well, the training must be pretty darn good to warrent such expenditures–especially when one considers that entry level salaries are on the decline and not terribly high to start!

Oh well, so much for high hopes.

Here are the facts, as recounted in a recent, concisely written summary of the evidence by John Malouff:

1. Studies comparing treatments delivered by professionals and paraprofessionals either show that paraprofessionals have better outcomes or that there is no difference between the two groups;

2. There is virtually no evidence that supervision of students by professionals leads to better client outcomes (you should have guessed this after reading the first point);

3. There is no evidence that required coursework in graduate programs leads to better client outcomes.

If you are hoping that post doctoral experience will make up for the shortcomings of professional training, well, keep hoping. In truth, professional experience does not correlate often or significantly with client therapy outcomes.

What can you do? As Malouf points out, “For accrediting agencies to operate in the realm of principles of evidence-based practice, they must produce evidence…and this evidence needs to show that…training…contribute(s) to psychotherapy outcomes…[and] has positive benefits for future clients of the students” (p. 31).

In my workshops, I often advise therapists to forgo additional training until they determine just how effective they are right now. Doing otherwise, risks perceiving progress where, in fact, none exists. What golfer would buy new clubs or pursue expensive lessions without first knowing their current handicap? How will you know if the training you attend is “worth the bother” if you can’t accurately measure the impact of it on your performance?

Determining one’s baseline rate of effectiveness is not as hard as it might seem. Simply download the Outcome Rating Scale and begin using it with your clients. It’s free. You can then aggregate and analyze the data yourself or use one of the existing web-based systems (www.fit-outcomes.com or www.myoutcomes.com) to get data regarding your effectiveness in real time.

After that, join your colleagues at the upcoming Advanced Intensive Training in Feedback Informed Treatment. This is an “evidence-based” training event. You learn:

• How to use outcome management tools (e.g., the ORS) to inform and improve the treatment services you provide;

• Specific skills for determining your overall clinical success rate;

• How to develop an individualized, evidence-based professional development plan for improving your outcome and retention rate.

There’s a special “early bird” rate available for a few more weeks. Last year, the event filled up several months ahead of time, so don’t wait.

On another note, just received the schedule for the 2013 Evolution of Psychotherapy conference. I’m very excited to have been invited once again to the pretigious event and will be bring the latest information and research on acheiving excellence as a behavioral health practitioner. On that note, the German artist and psychologist, Andreas Steiner has created a really cool poster and card game for the event, featuring all of the various presenters. Here’s the poster. Next to it is the “Three of Hearts.” I’m pictured there with two of my colleagues, mentors, and friends, Michael Yapko and Stephen Gilligan: