International Center for Clinical Excellence: Update and Announcement

October 2, 2009 By scottdm Leave a Comment

On August 25th, right here on the “Top Performance” blog, I announced the formation of the International Center for Clinical Excellence. As anyone who has been reading my recent posts or publication knows, my work is evolving; specifically, putting prior research on the common factors, measurement of outcome and alliance, and feedback to work in helping diverse providers improve their effectiveness and the services they offer consumers.

Since the announcement, my colleagues and I have been busy at work creating the ICCE web platform. Based on the latest Web2.0 technology, the site is specifically designed to support clinical excellence through creating virtual clinical networks, groups and clinical communities where clinicians can be supported in eveloping clinical excellence. We are in the second round of beta-testing right now and are expecting to go live in a very short while. So, stay tuned! And if you haven’t already done so, please visit the ICCE site and register. There’s no obligation or cost, and you’ll also be among the first to know when the site is officially lanuched.

In the meantime, I wanted to call attention to the talented and diverse group of clinicians who will be working with the ICCE as “Associates” and “Trainers.” Included among them are representatives from every discipline within behavioral healthcare (psychology, psychiatry, social work, marriage and family therapy, addictions, criminal justice) and from countries all over the globe. They are: William Andrews, Susanne Bargmann, Jim Walt, Reg Fleming, Cynthia Maeschalck, Michael Clark, Alan Scheuermann, Rob Axsen, Stephen Michael, William Plum, Bill Robinson, Michael Hutchison, Jason Seidel, Michelle Sanders, Von Borg, Dave Nylund, Magnus Johannsen, Dave Green, Gunnar Lindfeldt, Gun Eva Langdahl, Wendy Amey, Luci Doppler, Megan Boylan, Melissa Newland, Amanda Pardue, Flip Van Oenen, Mark Crouzen, Frank Asmus, Dee Dee Stout, and Robbie Babins-Wagner. Consistent with the latest web 2.0 technology, each of these ICCE Trainers will have be blogging, uploading short, instructional videos and other content, and providing supervision and consultation to ICCE members.

Membership is easy, by the way, and free. For now, just register online and we’ll notify you when the site goes live. Then you can enter, create your own professional profile and begin tapping into the international network of providers and experts that make up the ICCE community.

How NOT to Achieve Clinical Excellence: The Sorry State of Continuing Professional Education

September 30, 2009 By scottdm 5 Comments

Greg Neimeyer, Ph.D., is causing quite a stir in continuing education circles. What has he done? In several scholarly publications, he’s reviewed the existing empirical literature and found that continuing professional education in heavioral health is not particularly, well, …educational. Indeed, in a soon-to-be published piece in the APA journal, Professional Psychology, he notes, “While the majority of studies report high levels of participants’ satisfaction with their CE experiences, little attention has been paid to assessing actual levels of learning, the translation of learning into practice, or the impact of CE on actual professional service delivery outcomes.” Neimeyer then goes on to cite a scholarly review published in 2002 by Daniels and Walter which pointed out that “a search [of the research literature] revealed no controlled studies of the impact of continuing education in the…behavioral health disciplines” (p. 368). Said another way, the near ubiguitous mandate that clinicians attend so many hours per year of approved “CE” events in order to further their knowledge and skill base has no empirical support.

Personally, my guess is that any study that might be done on CE in Behavioral Health would show little or no impact on performance anyway. Why? Studies in other fields (i.e., medicine, flight training) have long documented that traditional CE activities (i.e., attending conferences, lectures, reading articles) have no demonstrable effect. So, what does work? The same research that calls the efficacy of current CE activities into questions provide clear guidance: namely, brief, circumscribed, skill-based training, followed by observed practice, real-time feedback, and performance measurement. Such characteristics are, in fact, part and parcel of expert performance in any field. And yet, it is virutally non-existent in behavioral health.

Let me give you an example of a CE offering that arrived in my box just this week. The oversized, multi-color, tri-fold brochure boldly asserts a workshop on CBT featuring the “top evidence-based techniques.” Momentarily setting aside the absolute lack of evidence in support of such trainings, consider the promised content–and I’m not kidding: clinical applications of cognitive behavior therapy, motivational interviewing, cognitive therapy, mindfulness and acceptance based therapies, and behavior therapy. As if that were not enough, the outline for the training indicates that participants will learn 52 other bulleted points, including but not limited to: why CBT, integration of skills intro practice, identifying brain-based CBT strategies, the latest research on CBT, the stages of change, open-ended and reflective listening, behavioral activiation, acceptance and commitment, emotional regulation and distrss tolerance skills, the ABC technique to promote rational beliefs, homework assignments that test core beliefs, rescripting techniques for disturbing memories and images…and so on…AND ALL IN A SINGLE 6 HOUR DAY! You say you have no money? Your agency has suffered budget cuts? No worries, the ad states in giant print, as the same content is available via CD, web and podcast.

Such an agenda defies not only the evidence but strains credulity to the breaking point. Could anyone accomplish so much in so little time? Clinicians deserve and should demand more from the CE events they register for and, in many instances, are mandated to attend in order to maintain licensure and certification. The International Center for Clinical Excellence web platform will soon be launched. The mission of the site, as indicated in my blog post of August 25th, is to “support clinical excellence through creating virtual clinical networks, groups and clinical communities where clinicians can be supported in the key behavior changes required for developing clinical excellence.” Members of the site will use a variety of social networking and collaborative tools to learn skills, obtain real-time feedback, and measure their performance. Anyway, kudos to Dr. Greg Neimeyer for confronting the ugly truth about CE in behavioral health and saying it out loud!

Top Resources for Top Performers

September 28, 2009 By scottdm 1 Comment

Since the 1960’s, over 10,000 “how-to” book on psychotherapy have been published. I joke about this fact at my workshops, stating “Any field that needs ten thousand books to describe what it’s doing…surely doesn’t know what its doing!” I continue, pointing out that, “There aren’t 10,000 plus books on ‘human anatomy,’ for example. There are a handful! And the content of each is remarkably similar.” The mere existence of so many, divergent points of view makes it difficult for any practitioner to sort the proverbial “wheat from the chaff.”

Over the last 100 years or so, the field has employed three solutions to deal with the existence of so many competing theories and approaches. First, ignore the differences and continue with “business as usual”– this, in fact, is the approach thats been used for most of the history of the field. Second, force a consolidation or reduction by fiat–this, in my opinion, is what is being attempted with much of the current evidence-based practice (“specific treatments for specific disorders”) movement. And third, and finally, respect the field’s diverse nature and approaches, while attempting to understand the “DNA” common to all–said another way, identify and train clinicians in the factors common to all approaches so that they can tailor their work to their clients.

Let’s face it: option one is no longer viable. Changes in both policy and funding make clear that ignoring the problem will result in further erosion of clinical autonomy. For anyone choosing option two–either enthusistically or by inaction–I will blog later this week about developments in the United States and U.K. on the “evidence-based practice” front that I’m sure will give you pause. Finally, for those interested in movng beyond the rival factions and delivering the best clinical service to clients, I want to recommend two resources. First, Derek Truscott’s, Becoming an Effective Psychotherapist. The title says it all. Whether you are new to the field or an experienced clinician, this book will help you sort through the various and competing psychotherapy approaches and find a style that works for you and the people you work with. The second volume, is Mick Cooper’s Essential Research Findings in Counselling and Psychotherapy. What can I say about this book? It is a gem. Thorough, yet readable. Empirical in nature, but clinically relevant. When I’m out and about teaching around the globe and people ask me what to read in order to understand the empirical literature on psychotherapy, I recommend this book.

OK, enough for now. Stay tuned for further updates this week. In the meantime, I did manage to find a new technique making the rounds on the workshop circuit. Click on the video below.