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.”

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 The Feedback Informed Treatment and Training Manual, FIT 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 helping relationship and outcome of care and using the resulting information to inform and tailor service delivery.”

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 and PCOMS are ones I no longer use. For me, the former had always been 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.

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.

What can therapists learn from the CIA? Experts versus the "Wisdom of the Crowd"

May 6, 2014 By scottdm Leave a Comment

What can we therapists learn from the CIA? In a phrase, “When it comes to making predictions about important future events, don’t rely on experts!”

After a spate of embarrassing, high-profile intelligence failures, a recent story showed how a relatively small group of average people made better predictions about critical world events than highly-trained analysts with access to classified information. The four-year study, known as the Good Judgment Project, adds to mounting evidence regarding the power of aggregating independent guesses of regular folks–or what is known as, “the wisdom of the crowd.”

When it comes to therapy, multiple scientific studies show that inviting the “wisdom of the crowd” into treatment as much as doubles effectiveness, while simultaneously cutting drop out and deterioration rates.

Whatever your profession, work setting, or preferred therapeutic approach, the process involves formally soliciting feedback from clients and then comparing the results to empirically established benchmarks. Getting started is easy:

Download and begin using two free, easy to use tools–one that charts progress, the other the quality of the therapeutic relationship.
Next, access cutting edge technology available on the web, smartphones, and tablets, that makes it easy to anonymously compare the progress of your clients to effective patterns of practice worldwide.

You can learn more by reading other posts, visiting the ICCE YouTube channel, or attending one of the FIT Intensives. https://www.eventbrite.com/o/the-international-centre-for-clinical-excellence-298540255

Do you know who said, "Sometimes the magic works, sometimes it doesn’t"?

April 30, 2014 By scottdm Leave a Comment

Well, do you?

It was Chief Dan George playing the role of Old Lodge Skins in the 1970 movie, “Little Big Man.” Whether or not you’ve seen or remember the film, if you’re a practicing therapist, you know the wisdom contained in that quote. No matter how skilled the clinician or devoted the client, “sometimes therapy works, sometimes it doesn’t.”

Evidence from randomized clinical trials indicates that, on average, clinicians achieve a reliable change–that is, a difference not attributable to chance, maturation, or measurement error–with approximately 50% of people treated. For the most effective therapists, it’s about 70%. Said another way, all of us fail between 30-50% of the time.

Of greater concern, however, is the finding that we don’t see the failure coming. Hannan and colleagues (2005) found, for example, that therapists correctly predicted deterioration in only 1 of 550 people treated, despite having been told beforehand the likely percentage of their clients that would worsen and knowing they were participating in a study on the subject!

It’s one thing when “the magic doesn’t work”–nothing is 100%–but it’s an entirely different matter when we go on believing that something is working, when it’s not. Put bluntly, we are a terminally, and forever hopeful group of professionals!

What to do? Hannan et al. (2005) found that simple measures of progress in therapy correctly identified 90% of clients “at risk” for a negative outcome or dropout. Other studies have found that routinely soliciting feedback from people in treatment regarding progress and their experience of the therapeutic relationship as much as doubles effectiveness while simultaneously reducing dropout and deterioration rates.

You can get two, simple, evidence-based measures for free here. Get started by connecting with and learning from colleagues at The International Center for Clinical Excellence. It’s free and signing up takes only a minute or two.

Finally, read the Feedback Informed Treatment and Training Manual, containing step by step instructions for using the scales to guide and improve the services you offer.

Here’s to knowing when our “magic” is working, and when it’s not!