SCOTT D Miller - For the latest and greatest information on Feedback Informed Treatment

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What’s disturbing Mental Health? Opportunities Lost

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In a word, paperwork.  Take a look at the book pictured above.  That massive tome on the left is the 2011 edition of “Laws and Regulations” governing mental health practice in the state of California.  Talk about red tape!  Hundreds and hundreds of pages of statutes informing, guiding, restricting, and regulating the “talking cure.”  Now, on top of that, layer federal and third party payer policies and paperwork and you end up with…lost opportunities.  Many lost opportunities.  Indeed, as pointed out in our recent article, The Road to Mastery, as much as 30% of clinicians time is spent completing paperwork required by various funding bodies and regulatory agencies.  THIRTY PERCENT.  Time and money that could be spent much more productively serving people with mental health needs. Time and money that could be spent on improving treatment facilities and training of behavioral health professionals.  In the latest edition of our book, The Heart and Soul of Change, authors Bob Bohanske and Michael Franczak described their struggle to bring sanity to the paperwork required in public mental health service settings in the state of Arizona.  “The forms needed to obtain a marriage certificate, buy a new home, lease an automobile, apply for a passport, open a bank account, and die of natural causes were assembled,” they wrote, “…and altogether weighed 1.4 ounces.  By contrast, the paperwork required for enrolling a single mother in counseling to talk about difficulties her child was experiencing at school came in at 1.25 pounds” (p. 300).  What gives?

The time has come to confront the unpleasant reality and say it outloud: regulation has lost touch with reality.  Ostensibly, the goal of paperwork and oversight procedures is to improve accountability.  In these evidence-based times, that leads me to say, “show me the data.”  Consider the wide-spread practice–mandate, in most instances–of treatment planning. Simply put, it is less science than science fiction.  Perhaps this practice improves outcomes in a galaxy far, far away but on planet Earth, supporting evidence is spare to non-existent (see the review in The Heart and Soul of Change, 2nd Edition).

No amount of medication will resolve this craziness.  Perhaps a hefty dose of CBT might do some good identifying and correcting the distoreted thinking that has led to this current state of affairs.  Whatever happens, the field needs an alternative.  What practice not only insures accountability but simultaneously improves the quality and outcome of behavioral health services?  Routine outcome measurement and feedback (ROMFb).  As I’ve blogged about several times, numerous RCT’s document increased effectiveness and efficiency and decreased costs and rates of deterioration.   Simply put, as the slide below summarizes, everybody wins.  Clinicians.  Consumers.  Payers.
Everybody wins

Learn about or deepen your knowledge of feedback-informed treatment (FIT) by attending the upcoming “Advanced Intensive” workshop in March 2012; specfically, the 19th-22nd.  We will have four magical days together.  Space is filling rapidly, so register now.  And then, at the end of the last day of the training, fly to Washington, D.C. to finish off the week by attending the Psychotherapy Networker conference.  Excellence is front and center at the event and I’ve been asked to do the keynote on the subject on the first day!

Feedback-Informed Treatment as Evidence-based Practice: APA, SAMSHA, and NREPP

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What is evidence-based practice?  Visit the UK-based NICE website, or talk to proponents of particular theoretical schools or therapeutic models, and they will tell you that being “evidence-based” means using the approach research has deemed effective for a particular diagnosis  (e.g., CBT for depression, EMDR for trauma).  Over the last two decades, numerous organizations and interest groups have promoted lists of “approved” treatment approaches–guidelines that clinicians and funding bodies should follow when making practice decisions.  Throughout the 1990’s, for example, division 12 within the American Psychological Association (APA) promoted the idea of “empirically supported treatments.”

However, when one considers the official definition of evidence-based practice offered by the Institute of Medicine and the APA, it is hard to fathom how anyone could come to such a conclusion.  According to the APA, evidence-based practice is, “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” (see American Psychologist, May 2006).  Nothing here about “empirically supported treatments” or the mindless application of specific treatment protocols.  Rather, according to the APA and IOM, clinicians must FIT the treatment to the client, their preferences, culture, and circumstances.  And how can one do that?  Well, conspicuously absent from the definition is, “consult a set of treatment guidelines.”  Rather, when evidence-based, clinicians must monitor “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. 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.”

The principles and practices of feedback-informed treatment (FIT) are not only consistent with but operationalize the American Psychological Association’s (APA) definition of evidence-based practice.  To wit, routinely and formally soliciting feedback from consumers regarding the therapeutic alliance and outcome of care and using the resulting information to inform  and tailor service delivery.  And indeed, over the last 9 months, together with Senior Associates, I completed and submitted an application for FIT to be reviewed by NREPP–SAMSHA’s National Registry of Evidence-based Practices and Approaches!  As part of that application and ICCE’s commitment to improving the quality and outcome of behavioral health, we developed a list of “core competencies” for FIT practice, a series of six detailed treatment and implementation manuals, a gap assessment tool that organizations can use to quickly and expertly assess implementation and fidelity problems, and supportive documentation and paperwork.  Finally, we developed and rigorously tested training curricula and administered the first standardized exam for certifying FIT practitioners and trainers.  We are in the final stages of that review process soon and I’m sure I’ll be making a major announcement right here on this blog shortly.  So, stay tuned.

In the meantime, this last Saturday, clinicians located the globe–Canada, New Zealand, Australia, the US,a nd Romania–sat for the first administration of ICCE “Core Competency” Exam.  Taking the test is the last step in becoming an ICCE “Certified Trainer.”   The other requirements include: (1) attending the “Advanced Intensive” and “Training of Trainers” workshops; and (2) submitting a training video on FIT for review.  The exam was administered online using the latest technology.


The members, directors, and senior associates of ICCE want to congratulate (from top left):

  • Eeuwe Schuckard, Psychologist, Wellington, New Zealand;
  • Aaron Frost, Psychologist, Brisbane, Australia;
  • Cindy Hansen, BA-Psych, HHP, Manager Myoutcomes;
  • David Prescott, Director of Professional Development, Becket Family of Services, Portland, Maine;
  • Arnold Woodruff, LMFT, Clinical Director, Home for Good, Richmond, Virginia;
  • Bogdan, Ion, Ph.D., Bucharest University, Bucharest, Romania;
  • Daniel Buccino, Clinical Supervisor, Community Psychiatry Program. Johns Hopkins;
  • Dwayne Cameron, Outreach Counselor, Prince Albert, Saskatoon, Canada;
  • Mark Goheen, the Clinical Practice Lead at Fraser Health, British Columbia.

If you are not yet a member of the ICCE community, please join the largest, fastest growing, and friendly group of behavioral health professionals today at: www.centerforclinicalexcellence.com.

Achieving Clinical Excellence Conference 2013: CALL FOR PAPERS

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Horsholm, Denmark

Spent the weekend with the planning committe for the 2013 Achieving Clinical Excellence Conference.  Committee members came in from all over the world–the USA, Romania, Holland, the UK, and Denmark–to finalize speakers, the conference venue, and mock up the logo for the conference brochure and advertizing.  Like last time, we are not only bringing in the top researchers to present the latest scientific findings, but also superior performers from a variety of vocations to inspire all of us to achieve our personal best.

Despite all the effort, a significant part of the program remains incomplete.  That part involves YOU!  The conference committee is issuing a formal “call for papers”on expertise and expert performance in the field of behavioral health.  In keeping with the theme of the conference–“Putting the Pieces Together: The Fragile Balance”–the committe is looking for presentations on:

  • Innovative strategies for improving the quality and outcome of behavioral health;
  • Research and experiences of using routine monitoring of progress and the alliance to improve retention and outcome of treatment services;
  • Principles, practices, and experiences regarding maintaining balance between professional and personal life in the achievement of clinical excellence;
  • Implementation of strategies for improving performance in agencies and systems of care
  • How professional development can improve performance of behavioral health professionals;
  • Management and leadership practices associated with superior performance in behavioral health;

Any and all papers may be submitted directly to: info@scottdmiller.com.  The conference website is also available for earlybird registration.

There are so many other developments that I hope to blog in detail about in the coming days.  In the meantime, here’s a short summary of what’s in store:

Becoming FIT: The 2011 Training of Trainers

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August 10th, 2011

Chicago, IL

The first week of August was one of the hottest weeks on record in Chicago.  It was also the location of the hottest training on “feedback-informed treatment” (FIT)–the 5th Annual “Training of Trainers” weeklong intensive training.  We worked intensively over 5 days preparing an international group of administrators, supervisors, researchers, and clinicians to train others in the principles and practices of FIT.  We also played hard: dinners, music, magic, and more.  Here’s what attendee’s said about this years event:

Be sure and join us for the 4-day “Advanced Intensive” scheduled in March.  More information can be found at: scottdmiller.com.

 

The World Did Not End: What it a Bad Thing?

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May 25th, 2011

Chicago, Illinois

On Saturday the 21st of May, 2011 the world was supposed to come to an end.  It did not.  My question: was that a bad thing?  Would it have been better if, as the now twice wrong Prophet Harold Camping predicted, the world had ended.

In the world of public behavioral health, the answer is perhaps. Since the crash of the United States economy in 2008, funding for public behavioral health has been on the chopping block.  It’s not the “end of world in one fell swoop.”  Rather, its more like slowly having the life strangled out of you.  And unlike teachers and prison guards, public behavioral health doesn’t have a strong and vocal lobby.

“It’s sad,” says the director of one agency in the midwest, “I come to work every day feeling weighed down.  We are going to experience very close to another one mission dollar cut, that is, on topic of the same cut last year.”

Agencies are doing everything they can to continue to provide effective treatment in the current environment.  Here’s what the staff and management in Marion-Crawford county, Ohio have done:

As Bob and Shirley make clear, routinely monitoring outcome and alliance and using the information to inform service delivery is a key to survival in these challenging economic times.

At ICCE, we are working with hundreds of agencies around the US and abroad to improve quality, effectiveness, and efficiency.  Soon, we’ll be gathering in Chicago for our annual “Training of Trainers” event.  The hands-on, intensive training is the first step to acquiring the skills necessary for navigatng the troubled waters ahead.  Here’s what attendee’s from last year said about the event:

Read more about the event or register online by clicking here.

The Mystery of Mastery: Excellence Takes Center Stage in the Psychotherapy Networker

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The Psychotherapy Networker has long been the most popular periodical among practicing clinicians.  Rumor has it that the magazine has 80,000+ subscribers and sells over 120,000 copies of each issue.  If you want to know what therapists are thinking and talking about, the Networker magazine is the place to look.  And in the May/June issue, the topic of excellence is front and center.

The reason is obvious: the field of psychotherapy is in trouble.  Think about it for a moment.  What real accomplishments can psychotherapy boast of in recent years? What was the last truly revolutionary discovery in the field of psychotherapy? What “treatment” (analogous to penicillin in medicine) has ever successfully eradicated a mental or emotional disorder? In fact, while we’ve been at our posts, provisioning and parading an army of techniques and methods, rates of depression and anxiety have soared.  Even if one disagrees with this grim assessment of the field’s contributions and influence, it’s hard to be sanguine about our status. Over the last decade, median incomes for psychologists, both applied and academic, have dropped by thousands of dollars. In the same period, workloads have increased, professional autonomy has been subverted, and funding for public behavioral healthcare has all but disappeared.  Meanwhile, the very relevance of psychotherapy is an open question in the minds of many current and prospective consumers. Despite overwhelming evidence that therapy works, and that more than 90 percent of people say they’d prefer to talk about their problems than take psychopharmacological drugs, most people doubt the efficacy of treatment. Perhaps this accounts for the fact that the use of medications has steadily increased, while visits to a psychotherapist have been decreasing.

What can be done?

In 2007, we wrote an article that appeared in the pages of the Networker on the subject of “top performing” clinicians–those that consistently achieve superior results with their clients.  Over the last four years, we’ve continued to research and write on the subject and in the latest issue of the Networker we review the latest findings.  ICCE Associate, Dr. Bob Bertolino, also has an article in the issue detailed the steps required to reac excellence in agencies and healthcare systems.

Scott Miller         Mark Hubble          Bob Bertolino

Never has a moment in the history of the field existed when the need for a “culture of excellence” has been more pressing or when the qualities of that culture are more unambiguous.  Seeing as we spend so much of our lives at work anyway—often more in total than with our families, friends, and in leisure—the question is, “why not?”   If not for ourselves, then for our clients, the very people the research shows benefit the most from top performance and on whom our livelihoods depend.  Don’t wait.  Click on the links above to read both articles.

The "Fragile Balance": Putting the Pieces together at the 2013 Achieving Clinical Excellence Conference in Amsterdam, Holland

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Dateline: May 8th, 2011

Copenhagen, Denmark

It is with great pleasure and high expectations that I announce the second “Achieving Excellence Conference” to be held in Amsterdam, Holland on May 16th-18th, 2013.

The title of the 2013 ACE conference is, “Putting the Pieces Together: The ‘Fragile Balance,'” emphasizing the steps, practices, and supports required for excellence in the field of behavioral health.

This last weekend, the organizing committe met in Horsholm, Denmark to begin planning the event.  The 2013 conference chair is Dutch psychologist Rick Plutt (pictured on the left in the photo to the right).  Committee members flew in from all over Europe and include ICCE associates (from left to right in the photo on the left) Liz Plutt (Holland), Rick Plutt (Holland), Anthony Jordan (Sweden), Bogdan Ion (Romania), Bill Andrews (UK), and Susanne Bargmann (Denmark).

Information about the event is already available on the official ACE 2013 Conference website.  Registration will soon be available.

The committee has also issued a “Call for Papers” from clinicians, researchers, and policy makers interested in presenting at the event.  Guidelines for submitting a proposal to present at the conference can be obtained by sending an email to:  info@centerforclinicalexcellence.com.

Details regarding the event, including keynote presenters will be released shortly so stay tuned.  In the meantime, make sure you watch the video highlights from the 2010 conference in Kansas City, Missouri:

More videos from the conference are available on the International Center for Clinical Excellence video channel.

Don’t wait until 2013 to begin improving the quality and outcome of your clinical work.  The one and only, official “Training of Trainers” is open for registration.  This hands on event is conducted by me and other ICCE Senior Associates.  Space is limited to 35 participants.  You can register by clicking the icon below.

Here’s what last year’s participants said about the “Training of Trainers”:

Getting FIT: The Advanced Intensive Training

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Dateline: January 19, 2011
Buffalo, New York

The New Year is here and travel/training season is in full swing.  Last week, I was in Ohio and Virginia.  This week New York and Idaho (keep your weather fingers crossed, it’s going to be dicey getting from here to there and home again).

Interest in “Feedback Informed Treatment” continues to grow.  Agencies across the United States and abroad–as my travel schedule attests–are implementing the ORS and SRS in routine clinical practice.  Clinicians are finding the support they need on the International Center for Clinical Excellence web-based community.  As I blogged about a while back, the ICCE is the largest and most diverse group of practitioners working to improve the quality and outcome of behavioral health services.  Many will soon be joining me in Chicago for the 2011 “Advanced Intensive” training.  Once again, clinicians from all over the world will be in attendance–Sweden, Holland, England, Australia and so on.  Interest is high as participants receive a thorough, state-of-the-art grounding in the principles and practice of FIT.  I look forward to meeting everyone soon.

Last summer, I videoblogged about the event.  Ah, summer!   With everything my co-teacher, psychologist Susanne Bargmann, and I have planned, we promise a warm and rewarding event.

Growing by Leaps and Bounds: ICCE Membership Nearing 2000!

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In December 2009, the International Center for Clinical Excellence was officially launched.  From our booth at the Evolution of Psychotherapy conference, the international web-based community “went live,” adding hundreds of members in a few days.  By April, as I reported in my blog, over 1000 clinicians, researchers, policy makers, and adminsitrators had joined the site, making it the largest organization in the world dedicated to improving the quality and outcome of behavioral healthcare.  And now, just shy of a year, the ICCE community is fast approaching 2000 members!

Unlike traditional list-serves dependent on email, limited to a single topic, and often hobbled by irrelevant chatter between participants, the ICCE community uses the latest web 2.0 technology to connect behavioral health practitioners from around the globe.  On the site, clinicians can start a discussion group, upload documents, view videos by the field’s most effective practitioners, and seek counsel regarding their most difficult and challenging questions from a group of experts from around the world.

Right now, members are discussing the recent ACE conference, research on the therapeutic alliance, what the literature says about achieving one’s personal best as a clinician, plus much, much more.  If you’re not yet a member, nows the time to join.  It’s free.  No cost whatsoever to join and you won’t be bombarded with adds for books, webinars, videos, or training.  Look forward to meeting you online!

Pushing the Research Envelope: Getting Researchers to Conduct Clinically Meaningful Research

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ACE Health Innovations - Developers of openFIT and mFIT

At the recent ACE conference, I had the pleasure of learning from the world’s leading experts on expertise and top performance.  Equally stimulating were conversations in the hallways between presentations with clinicians, policy makers, and researchers attending the event.  One of those was Bill Andrews, the director of the HGI Practice Research Network in the UK who work over the last 3+ years has focused on clinicians whose outcomes consistently fall in the top quartile of effectiveness.

In this brief interview, Bill talks about the “new direction” his research on top performing clinicians is taking.  He is truly “pushing the research envelope, challenging the field to move beyond the simplistic randomized clinical trials comparing different treatment packages.  Take a look:

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

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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.

Clinician Beware: Ignoring Research Can be Hazardous to Your Professional (and Economic) Health

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“Studies show…”
“Available data indicate…”
“This method is evidence-based…”
My how things have changed. Twenty years ago when I entered the field, professional training, continuing education events, and books rarely referred to research or evidence. Now, everyone refers to the “data.”  The equation is simple: no research = no money.  Having “an evidence-base” increasingly determines book sales, attendance at continuing education events, and myriad other funding and reimbursement decisions.

So what do the data actually say? S adly, the answer is often, “it depends on who you ask.”  If you read the latest summary and treatment recommendations for post-traumatic stress disorder (PTSD) posted by the Cochrane Collaboration, you are told that TFCBT and EMDR are the most effective, “state of the art” treatments on offer.  Other summaries, as I recently blogged about, arrive at very—even opposite—conclusions; namely, all psychotherapies (trauma-focused and otherwise) work equally well in the treatment of PTSD.  For the practicing clinician (as well as other consumers of research), the end result is confusion and, dare I say, despair.

Unable to resolve the discrepant findings, the research is either rejected out of hand (“it’s all crap anyway”) or cherry-picked (“your research is crap, mine is good”).  In a world where experts disagree–and vehemently–what is the average Joe or Jane therapist to do?

Fortunately, there is another way, beyond agnosticism and instead of fundamentalism.   In a word, it is engagement. This last week, I spent 5 days teaching an intensive workshop with ICCE Senior Associate Susanne Bargmann to a group of Danish psychologists on “Statistics and Research Design.”  That’s right.  Five days, 6 hours a day spent away from work and clients learning how to understand, read, and conduct research.

The goal of the training was simple and straight-forward: help practitioners learn to evaluate the methods and meanings, strengths and weaknesses, and political and paradigmatic influences associated with research and evidentiary claims. At the conclusion of the five days, none of those assembled had difficulty engaging with and understanding the reasons for the seemingly discrepant findings noted above. As a result, they could state with confidence “what works” with PTSD, helping clarify this not only to colleagues, payers, and policy members but also to consumers of behavioral health services.

The “Statistics and Research Design” course will be held again in Denmark in 2011.  If the experience of this year’s participants proves anything, it is that, “The only thing therapists have to fear about statistics and research design, is fear itself.”  Please contact Vinther and Mosgaard directly for more information.

Finally, as part of the International Center for Clinical Excellence (ICCE) efforts to improve the quality and outcome of behavioral health services worldwide, two additional intensive trainings will be offered in Chicago, Illinois (USA). First, the “Advanced Training in Feedback-Informed Treatment (FIT).”  And second, the annual “Training of Trainers.”   In the Advanced Training, participants learn:

·         The empirical foundations of feedback-informed clinical work (i.e., empirically supported factors underlying successful clinical work, the impact of feedback on performance)
·         Clinical skills for enhancing client engagement that cut across different therapeutic orientations and diverse treatment populations
·         How to integrate outcome management tools (including one or more of the following: ORS, SRS, CORE, and OQ 45) into clinical practice
·         How to use the outcome management tools to inform and improve service delivery
·         How to significantly improve your clinical skills and outcomes via feedback and deliberate practice
·         How to use data generated from outcome measures to inform management, supervision, and training decisions
·         Strategies for successful implementation of CDOI and FIT in your organization or practice
Need more information about the course?  Email us or click on the video below to hear more about the course.  In the meantime, space is limited so register early at: http://www.eventbrite.ie/o/the-international-centre-for-clinical-excellence-298540255.

Connecting, Learning, and Sharing: The ICCE at One Year

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September 7, 2010
Chicago, Illinois USA

I can’t believe it. Summer is over. Kids are back in school.  And, the International Center for Clinical Excellence (ICCE) is celebrating its one year anniversary!  Time passes so quickly.

On August 25th, 2009, I blogged about the creation of a web-based community of clinicians using the latest Web2.0 technology where participants could learn from and share with each other.  The ICCE website and community was officially launched the following December at the Evolution of Psychotherapy conference.  In a few short months, ICCE had become the largest, international online community of professionals, researchers, and policy makers working to improve the quality and outcome of behavioral health services.

So much more has happened over the last year, including the development and standardization of a training package for clinicians and agencies interested in streamlining the implementation of Feedback-Informed Treatment (FIT), the annual “training of trainers” conference, and much more.  Take a look at the video and see for yourself, and if you are not already a member, join us online today at: www.centerforclinicalexcellence.com.

A week or so ago, I received an email from Susanne Helfgott, the sister of concert pianist David Helfgott who, as you know, will be performing at the upcoming “Achieving Clinical Excellence” conference in Kansas City.  She sent me a link to an interview with David that appeared on Australian morning TV.  David is a perfect example of the theme of the conference: achieving superior performance under challenging circumstances.  Check it out:

Implementing Consumer-Driven, Outcome-Informed (CDOI) Behavioral Health Services: The ICCE and 2010 Training of Trainers Event

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This week I’m in Calgary, Canada. Last week, I was in Charleston, South Carolina. Next week, I’ll be in Marion, Ohio and Bay City, Michigan. In each instance, I’m working with the management and staff of public behavioral health agencies that are busy implementing consumer-driven, outcome-informed clinical work.

Some of the groups are just beginning the process.  Others, as reported here on my blog, have been at it long enough to document significant improvements in outcome, retention, and productivity (i.e., in Ohio and Virginia).  All have told me that implementing the seemingly simple ideas of outcome-informed practice is incredibly hard work–impacting nearly every aspect of agency life.  Being able to access the expertise and experience of fellow clinicians and agency directors in real time when questions and challenges arise is, I’ve also learned, critical in maintaining the momentum necessary for successful implementation.

Enter the ICCE: The International Center for Clinical Excellence.  Briefly, the ICCE is a web-based community of clinicians, researchers, agency managers, and policy makers dedicated to excellence in behavioral health.  Many of the groups I’m working with have joined the site providing them with 24/7/365 access to a deeply knowledgeable world-wide community.  In addition to the numerous topic-specific discussion groups and member-generated videos, organizations can set up private forums where management and clinicians can have confidential discussions and coordinate implementation efforts.

If you are a clinician or agency director and are not already a member, you and/or your organization can access the ICCE community today by visiting the website at: www.centerforclinicalexcellence.com.  Membership is free.  In the video below, I talk with Arjan Van der Weijde, about groups in Holland that are meeting on on the ICCE for practitioners to discuss their implementation of feedback-informed work in the Netherlands.  Check it out.

I’ve also included a brief video about the upcoming “Training of Trainers” course, held each year in August in Chicago.  As in prior years, professionals from all over the world will be joining me and the state-of-the-art faculty for four intensive days of training.  Agencies both public and private, in the U.S. and abroad, are sending staff to the event to learn the skills necessary to lead transformation projects.  Space is already limited so register soon.

The Training of Trainers

The Road to Clinical Excellence is Paved with Practice, Mistakes, & Hard Work

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Last week, I received an email from David Claud.  I’ve known Dave for the better part of a decade, having met–I believe–at a Ericksonian Conference in Florida where he lives and works.  He and the crew at the Center for Family Service in Palm Beach County figure prominently in the history of routine outcome measure and feedback.  After hearing me speak, Dave took the measures back to the center and, together with the staff, became one of the first agencies in the country to formally adopt and use the ORS and SRS.  Additionally, data gathered at CFS was used in some of the initial validation studies of the measures.  Finally, their own research, cited in the second edition of The Heart and Soul of Change document dramatic improvements in outcome as well as decreased lengths of stay, cancellation and no show rates (40, 40, and 25% respectively).

Anyway, in his email, Dave included a link to a recent article by Ann Hulbert in Slate magazine.  I’m lucky to have friends like Dave and others who keep me informed and up-to-date.  The title of the piece certainly got my attention: “The Dark Side of the New Theories of Success: What the New Success Books Don’t tell you about Superachievement.”

As readers of my blog know, I’ve been pouring through the literature on excellence over this last year in an attempt to understand why some clinicians achieve reliably better outcomes than others.  I first wrote about our findings in an article titled, “Supershrinks: Learning from the Field’s Most Effective Practitioners” that appeared in the Psychotherapy Networker.  Since then, I’ve continued to work and research, together with senior associates at the International Center for Clinical Excellence, to deepen and refine the “steps to clinical excellence” that any therapist could follow to improve performance.

Alas, I’m not alone in my interest in the literature on expertise.  A number of books, starting with Gladwell’s delightfully engaging Outliers, have appeared in the last year or so on the subject, including: The Talent Code, Bounce: The Science of Success, The Genius in All of Us: Why Everything You’ve Been Told About Genetics, Talent, and IQ Is Wrong and my personal favorite Talent Is Overrated: What Really Separates World-Class Performers from Everybody Else.  The appearance of so many books is interesting.  With few exceptions (i.e., sports psychology), K. Anders Erickson and colleagues labored in viritual academic obscurity for decades formulating hypotheses, conducting research and assembling evidence.  And then suddenly: boom!  EVERYBODY is talking about their work.

Always wanting to “hear” both sides of the story, I immediately clicked on the link in Dave’s email and read the article.  I was dumbfounded.  Hulbert’s gripe about the recent spate of books is in fact the central point of each: achieving superior performance in any field is bloody hard work.  “They don’t always do realistic justice to the grunt work they champion,” whines Hulbert, tending instead to, “gloss over the sweaty specifics….distracting us from how arduous, tedious, and dependent on adult pushiness it can be…[and] glamorizing its intensity.”

My response: “Oh, contraire mon fraire!”

All of the books and research studies point to the years of dedicated and painstaking work involved in achieving world class levels of performance across a variety of domains (sports, music, medicine, computer programming, and psychology).  K. Ander’s Erickson–who will, by the way, be one of the keynote presenters at the upcoming “Achieving Clinical Excellence” conference–is fond of saying, “Unlike play, deliberate practice is not inherently motivating; and unlike work, it does not lead to immediate social and monetary rewards…and actually generates costs…”.  Little wonder few of us–myself included–engage in it on any regular basis.

The question that begs an answer is, “why would anyone do it?”  Consider the brief video clip below:

Impressive, huh?  I can’t imagine the amount of time it must have taken to master such a performance.  No camera tricks. Just plain old fashioned trial-and-error, practice, and hard work.

We are finding the same pattern among top performing therapists.  In short, they have an “error-centric” approach to practice–constantly looking for what they do that doesn’t work and taking time to plan, identify and try alternatives, and then reflect and refine their process-improvement efforts.  Such activity is cognitively taxing and, in most instances, not immediately rewarding (financially or otherwise).  But there is more to the story.  It turns out that superior performance is not a matter of working harder.  Most of us work hard at our jobs.  Rather, becoming a better clinician is about working smarter.   Here, the literature on expertise provides clear, empirically-supported guidelines.

If you’re feeling inspired, why not pick up one of the books?  Also, be sure and join us at the upcoming “Achieving Clinical Excellence” conference where the ideas and steps will be discussed in detail.

After the Thrill is Gone: Sustaining a Commitment to Routinely Seeking Feedback

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Helsingor Castle (the setting for Shakespeare’s Hamlet)

Dateline: May 8th, 2010, Helsingor, Denmark

This weekend I’m in Denmark doing a two-day workshop on “Supershrinks” sponsored by Danish psychologist and ICCE Senior Associate and Trainer Susanne Bargmann.  Just finished the first day with a group of 30 talented clinicians working diligently to achieve their personal best.  The challenge, I’m increasingly aware, is sustaining a commitment to seeking client feedback over time once the excitement of a workshop is over.  On the surface, the idea seems simple: ask the consumer.  In practice however, it’s not easy.  The result is that many practitioners who are initially enthusiastic lose steam, eventually setting aside the measures.  It’s a serious concern given that available evidence documents the dramatic impact of routine outcome and alliance monitoring on outcome and retention in behavioral health.

Support of like-minded colleagues is one critical key for sustaining commitment “after the thrill is gone.”  Where can you find such people?  As I blogged about last week, over a thousand clinicians are connecting, sharing, and supporing each other on the web-based community of the International Center for Clinical Excellence (If you’re not already a member, click here to request your own personal (and free) invitation to join the conversation).

In the brief interview above, Susanne identifies a few additional steps that practitioners and agencies can take for making the process of seeking feedback successful over the long haul.  By the way, she’ll be covering these principles and practices in detail in an afternoon workshop at the upcoming Achieving Clinical Excellence conference.  Don’t miss it!

Learning, Mastery, and Achieving One’s Personal Best

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Dateline: Sunday, April 25th, 2010 Chicago, IL

There’s a feeling I get whenever I’m learning something new.  It’s a combination of wonder and possibility.  Even though I’ve been traveling and teaching full time for over 18 years, I still feel that get that feeling of excitement whenever I step on a plane: What will I see?  Who will I meet?  What will I learn?  Move over Indiana Jones, you’ve got nothing on me!

On my desk right now are stacks of books on the subject of expertise and expert performance: The Talent Code: Greatness Isn’t Born. It’s Grown. Here’s How, The Genius in All of Us: Why Everything You’ve Been Told About Genetics, Talent, and IQ Is Wrong, The Cambridge Handbook of Creativity, The Psychology of Abilities, Competencies, and Expertise, Why We Make Mistakes: How We Look Without Seeing, Forget Things in Seconds, and Are All Pretty Sure We Are Way Above Average, and many, many more.

On the floor, arranged in neat little piles, are reams of research articles, newspaper clippings, and pages torn out of magazines.  Literally, all on the same subject: how can we clinicians reliably achieve better results?

I’ve never been one to “settle” for very long.  It’s the journey not the destination I find appealing.  Thus, I began exploring the common factors when it became clear that treatment models contributed little if anything to outcome (click here to read the history of this transition).  When I became convinced that the common factors held little promise for improving results in psychotherapy, I followed the lead of two my mentors, professor Michael Lambert (who I worked with as an undergraduate) and psychologist Lynn Johnson (who trained and supervised me), and began measuring outcome and seeking feedback.  Now that research has firmly established that using measures of the alliance and outcome to guide service delivery significantly enhances performance (see the comprehensive summary of research to date below), I’ve grown restless again.

In truth, I find discussions about the ORS and SRS a bit, well, boring.  That doesn’t mean that I’m not using or teaching others to use the measures.  Learning about the tools is an important first step.  Getting clinicians to actually use them is also important.  And yet, there is a danger if we stop there.

Right now, we have zero evidence that measurement and feedback improves the performance of clinicians over time.  More troubling, the evidence we do have strongly suggests that clinicians do not learn from the feedback they receive from outcome and alliance measures.  Said another way, while the outcome of each particular episode of care improves, clinicians overall ability does not.   And that’s precisely why I’m feeling excited–the journey is beginning…

…and leads directly to Kansas City where, on October 20-22nd, 2010, leading researchers and clinicians will gather to learn the latest, evidence-based information and skills for improving performance in the field of behavioral health.  As of today, talented professionals from Australia, Sweden, Norway, Denmark, Germany, England, Israel, and the United States have registered for the international “Achieving Clinical Excellence” conference.  Some common questions about the event include:

1. What will I learn?

How to determine your overall effectiveness and what specifically you can do to improve your outcomes.

2. Is the content new?

Entirely.  This is no repeat of a basic workshop or prior conferences.  You won’t hear the same presentations on the common factors, dodo verdict, or ORS and SRS.   You will learn the skills necessary to achieve your personal best.

3. Are continuing education credits available?

Absolutely–up to 18 hours depending on whether you attend the pre-conference “law and ethics” training.  By the way, if you register now, you’ll get the pre-conference workshop essentially free!  Three days for one low price.

4. Will I have fun?

Guaranteed.  In between each plenary address and skill building workshop, we’ve invited superior performers from sports, music, and entertainment to perform and inspire .  If you’ve never been to Kansas City, you’ll enjoy the music, food, attractions, and architecture.

Feel free to email me with any questions or click here to register for the conference.  Want a peak at some of what will be covered?  Watch the video below, which I recorded last week in Sweden while “trapped” behind the cloud of volcanic ash.  In it, I talk about the “Therapists Most Likely to Succeed.”

Outcomes in New Zealand

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Made it back to Chicago after a week in New Zealand providing training and consultation.  As I blogged about last Thursday, the last two days of my trip were spent in Christchurch providing a two-day training on “What Works” for Te Pou–New Zealand’s National Centre of Mental Health Research, Information, and Workforce Development.  Last year around this same time, I provided a similar training for Te Pou for managers and policy makers in Auckland.  News spread and this year my contact at Te Pou, Emma Wood brought the training to the south island.  It is such a pleasure to be involved with such a forward thinking organization.

Long before I arrived, leadership at Te Pou were promoting outcome measurement and feedback.  Here’s a direct quote from their website:

Outcomes information can assist:

  • service users to use their own outcomes data to reflect on their wellbeing and circumstances, talk to clinicians about their support needs and inform their recovery plans
  • clinicians to use outcomes information to support their decision-making in day-to-day practice, monitoring change, better understanding the needs of the service user, and also to begin evaluating the effectiveness of different interventions
  • planners and funders to assess population needs for mental health services and assist with allocation of resources policy and mental health strategy developments through nationally aggregated data.

Indeed, using outcome to inform mental health service delivery is a key aspect of the Past, Present, and Future: Vision Paper–a review of “what works” in care and a plan for improving treatment in the future.  The site even publishes a quarterly newsletter Outcomes Matter.  Take a few minutes and explore the Te Pou website.  While you are there, be sure and download the pamphlet entitled, “A Guide to Talking Therapies.”  As the title implies, this brief, easy-to-read text provides a non-nonsense guide to the various “talk therapies” for consumers (I took several copies home with me from the workshop).

Before ending, let me say a brief hello to the Clinical Practice Leaders from the Problem Gambling Foundation of New Zealand who attended the two-day training in Christchurch.    The dedicated staff use an integrated public health and clinical model and are working to implement ongoing measurement of outcome and consumer feedback into service delivery.  The website contains a free online library including fact sheets, research, and books on the issue of problem gambling that is an incredible resource to professionals and the public.  Following the workshop, the group sent a photo that was taken of us together.  From left to right, they are Wenli Zhang, me, Margaret Sloan, and Jude West.

Leading for a Change: The Training of Trainer’s (TOT) Chicago

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I’m writing tonight from my hotel room at the River Rock Inn in Rockland, Ontario, Canada.  For those of you who are not familiar with the area, it is a bilingual (French & English) community of around 9,000 located about 25 km west of Ottawa.

Today through Thursday, I’m working with the staff, supervisors, and agency administrators of Prescott-Russell Services to Children and Adults.  The goal?  Introduce the latest “cutting-edge” research on “what works” in behavioral health and initiate a system transformation project for this group that provides child protection, mental health, family violence, and development services in the area.  The time spent with the first cohort of 125 direct services providers and supervisors went by, as they say, in “the blink of an eye.”  Tomorrow, I’ll be repeating the same training for the rest of the crew.  On Wednesday and Thursday I’ll meet with supervisors and administrators.  Suffice it to say, it’s an incredible opportunity for me to take part in such a large and well executed service improvement project.  In these lean economic times, I’m inspired by both the time and resources being directed at improving services offered to this area’s most needy.  By the end of the week, I hope to have interviews posted with some of the providers and leaders working in the project.

While on the subject of training, let me share the brochure for this year’s “Training of Trainers” event in Chicago, Illinois during the second week of August.  As in prior years, professionals from all over the world will be joining me and the state-of-the-art faculty for four intensive days of training on feedback-informed treatment (FIT).  Please note: this is not an “advanced training” in FIT where time is spent reviewing the basics or covering content.  Rather, the TOT curriculum has been designed to prepare participants to train others.  Every day of the training, you will learn specific skills for training others, have an opportunity to practice those skills, and then receive detailed feedback from ICCE Senior Associates and Trainers Rob Axsen, Cynthia Maeschalck, and Jason Seidel.  Anyway, read for yourself.  Agencies both public and private, in the U.S. and abroad, are sending staff to the event to learn the skills necessary to lead transformation projects.  Space is already limited so register soon.

Click here to download the brochure to review or forward to colleagues

Deliberate Practice, Expertise, & Excellence

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Later today, I board United flight 908 on my way to workshops scheduled in Holland and Belgium.  My routine in the days leading up to an international trip is always the same.  I slowly gather together the items I’ll need while away: computer (check); european electric adapter (check); presentation materials (check); clothes (check).   And, oh yeah, two decks of playing cards and close up performance mat.

That’s me (pictured above) practicing a “ribbon spread” in my hotel room following a day of training in Marion, Ohio.  It’s a basic skill in magic and I’ve been working hard on this (and other moves using cards) since last summer.  Along the way, I’ve felt both hopeful and discouraged.  But I’ve kept on nonetheless taking heart from what I’m reading about skill acquisition.

Research on expertise indicates that the best performers (in chess, medicine, music, sports, etc.) practice every day of the week (including weekends) for up to four hours a day.  Sounds tiring for sure.  And yet, the same body of evidence shows that world class performers are able to sustain such high levels of practice because they view the acquisition of expertise as a long-term process.  Indeed, in a study of children, researcher Gary McPherson found that the answer to a simple question determined the musical ability of kids a year later: “how long do you think you’ll play your instrument?”  The factors that were shown to be irrelevant to performance level were: initial musical ability, IQ, aural sensitivity, math skills, sense of rhythm, income level, and sensorimotor skills.

The type of practice also matters.  When researchers Kitsantas and Zimmerman studied the skill acquisition of experts, they found that 90% of the variation in ability could be accounted for by how the performers described their practice; the types of goals they set, how they planned and executed strategies, self-monitored, and adapted their performance in response to feedback.

So, I take my playing cards and close-up mat with me on all of my trips (both domestic and international).  I don’t practice on planes.  Gave that up after getting some strange stares from fellow passengers as they watched me repeat, in obsessive fashion, the same small segment of my performance over, and over, and over again.  It only made matters worse if they found out I was a psychologist.  I’d get that “knowing look,” that seemed to say, “Oh yeah.”  Anyway, I also managed to lose a fair number of cards when the deck–because of my inept handling while trying to master some particular move–went flying all over the cabin (You can imagine why I’ve been less successful in keeping last year’s New Year resolution to learn to play the ukelele).

Once I’m comfortably situated in my room, the mat and cards come out and I work, practice a specific handling for up to 30 minutes followed by a 15-20 minute break.  Believe it or not, learning–or perhaps better said, attempting to learn–magic has really been helpful in understanding the acquisition of expertise in my chosen field: psychology and psychotherapy.  Together with my colleagues, we are translating our experience and the latest research on expertise into steps for improving the performance and outcome of behavioral health services.  This is, in fact, the focus of the newest workshop I’m teaching, “Achieving Clinical Excellence.”   It’s also the organizing theme of the ICCE Achieving Clinical Excellence conference that will be held in Kansas City, Kansas in October 2010.  Click on the photo below for more information.

In the meantime, check out the two videos I’ve uploaded to ICCETV featuring two fun magic effects.  And yes, of course, feedback is always appreciated!

The Future of Behavioral Health: Integrated Care & Entrepreneurship

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Nicholas Cummings, Ph.D.

Sometime in late 1986 I wrote a letter to Dr. Nicholas Cummings.  As a then student-member of the American Psychological Association (APA), I was automatically subscribed to and receiving the American Psychologist.  In the April issue, Dr. Cummings published an article, provocatively titled, “The Dismantling of Our Health System: Strategies for the Survival of Psychological Practice.”  Change was in the air. “Traditional psychology practice is both inefficient and ineffective,” he argued, and a “growing revolution in heath care” was a clear and present danger to the very survival of the field.

What can I say?  As someone at the beginning of his career (with large student loans to repay and a long time to go before retirement), the five page article spooked me.  So I did what I’d done before: I wrote a letter.  I’d been writing and calling prominent researchers and clinicians ever since I was an undergraduate.  During the 70’s, I’d exchanged letters and even phone calls with B.F. Skinner!

In all honesty, I didn’t know anything about Dr. Cummings–for example, that he was a former president of the APA, launched the Professional Schools of Psychology movement and founded four campuses of the California School of Professional Psychology, wrote the freedom-of-choice legislation requiring insurers to reimburse non-medical, behavioral health providers, and started American Biodyne in the hopes that psychologists could own rather than be owned–as eventually happened–by managed care (read a history here).  Neither did I know that he was a member of Psychology’s famed “Dirty Dozen.” Without a doubt, however, the decision to write him, changed the arc of my career.

Fast forward 25 years, and 86-year-old Nicholas Cummings is at it again–not only sounding a warning klaxon but identifying the opportunities available in the dramatically changing healthcare environment.  Sadly, the field (and professional psychology in particular) ignored the counsel he’d given back in 1986.  As a result, business interests took over managed care, resulting–just as he predicted–in low wages and the near complete lack of professional autonomy.

So, what can clinicians do now to survive and thrive?  According to Dr. Cummings, two words best capture the future of behavioral health: (1) integrated care; and (2) entrepreneurship.  Let’s face the unpleasant reality and say it out loud: independent practice is on life support.  Agency work is no picnic either given the constant threats to funding and never ending amount of regulation and paperwork.  Finally, when it comes to practitioner income, its a buyer’s market.

That said, it’s not all doom and gloom.  Far from it.  There is a tremendous need (and opportunity) in the present reform-driven healthcare marketplace for clinicians who are able to blend behavioral interventions, medical literacy, knowledge about healthcare delivery systems, and entrepreneurship skills.  Possibilities do exist.  The real question is, “Do we have the will to change?”  Here’s where the power of one simple action–in this instance, a phone call–can have such a profound effect on one’s life and success.

Though we never formally worked together, I’ve been calling and writing Nick off and on for the two and a half decades.  Late last fall, my partners and co-creators of the International Center for Clinical Excellence, Brendan Madden and Enda Madden, flew to Reno to seek his advice on our business plan.  We simply called him.  He said, “When can you get here?”  The result?  His sage counsel helped us win the InterTrade Seedcorn Regional Prize for “Best Emerging Company” as well as secure investors in the most restrictive venture capital environment since the Great Depression.  And that’s not all…

Chief Technology Officer Enda Madden    Chief Executive Officer Brendan Madden

Just last week, I flew to Phoenix, Arizona to give a presentation on using outcomes to improve behavioral healthcare service delivery at Arizona State University.  Nick was there to meet me, along with the director of an entirely new program for behavioral health entrepreneurs, Dr. Ron O’Donnell.  Briefly, the “Doctor of Behavioral Health” is the culmination of Nick’s vision of creating a doctoral training program tailored to the emerging need for innovative behavioral clinicians to practice in primary care and medical settings.  Response has been overwhelming to say the least.  Fifty plus post-graduate clinicians are enrolled.   That’s right, post-graduate.  In other words, these are practicing clinicians returning to add “integrated care expert and behavioral health entrepreneur” to their resume.


School of Letters and Sciences

As it turns out, I’ll be traveling from Chicago to Phoenix a fair amount in the future.  When he stood to introduce me, Nick announced that I’d be filling the “Cummings Professor of Behavioral Health” faculty position at ASU.  The power of a single call.

Behavioral Healthcare in Holland: The Turn Away from the Single-payer, Government-Based Reimbursement System

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Several years ago I was contacted by a group of practitioners located in the largest city in the north of the Netherlands–actually the capital of the province known as Groningen.  The “Platform,” as they are known, were wondering if I’d be willing to come and speak at one of their upcoming conferences.  The practice environment was undergoing dramatic change, the group’s leadership (Dorti Been & Pico Tuene) informed me.  Holland would soon be switching from government to a private insurance reimbursement system.  Dutch practitioners were “thinking ahead,” preparing for the change–in particular, understanding what the research literature indicates works in clinical practice as well as learning methods for documenting and improving the outcome of treatment.

I was then, and remain now, deeply impressed with the abilities and dedication of Dutch practitioners.  During that visit to Groningen, and the many that have followed (to Amsterdam, Rotterdam, Beilen, etc.), its clear that clinicians in the Netherlands are determined to lead rather than be led.  I’ve been asked to meet with university professors, practitioner organizations, training coordinators, and insurance company executives.  In a very short period of time, two Dutch therapists–physician Flip Van Oenen and psychologist Mark Crouzen–have completed the “Training of Trainers” course and become recognized trainers and associates for the International Center for Clinical Excellence.  And finally, a study will soon be published showing sound psychometric properties of the Dutch translations of the ORS and SRS.

I’ve also been working closely with the Dutch company Reflectum–a group dedicated to supporting outcome-informed healthcare and clinical excellence.  Briefly, Reflectum has organized several conferences and expert meetings between me and clinicians, agency managers, and insurance companies.  One thing for sure: we will be working closely together to train a network of trainers and consultants to promote, support, and train agencies and practitioners in outcome-informed methods in order to meet the demands of the changing practice climate.

Check out the videobelow filmed at Schipol airport during one of my recent trips to Holland:

Outcomes in the Artic: An Interview with Norwegian Practitioner Konrad Kummernes

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Dateline: Mosjoen, Norway

The last stop on my training tour around northern Norway was Mosjoen.  The large group of psychologists, social workers, psychiatrists, case managers, and physicians laughed uproariously when I talked about the bumpy, “white-knuckler” ride aboard the small twin-engine airplane that delivered me to the snowy, mountain-rimmed town. They were all to familiar with the peculiar path pilots must follow to navigate safely between the sharp, angular peaks populating the region.

Anyway, I’d been invited nearly two years earlier to conduct the day-long training on “what works in treatment.” The event was sponsored by Helgelandssykehuset-Mosjoen and organized by Norwegian practitioner Konrad Kummernes.  I first met Konrad at a conference held in another beautiful location in Norway (is there any other type in this country?!), Stavanger–best known for its breathtaking Fjordes.  The goal for the day in Mosjoen?  Facilitate the collaboration between the many different services providers and settings thereby enabling the delivery of the most effective and comprehensive clinical services.  Meeting Konrad again and working with the many dedicated professionals in Mosjoen was an inspiration. Here’s Konrad:

"What Works" in Norway

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Dateline: Tromso, Norway
Place: Rica Ishavshotel

For the last two days, I’ve had the privilege of working with 125+ clinicians (psychotherapists, psychologists, social workers, psychiatrists, and addiction treatment professionals) in far northern Norway.  The focus of the two-day training was on “What Works” in treatment, in particular examining what constitutes “evidence-based practice” and how to seek and utilize feedback from consumers on an ongoing basis.  The crowd was enthusiastic, the food fantastic, and the location, well, simply inspiring.  Tomorrow, I’ll be working with a smaller group of practitioners, doing an advanced training.  More to come.

Magical Moments in Kansas

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Registrations are already coming in for the first International Conference on “Achieving Clinical Excellence.”

Not too long ago, I announced that internationally known researcher K. Anders Erickson, Ph.D.–the “expert on experts”–had agreed to present at the event.  At that time, I also indicated that a number of internationally accomplished performers from a variety of professions (including psychology, business, medicine, science, music, entertainment, and sports) would be with us in Kansas City to teach and inspire.  Attendees will learn the science and skills for achieving their personal best as a behavioral health practitioner by literally learning from the best.

Practice, as anyone who has been reading my recent blogosts and publications knows, is key for achieving excellence–and not just any old kind will do.  To be effective, it must be deliberate, reflective, and ongoing.   What’s more, it must be accompanied with high levels of support and detailed instruction from exceptional teachers.

michael ammart

No performer embodies these two principles–dedicated practice and exceptional teaching–better than FISM gold-medial winning magician, Michael Ammar.  Magic magazine named him one of the 100 most influential magicians of the century.

Michael will open the second day of the the conference.  First, he’ll perform. What can I say?  You’ll be astonished and amazed.  After that, Michael will talk about the role of practice in achieving excellence.  He’s a master teacher who has spent years studying the elements of successful practice.  He’ll not only inspire you, he will provide you with the means to excel.

Join us for three action packed days of fun, science and skill building.  In the meantime, if you have a spare moment, watch Michael Ammar perform one of the classics of magic: the cups and balls.

 

The Evolution of Psychotherapy: Meeting Michael Hoyt

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I’m still reeling from the experience in Anaheim this last week.  I met so many leaders in the field, heard so many presentations on cutting edge clinical practice–as well as was reminded of some “classic” principles of effective psychotherapy.

One of the people I met was colleague and friend, Michael F. Hoyt, Ph.D.  Michael and I go back 15+ years, having met–I believe–the first time at a workshop I was giving in Northern California (somewhere in the Bay Area where Michael works and resides).  Since that time, we chatted regularly, and written editorials and book chapters together.  His books (The First Session in Brief Therapy, Brief Therapy & Managed Care, The Handbook of Constructive Therapies, Some Stories are Better than Others) always balance theory and practice and are among my favorites.

My two favorite books are also his most recent: The Present is a Gift and Brief Psychotherapies: Principles & Practice (Hint: his chapters on couples therapy are among the best I’ve ever read).  Anyway, the two of us caught up at the ICCE booth this last week at the Evolution conference.

Five Incredible Days in Anaheim

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From December 9-13th, eight thousand five hundred mental health practitioners, from countries around the globe, gathered in Anaheim, California to attend the “Evolution of Psychotherapy” conference.  Held every five years since 1985, the conference started big and has grown only larger.  “Only a few places in the US can accommodate such a large gathering,” says Jeffrey K. Zeig, Ph.D., who has organized the conference since the first.

The event, held every five years, brings together 40 of the field’s leading researchers, practitioners, trend setters, and educators to deliver keynote addresses and workshops, host discussion panels, and offer clinical demonstrations on every conceivable subject related to clinical practice.  Naturally, I spoke about my current work on “Achieving Clinical Excellence” as well as served on several topical panels, including “evidence based practice” (with Don Meichenbaum), “Research on Psychotherapy” (with Steven Hayes and David Barlow), and “Severe and Persistent Mental Illness (with Marsha Linnehan and Jeff Zeig).

Most exciting of all, the Evolution of Psychotherapy conference also served as the official launching point for the International Center for Clinical Excellence.  Here I am pictured with long-time colleague and friend, Jeff Zeig, and psychologist and ICCE CEO, Brendan Madden, in front of the ICCE display in the convention center hall.

Over the five days, literally hundreds of visitors stopped by booth #128 chat with me, Brendan, and Senior ICCE Associates and Trainers, Rob Axsen, Jim Walt, Cynthia Maeschalck, Jason Seidel, Bill Andrews, Gunnar Lindfeldt, and Wendy Amey.  Among other things, a cool M and M dispenser passed out goodies to folks (if they pressed the right combination of buttons), we also talked about and handed out leaflets advertising the upcoming “Achieving Clinical Excellence” conference, and finally people watched a brief video introducing the ICCE community.  Take a look yourself:.


More to come from the week in Anaheim….

Evolution of Psychotherapy and the International Center for Clinical Excellence

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evolution-2005

Dateline: Chicago, Illinois
December 7, 2009

I’ve just finished packing my bags and am heading for the airport.  Tomorrow the “Evolution of Psychotherapy” begins.  Nearly 25 years after volunteering at the first “Evolution” conference, I’m back a second time to present.  Tomorrow, I’ll be talking about “Achieving Clinical Excellence.”  On the days that follow, I’m on panels with my friend Don Meichenbaum, as well as David Barlow, Marsha Linnehan, and others.  I’m really looking forward to the four days in Anaheim.

Of everything going on in sunny southern California, I have to say that I’m most excited about the launch of the International Center for Clinical Excellence.  We have a booth (#128) in the exhibitor hall where folks can stop by, talk, and peruse our new website.  As promised, it is a true web 2.0 experience, enabling clinicians researchers. and educators around the world to connect, share, and learn from each other.

We’ll be streaming video to facebook and twitter. Stay tuned to my blog and twitter accounts as well for updates, videos, and pictures from the conference.

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

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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!

International "Achieving Clinical Excellence" Conference

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Mark your calendars!  The International Center for Clinical Excellence is pleased to announce the “Achieving Clinical Excellence” (ACE) conference to be held at the Westin Hotel in Kansas City, Missouri on October 20-22nd, 2010.

K. Anders Erickson, Ph.D., the editor of The Cambridge Handbook of Expertise and Expert Performance and recognized “expert on experts,” will keynote the event. Through a combination of plenary presentations and intensive workshops, an internationally renowned faculty of researchers and educators, including Scott D. Miller, Ph.D. and John Norcross, Ph.D., will help participants discover the means to achieve excellence in clinical practice, leadership, ethics, and personal care.

Attendees will also meet and learn directly from internationally ranked performers from a variety of professions, including medicine, science, music, entertainment, and sports.  As just one example, the Head Coach of the Olympic, Gold-Medal-winning Women’s volleyball team, Hugh McCutcheon, will present at the conference.  In addition to a pre-conference day on ethics and law, internationally renowned concert pianist David Helfgott, whose heart-warming story was featured in the award winning film Shine, will perform on Thursday evening, October 21st. Join us in Kansas City for three days of science, skill building, and inspiration.