Questions and Answers about Feedback Informed Treatment and Deliberate Practice: Another COVID-19 Resource

April 16, 2020 By scottdm 5 Comments

Since they were developed and tested back in the late 90’s, the Outcome and Session Rating Scales have been downloaded by practitioners more than 100,000 times! Judging by the number of cases entered into the three authorized software applications, the tools have been used inform service delivery for millions of clients seeking care for different problems in diverse treatment settings. The number of books, manuals, and “how to” videos describing how to use the tools has continued to grow dramatically. And most weeks, I’m traveling somewhere to provide training or consultation on feedback informed treatment (FIT) — that is, until the COVID-19 outbreak.

Wanting to stay in touch, I offered to meet people online to connect and answer any FIT-related questions. When all 100 spots for the first webinar filled within two hours, we scheduled another. It’s also full to capacity. We are planning more such free events in the future.

In the meantime, I’m making the recordings for each available here. While I know its not the same as being together live, I think you’ll be surprised by the depth and breadth of the information covered. Below you will find the first. You can listen to the entire broadcast or use the guide below to jump directly to the questions that matter most to you. In the meantime, be on the lookout for the announcement of the next live broadcast!

How to get started with FIT? (2:23)
How can I encourage my clients to provide open, honest feedback? (10:30; revisited 36:15)
Should I start using the measures with established clients? (13:18, revisited 17:05)
How do I know how effective I am? (14:45)
How to interpret ORS and SRS feedback (18:10)
How to use the scales online/on the phone? (22:00)
How effective is supervision? (26:58)
How to work with mandated clients? (31:30)
Why do some clients not give feedback? (37:00)
What is deliberate practice and how to apply it for improving therapist effectiveness? (46:00)

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

Joint Commission and SAMHSA Set New Standard of Care for Measurement Based Care

January 29, 2018 By scottdm 1 Comment

The Joint Commission has recently revised their standards of care. To maintain accreditation, organizations are now required to assess outcomes with a standardized measurement tool.

The Substance Abuse and Mental Health Services Administration is moving in the same direction.

Two scales I developed met the new standard. Both are listed on the Joint Commission and SAMSHA websites. The Outcome and Session Rating Scales (ORS, SRS) are brief, well-validated tools in use in clinical settings around the world.

The new standard has the potential to significantly improve the effectiveness and efficiency of care. Studies also show, however, that implementation is a complex process with many challenges. Indeed, despite significant investment of time and resources, many organizations fail.

Click here for a free handout to assess the readiness of your agency. It’s one of the many resources provided at the ICCE Feedback-Informed Treatment Implementation workshop—the only evidence-based implementation training on measurement-based care to receive perfect marks for implementation materials, training and support resources, and quality assurance procedures by the National Registry of Evidence-based Programs and Practices (NREPP).

As always, feel free to email me with any questions.

All the best,

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

Something BIG is Happening: The Demand for Routine Outcome Measurement from Funders

October 16, 2017 By scottdm 2 Comments

Something is happening. Something big.

Downloads of the Outcome and Session Rating Scales have skyrocketed.

The number of emails I receive has been steadily increasing.

The subject? Routine outcome measurement. The questions:

Where can I get copies of your measures?

Paper and pencil versions are available on my website.

What is the cost?

Individual practitioners can access the tools for free. Group licenses are available for agencies and healthcare systems.

Can we incorporate the tools into our electronic healthcare record (E.H.R.)?

Three companies are licensed and authorized to provide an “Application Program Interface” (or API) for integrating the ORS, SRS, data aggregation formulas, and feedback signals directly into your E.H.R. Detailed information and contact forms are available in a special page on my website.

What evidence is available for the validity, reliability, and effectiveness of the measures?

Always a good question! Since the tools were published seventeen years ago, studies have multiplied. Keeping up with the data can be challenging as the tools are being used in different settings and with diverse clinical populations around the world.

Each year, together with my colleague, New Zealand psychologist, Eeuwe Schuckard, we add the latest research to a comprehensive document available for free online, titled “Measures and Feedback.”

Additionally, the tools have been vetted by an independent group of research scientists and are listed on the Substance Abuse and Mental Health Administration’s National Registry of Evidence-based Programs and Practices.

How can I (or my agency) get started?

Although it may sound simple and straightforward, this is the hardest question to answer. There is often a tone of urgency in the emails I receive, “We need to measure outcomes now,” they say.

I nearly always respond with the same advice: the fastest way to succeed is to go slow.

We’ve learned a great deal about implementation over the last 10 years. Getting practitioners to administer outcome measures is easy. I can teach them how in less than three minutes. Making the process more than just another, dreary “administrative task” takes time, patience, and persistence.

I caution against purchasing licenses, software, or onsite training. Instead, I recommend taking time to explore. It’s why the reviewers at SAMHSA gave our application for evidence-based status the highest ratings on “implementation support.”

To succeed, start with:

Accessing a set of the ICCE Feedback Informed Treatment Manuals–the single, most comprehensive resource available on using the ORS and SRS. Read and discuss them together with colleagues.
Connect with practitioners and agencies around the world who have already implemented. It’s easy. Join the International Center for Clinical Excellence–the world’s largest online community dedicated to routine outcome measurement.
Send a few key staff–managers, supervisors, implementation team leaders–to the Feedback-Informed Treatment Intensives. The Advanced and Supervision workshops are held back-to-back each March in Chicago. Participants not only leave with a thorough understanding of the ORS and SRS, but ready to kick off a successful implementation at home. I tell people to sign up early as the courses are limited to 35 participants and always sell out a couple of months in advance.

Feel free to email me with any questions.

Until next time,

Scott

Scott D. Miller, Ph.D.
International Center for Clinical Excellence

The Illness and the Cure: Two Free, Evidence-based Resources for What Ails and Can Heal Serious Psychological Distress

April 18, 2017 By scottdm 14 Comments

Findings from several recent studies are sobering. Depression is now the leading cause of ill-health and disability worldwide–more than cancer, heart disease, respiratory problems, and accidents. Yesterday, researchers reported that serious psychological distress is at an all-time high, significantly affecting not only quality but actual life expectancy. And who has not heard about the opioid crisis–33,000 deaths in the U.S. in 2015 and rising?

The research is clear: psychotherapy helps. Indeed, its effectiveness is on par with coronary artery bypass surgery. Despite such results, availability of mental health services in the U.S. and other Westernized nations has seriously eroded over the last decade. Additionally, modern clinical practice is beset by regulation and paperwork, much of which gets in the way of treatment’s most important healing ingredient: the relationship.

What can practitioners do? Students Taking Notes at Desks by VCU_Brandcenter

Completing paperwork together with clients during the visit–a process termed, “collaborative (or concurrent) documentation”–has been shown to save full-time practitioners between 6 and 8 hours per week, thereby improving capacity up to 20%.

It’s a great idea: completing assessments, treatment plans, and progress notes together with clients during rather than after the session. Unfortunately, it’s chief selling point to date seems to be that it saves time on documentation–as though filling out paperwork is an end in and of itself! Clearly, the real challenges facing mental health services are getting people into and keeping them in care. Here, the research literature is clear, people are more likely to stay engaged in care that is: (1) organized around their goals; and (2) works. Collaborating on and coming to a consensus regarding the goals for treatment, for example, has the largest impact on outcome among all of the relationship factors in psychotherapy, including empathy! Additionally, when documentation FITs the clients’ view of the process and is deemed transparent and respectful, trust–another essential ingredient of the therapeutic relationship–improves.

For the last several years, practitioners and agencies around the world have been using the ICCE “Service Delivery Agreement” and “Progress Note” as part of their documentation of clinical services. Both were specifically designed to be completed collaboratively with clients at the time the service is provided and both are focused on documenting what matters to people in treatment. Most important of all, however, both are part of an evidence-based process documented to improve engagement and effectiveness listed on SAMHSA’s National Registry of Evidence-based Programs and Practices.

For the next short while, I’ll send you the forms for free, along with a detailed instruction booklet for incorporating them into your clinical work. Reduce the “paper curtain” in your practice. Just email me at scottdmiller@talkingcure.com. Better yet, register for our upcoming intensive trainings this summer in Chicago. Click on any of the course icons to the right for detailed information.

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence

Ohio Update: Use of CDOI improves outcome, retention, and decreases "board-level" complaints

August 5, 2010 By scottdm Leave a Comment

A few days ago, I received an email from Shirley Galdys, the Associate Director of the Crawford-Marion Alcohol and Drug/Mental Health Services Board in Marion, Ohio. Back in January, I blogged about the steps the group had taken to deal with the cutbacks, shortfalls, and all around tough economic circumstances facing agencies in Ohio. At that time, I noted that the dedicated administrators and clinicians had improved the effectiveness and efficiency of treatment so much by their systematic use of Feedback-Informed Treatment (FIT) that they were able to absorb cuts in funding and loss of staff without having to cut services to their consumers.

Anyway, Shirley was writing because she wanted to share some additional good news. She’d just seen an advance copy of the group’s annual report. “Since we began using FIT over two years ago,” she wrote, “board level complaints and grievances have decreased!”

In the past, the majority of such complaints have centered on client rights. “Because of FIT,” she continued, “we are making more of an effort to explain to people what we can and cannot do for them as part of the ‘culture of feedback’….we took a lot for granted about what people understood about behavioral health care prior to FIT.”

The Crawford-Marion Alcohol and Drug/Mental Health Services Board is now into the second full year of implementation. They are not merely surviving, they are thriving! In the video below, directors Shirley Galdys, Bob Moneysmith, and Elaine Ring talk about the steps for a successful implementation.

Outcomes in OZ III

December 4, 2009 By scottdm Leave a Comment

Dateline: November 28, 2009 Brisbane, Australia

Crown Plaza Hotel
Pelican Waters Golf Resort & Spa

As their name implies, LifeLine Australia is the group people call when they need a helping hand. During the last leg of my tour of eastern Australia, I was lucky enough to spend two days working with Lifeline’s dedicated and talented clinicians on improving the retention and outcome of clinical services they offer.

The two-day conference was the kick off for a “transformation project,” as Trevor Carlyon, the executive director of Lifeline Community Care points out in the video segment below, the stated goal of which is “putting clients back at the center of care.” Nearly 200 clinicians working with a diverse clientele located throughout northern Queensland gathered for the event. I look forward to returning in the future as the ideas are implemented across services throughout the system.