Am-ACE-ing Events in Kansas City: The First International Achieving Clinical Excellence Conference

October 27, 2010 By scottdm Leave a Comment

Here’s a riddle for you:

What do therapists, researchers, case managers, magicians, surgeons, award winning musicians, counselors, jugglers, behavioral health agency directors, and balloon twisting artists have in common?

Answer:

They all participated in the first “Achieving Clinical Excellence” held last week in Kansas City, Missouri.

It’s true. The “motley” crew of presenters, entertainers, and attendees came to Kansas City learn the latest, evidence-based strategies for helping clinicians achieve their “personal best” and, in the process, improve the quality and outcome of behavioral health services. Not only did participants and presenters come from all over the globe–Australia, New Zealand, Norway, Sweden, Denmark, Austria, the UK, Ireland, Scotland, Germany, Canada, Holland, and elsewhere–but ICCE web 2.0 technology was used to stream many of the presentations live to a worldwide audience (click on the link to watch the recordings).

“The atmosphere was positively electric,” one participant remarked to me on break, “and so friendly. First, I was inspired. Each presentation contained something new, a take-away. Then I wanted to sit with other attendees and discuss the content.”

And thanks to “Gillis for Children and Families,” who not only sponsored and ran the event, but provided a full breakfast and lunch each day of the conference, participants had ample opportunity to meet, process, and network with each other.

Rich Simon Anders Ericsson Michael Ammar

Rich Simon, Ph.D., the editor of the Psychotherapy Networker, kicked off the event using his time at the podium to place the conference’s emphasis on excellence within the broader history of the field of psychotherapy. He was followed by K. Anders Ericsson, the editor of the influential Cambridge Handbook of Expertise and Expert Performance, reviewed research on expert performance gathered over the last 3 decades. Scott D. Miller, Ph.D., translated existing research on expert performance into steps for improving outcomes in behavioral health. On day 2, professional magician Michael Ammar delivered a stunning performance of close up magic while teaching a specific method of deliberate practice that clinicians can use to improve their skills. Meanwhile, break out sessions led by psychologists, physicians, counselors, pharmacists, and agency directors addressed “nuts and bolts” applications.

Rachel Hsu Roger Shen

In between each plenary and breakout session, top performers from a variety of fields entertained and inspired. Moving performances on the violin and piano by nine year old Rachel Hsu and eleven year old Roger Shen amazed and challenged everyone in attendance. “It is not talent,” Rachel told me, “It’s a lot of hard work–4 to 5 hours a day, everyday of the week, including weekends.” The take home lesson from these exception kids was clear: there are no short cuts when it comes to top performance. If you want to achieve your personal best you must work hard. Promises otherwise are so much more snake oil.

On Thursday evening, the Australian classical pianist, David Helfott, whose lifestory was the subject of the award winning film, “Shine” entertained conference attendees. His partner, Gillian, introduced and provided the audience with a brief history of David’s life, unfortunate treatment in the mental health system, and their long marriage. The audience rose to their feet in a standing ovation at the conclusion of the performance. There were few dry eyes in the house. Afterwards, the two spent nearly an hour meeting and greeting attendees personally. Once again, portions of the performance were broadcast live via ICCE web 2.0 technology to a world wide audience.

The inspiration that conference attendees felt continues on the International Center for Clinical Excellence web-based community. Join us as we work to help each other achieve our personal best. Still looking for inspiration? Take a look at the following two videos; first, a montage of events at ACE; and second, Mr. Ah’ Lee Robinson, the director of the Kansas City Boys Choir, whose story and performance brought the conference to a moving conclusion.

What is "Best Practice?"

October 20, 2010 By scottdm Leave a Comment

You have to admit the phrase “best practice” is the buzzword of late. Graduate school training programs, professional continuing education events, policy and practice guidelines, and funding decisions are tied in some form or another to the concept. So, what exactly is it? At the State and Federal level, lists of so-called “evidence-based” interventions have been assembled and are being disseminated. In lockstep, as I reviewed recently, are groups like NICE. Their message is simple and straightforward: best practice is about applying specific treatments to specific disorders.

Admittedly, the message has a certain “common sense” appeal. The problem, of course, is that behavioral health interventions are not the psychological equivalent of penicillin. In addition to the numerous studies highlighted on this blog documenting the failure of the “specific treatments for specific disorders” perspective, consider research published in the Spring 2010 edition of the Journal of Counseling and Development by Scott Nyman, Mark Nafziger, and Timothy Smith. Briefly, the authors examined outcome data to “evaluate treatment effectiveness across counselor training level [and found] no significant outcome differences between professional staff and …. interns, and practicum students” (p. 204). Although the researchers are careful to make all the customary prevarications, the conclusion—especially when combined with years of similar findings reported in the literature– is difficult to escape: counseling and psychotherapy are highly regulated activities requiring years of expensive professional training that ultimately fails to make the practitioner any better than they were at the outset.

What gives? Truth is, the popular conceptualization of “best practice” as a “specific treatment for a specific disorder” is hopelessly outdated. In a report few have read, the American Psychological Association (following the lead of the Institute of Medicine) redefined evidence-based, or best practice, as, “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” Regarding the phrase “clinical expertise” in this definition, the Task Force stated, “Clinical expertise…entails the monitoring of patient progress (and of changes in the patient’s circumstances—e.g., job loss, major illness) that may suggest the need to adjust the treatment (Lambert, Bergin, & Garfield, 2004a). If progress is not proceeding adequately, the psychologist alters or addresses problematic aspects of the treatment (e.g., problems in the therapeutic relationship or in the implementation of the goals of the treatment) as appropriate” (p. 273; emphasis included in the original text).

Said another way, instead of choosing the “specific treatment for the specific disorder” from a list of approved treatments, best practice is:

· Integrating the best evidence into ongoing clinical practice;

· Tailoring services to the consumer’s characteristics, culture, and preferences;

· Formal, ongoing, real-time monitoring of progress and the therapeutic relationship.

In sum, best practice is Feedback Informed Treatment (FIT)—the vision of the International Center for Clinical Excellence. And right now, clinicians, researchers and policy makers are learning, sharing, and discussion implementing FIT in treatment settings around the globe on the ICCE web-based community.

Word is getting out. As just one example, consider Accreditation Canada, which recently identified FIT as a “leading practice” for use in behavioral health services. According to the website, leading practices are defined as “creative, evidence-based innovations [that] are commendable examples of high quality leadership and service delivery.” The accreditation body identified FIT as a “simple, measurable, effective, and feasible outcome-based accountability process,” stating that the approach is a model for the rest of the country! You can read the entire report here.

How exactly did this happen? Put bluntly, people and hard work. ICCE senior associates and certified trainers, Rob Axsen and Cynthia Maeschalck, with the support and backing of Vancouver Coast Health, worked tirelessly over the last 5 years both implementing and working to gain recognition for FIT. Similar recognition is taking place in the United States, Denmark, Sweden, England, and Norway.

You can help. Next time someone—be it colleague, trainer, or researcher—equates “best practice” with using a particular model or list of “approved treatment approaches” share the real, official, “approved” definition noted above. Second, join Rob, Cynthia, and the hundreds of other practitioners, researchers, and policy makers on the ICCE helping to reshape the behavioral health practice worldwide.

No Therapist Left Behind: Improving the Quality and Outcome of Behavioral Health Services One Practitioner at a Time

October 12, 2010 By scottdm Leave a Comment

Staying “up-to-date” isn’t easy in today’s practice environment. In these lean economic times, training budgets are often the first to be cut. On the other hand, trying to separate the “important” from “irrelevant” in our information-rich age can be, as Mitchell Kapor once observed, “a bit like trying to get a drink from a fire hydrant.”

Enter the ICCE—a web-based community of professionals dedicated to improving the quality and outcome of behavioral health services worldwide. Every day, in forums ranging from “research on psychotherapy” to “marketing and media,” members from around the world meet to learn from and share with each other. What’s more, groups have been created for practitioners working in specific countries (Sweden, Denmark, Norway, Poland, Netherlands, and so on). Crucially, in these forums members are able to address issues relevant to the specific environment in which they work and do so in their own language.

In the latest issue of the Psychotherapy Networker, internet and media consultant Elizabeth Doherty Thomas, identified ICCE as one of the “best clinical resources on the internet”—high praise when one considers the tens of thousands of websites featuring content related to behavioral health practice.

So, what are you waiting for? If you’re not a member, you can request an invitation to join by clicking here. Tapping into the rich knowledge base of clinicians around the globe will insure that you are not “left behind.”