An Easy Way to Improve Our Schools (and Psychotherapy)

November 13, 2012 By scottdm Leave a Comment

If you didn’t see the October Atlantic Monthly, you really missed a great issue. In it, Amanda Ripley wrote a delightful and informative article about a simple and straightforward method for improving the performance of the public schools: have kids grade teachers. What kind of grades you ask? Not those on standardized achievement tests, and certainly not measures of a teacher’s popularity. Although both of those methods are widely advocated and used, neither has proven particularly predictive of student performance. Rather, grades should be based on how well teachers engage students; particularly whether the kids believe the teacher makes them want to work hard, pay attention, understand the course material, and identify and correct their mistakes. Indeed, in thousands of surveys, kids as young as kindergartners “can identify with uncanny accuracy, their most–and least effective teachers.”

The findings stood out for me not only because I am a parent but also because they mirror results from psychotherapy research. First, data gathered over the last three decades documents that client engagement is the number one process-related predictor of treatment outcome. Second, a growing number of studies indicates that clients can identify “with uncanny accuracy” the most and least effective treatment services and providers. Importantly, this same body of evidence shows that client assessments of their sessions and progress can be used to enhance treatment results in general as well as the effectiveness and skill level of individual clinicians.

Viewpoint clearly matters–and in the case of schools and psychotherapy, it is the recipient of the service whose opinion we should be seeking. In her article, Ripley identifies the types of questions that can be used in schools. If you are a therapist, two brief, simple-to-use scales are available for free. Research has shown that regularly using the measures to solicit client feedback improves both retention in and outcome of psychotherapy. The largest, international professional community dedicated to enhancing the quality and outcome of behavioral healthcare is available to support you in your use of the tools. There, you will find a wealth of information, discussion forums, and how-to videos available at no charge 24 hours a day, 7 days a week, 365 days a year.

In March, many members from around the world will be joining colleagues from around the world for four days of intensive training. Why not join us? We work and play hard. Rest assured that by the end of the four days, you’ll be playing an “A” game. Click here to register today. In the meantime, here’s what participants from last year said about the event.

Have you got an App for that? The Therapeutic Outcome Management System (TOMS)

November 5, 2012 By scottdm 9 Comments

“Do you have an app for the ORS and SRS?” That’s the message that greeted me in my inbox this morning when I made it into the office. I was so happy to be able to write back and say, “Yes, absolutely!” In addition to two web-based systems for administering, scoring, tracking, and aggregating ORS and SRS scores, the Therapy Outcome Management System (TOMS) app is now available!

The simple and easy to use app for the iPad, iPhone, and iPod administers, scores, and plots ORS and SRS scores in real time. As such, it’s perfect for agencies, directors of clinical training programs, group practices, clinics, and private practices. As readers of this blog know, a sizable and growing body of evidence has demonstrated that incorporating client feedback into care improves both retention and effectiveness.

Grad student Nick Wiarda developed the app. His dissertation research investigated the impact of technology on the therapeutic alliance. Briefly, clients from a semi-rural primary care clinic completed the SRS (Session Rating Scale) in paper and pencil format, or via an iPad, or on a desktop computer. Importantly, no differences were found between the groups, indicating that the technology used does not impact peoples’ ability or willingness to provide feedback.

The bottom line? TOMS helps clinicians get the feedback they need efficiently and effectively—and I can add elegantly. Check it out!

Update: If you are looking to add the ORS, SRS and associated algorithms to an existing Electronic Health Record, Case Management System or eMental Health application take a look at openFIT developed by ACE Health.

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: