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

April 16, 2020 By scottdm 4 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.

Here is one more option for support: a recording of a live webinar discussing FIT and deliberate practice with professionals from around the world. I think you’ll be surprised by the depth and breadth of the information covered. You can listen to the entire broadcast or use the guide below to jump directly to the questions that matter most to you.

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)

It’s Time to Abandon the “Mean” in Psychotherapy Practice and Research

April 8, 2019 By scottdm 6 Comments

Recognize this? Yours will likely look at bit different. If you drive an expensive car, it may be motorized, with buttons automatically set to your preferences. All, however, serve the same purpose.

Got it?

It’s the lever for adjusting your car seat.

I’m betting you’re not impressed. Believe it or not though, this little device was once considered an amazing innovation — a piece of equipment so disruptive manufacturers balked at producing it, citing “engineering challenges” and fear of cost overruns.

For decades, seats in cars came in a fixed position. You could not move them forward or back. For that matter, the same was the case with seats in the cockpits of airplanes. The result? Many dead drivers and pilots.

The military actually spent loads of time and money during the 1940’s and 50’s looking for the source of the problem. Why, they wondered, were so many planes crashing? Investigators were baffled.

Every detail was checked and rechecked. Electronic and mechanical systems tested out. Pilot training was reviewed and deemed exceptional. Systematic review of accidents ruled out human error. Finally, the equipment was examined. Nothing, it was determined, could not have been more carefully designed — the size and shape of the seat, distance to the controls, even the shape of the helmet, were based on measurements of 140 dimensions of 4,000 pilots (e.g., thumb length, hand size, waist circumference, crotch height, distance from eye to ear, etc.).

It was not until a young lieutenant, Gilbert S. Daniels, intervened that the problem was solved. Turns out, despite of the careful measurements, no pilot fit the average of the various dimensions used to design the cockpit and flight equipment. Indeed, his study found, even when “the average” was defined as the middle 30 percent of the range of values on any given indice, no actual pilot fell within the range!

The conclusion was as obvious as it was radical. Instead of fitting pilot into planes, planes needed to be designed to fit pilots. Voila! The adjustable seat was born.

Now, before you scoff — wisecracking, perhaps, about “military intelligence” being the worst kind of oxymoron — beware. The very same “averagarianism” that gripped leaders and engineers in the armed services is still in full swing today in the field of mental health.

Perhaps the best example is the randomized controlled trial (RCT) — deemed the “gold standard” for identifying “best practices” by professional bodies, research scientists, and governmental regulatory bodies.

However sophisticated the statistical procedures may appear to the non-mathematically inclined, they are nothing more than mean comparisons.

Briefly, participants are recruited and then randomly assigned to one of two groups (e.g., Treatment A or a Control group; Treatment A or Treatment as Usual; and more rarely, Treatment A versus Treatment B). A measure of some kind is administered to everyone in both groups at the beginning and the end of the study. Should the mean response of one group prove statistically greater than the other, that particular treatment is deemed “empirically supported” and recommended for all.

The flaw in this logic is hopefully obvious: no individual fits the average. More, as any researcher will tell you, the variability between individuals within groups is most often greater than variability between groups being compared.

Bottom line: instead of fitting people into treatments, mental health care should be to made to fit the person. Doing so is referred to, in the psychotherapy outcome literature, as responsiveness — that is, “doing the right thing at the right time with the right person.” And while the subject receives far less attention in professional discourse and practice than diagnostic-specific treatment packages, evidence indicates it accounts for why, “certain therapists are more effective than others…” (p. 71, Stiles & Horvath, 2017).

I’m guessing you’ll agree it’s time for the field to make an “adjustment lever” a core standard of therapeutic practice — I’ll bet it’s what you try to do with the people you care for anyway.

Turns out, a method exists that can aid in our efforts to adjust services to the individual client. It involves routinely and formally soliciting feedback from the people we treat. That said, not all feedback is created equal. With a few notable exceptions, all routine outcome monitoring systems (ROM) in use today suffer from the same problem that dogs the rest of the field. In particular, all generate feedback by comparing the individual client to an index of change based on an average of a large sample (e.g., reliable change index, median response of an entire sample).

By contrast, three computerized outcome monitoring systems use cutting edge technology to provide feedback about progress and the quality of the therapeutic alliance unique to the individual client. Together, they represent a small step in providing an evidence-based alternative to the “mean” approaches traditionally used in psychotherapy practice and research.

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

Helping Therapists Help: MyOutcomes Wins Medipex NHS Innovation Award in UK

October 13, 2015 By scottdm 2 Comments

Documentation and regulation are on the rise. On average, clinicians spend 30% of their day doing paperwork that contributes little if anything to the health and welfare of their clients. What’s more, research shows that a high documentation to clinical service ratio leads to higher rates of:

Burnout and job dissatisfaction among clinical staff;
Fewer scheduled treatment appointments;
No shows, cancellations, and disengagement among consumers.

What practice not only insures accountability but simultaneously improves the quality and outcome of behavioral health services? According to the Substance Abuse and Mental Health Services Administration (SAMHSA), one evidence-based strategy is routinely and formally seeking feedback from consumers about how they are treated and their progress.

Earlier this year, I reviewed several electronic systems that make gathering and utilizing consumer feedback a snap.

Last week, one of these–MyOutcomes–was recognized by the National Health Service in the UK. Diane Tetley from Lincolnshire Partnership Foundation Trust was awarded the Medipex Innovation Award in the mental health and well being category for her work in using the system to track and enhance consumer engagement and progress.

Using cutting-edge technology to help clinicians help is what the award is all about. Congratulations to Diane, and the dedicated crew at MyOutcomes. The system provides a simple, elegant, and highly efficient method for implementing feedback-informed treatment in individual and agency treatment settings.

Room for Improvement: Feedback Informed Treatment and the Therapeutic Relationship

May 10, 2015 By scottdm 9 Comments

My Scandinavian Grandmother Christina was fond of saying, “The room for improvement…is the biggest one in our house.”

Turns out, when it comes to engaging people in physical and mental health services, Grandma was right. We healthcare professionals can do better—and recent research points the way.

Stanford psychologists Sims and Tsai found that recipients of care both choose, and are more likely to follow the recommendations of, healthcare providers who match how they ideally want to feel. People who valued feeling excitement, for example, were more likely to choose a professional who promoted excitement and vice versa.

Bottom line? Making the helping relationship FIT how people want to feel—their goals, values, and preferences—improves engagement and effectiveness.

Tailoring services in the manner suggested by Sims and Tsai is precisely what Feedback-Informed Treatment (FIT) is all about. Two simple scales—the Outcome and Session Ratings Scales—facilitate this process, enabling helping professionals to assess and adjust treatment in real time to improve the FIT.

Overwhelmed by paperwork? No worries. As I have written about in previous blogposts (1, 2), several web-based and electronic solutions exist that make integration a snap. The pioneer–the very first to come online–is MyOutcomes.

Since coming on the scene, the owners have doggedly sought feedback from users, working steadily to provide a system that maximizes practitioners’ effectiveness. The latest version is packed full of goodies, including a mobile app and the ability to have clients provide feedback remotely (e.g., home, between visits, etc.). Watch the video below to get a more comprehensive overview of its many features.

I’m also proud to say that the parent company of MyOutcomes has partnered with the International Center for Clinical Excellence to create the first online training on Feedback-Informed Treatment. Importantly, the FIT E-learning program is not another webinar. It is a true online classroom, complete with video instruction and an intuitive software interface that tailors learning and mastery to the individual user.

Together, the ORS and SRS, FIT E-learning, and MyOutcomes make “the room for improvement” a much less daunting, even enjoyable, undertaking.

I can almost see my Granma Stina smiling!

Until next time,

Scott

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

P.S.: We still have a few spots open for our FIT Implementation and FIT Ethics courses coming up in August. Don’t wait. The number of participants is limited and both courses fill about two months in advance!

Implementing Feedback Informed Treatment

April 1, 2015 By scottdm 1 Comment

What do the Sydney Opera House, Boston Central Artery Tunnel, and Eurozone Typhoon Defense Project all have in common? In each case, their developers suffered from, “The Planning Fallacy” (PF). First recognized in 1979 by Nobel Prize winning psychologists Daniel Kahneman and Amos Tversky, the planning fallacy is the all too human tendency to underestimate the amount of time and money projects will require for completion. The impact is far from trivial, especially if you are footing the bill. The Sydney Opera House, for example, took ten years longer and cost nearly 15 times more money than originally planned (102 versus 7 million). The tunnel project in Boston ran over budget to the tune of 12 billion dollars—a figure equivalent to 19,000 dollars for man, woman, and child living in the city!

Research documents that the same shortsightedness plagues implementation of new best practices in mental healthcare. As I blogged about previously, available data indicate that between 70 and 95 percent of such efforts fail. The same body of evidence shows that prior experience with similar projects offers no protection. Indeed, regardless of experience, when planners are asked to provide a “best” and “worst” case estimate, the vast majority fail to meet even their most dire predictions.

The impact of a failed implementation on staff morale can be devastating—not to mention the waste of precious time and resources, and missed opportunity to provide more effective services to consumers. I’ve seen it first hand, had it whispered to me on breaks at workshops, as I crisscross the globe teaching about Feedback-Informed Treatment (FIT). At a workshop in Ohio, a woman approached me saying, “So, you are the guy that developed the Outcome and Session Rating Scales?” When I answered yes, she leaned in, and in a quiet voice, asked, “Will you be telling us how to use them? ‘Cause we’ve been using them at my agency for about a year, but no one knows what they’re for.” More recently, at a training on the west coast, a participant told me he and his colleagues started using the scales following a two- day workshop at his agency, but eventually stopped. “Initially, there was a lot of excitement,” he said, “We really bought in. All of us were all doing it, or at least trying. Then, it just kind of fizzled.” I nodded in recognition. The planning fallacy strikes again!

Since first being reviewed and listed on SAMHSA’s National Registry of Evidence Based Programs and Practices, interest in the proven approach to improving the outcome and retention of mental health services has exploded. More than 100,000 practitioners have downloaded the ORS and SRS. Given the brevity and simplicity of scales, it is easy to assume that implementation will be quick and relatively easy. Ample evidence, as well as experience in diverse settings around the world, strongly suggests otherwise.

It goes without saying that getting started is not the problem. Fully implementing FIT is another story. It takes time and careful planning—for most, between five and seven years. Along the way, there’s plenty of support to aid in success:

Managers, supervisors, and clinicians can join a free, online, international community of nearly 10,000 like-minded professionals using FIT in diverse settings (www.iccexcellence.com). Every day, members connect and share their knowledge and experience with each other;
A series of “how to” manuals and free, gap assessment tool (FRIFM) are available to aid in planning, guiding progress, and identifying common blind spots in implementation; ,
The 2-day FIT Implementation workshop provides an in-depth, evidence-based training based on the latest findings from the field of implementation science. Over the last few years, we’ve learned a great deal about what leads to success. Immunize yourself against the planning fallacy by joining colleagues from around the world for this event.
Finally, there’s technology. Last blogpost, I introduce PragmaticTracker.com, a system for administering the ORS and SRS. The video below introduces www.fit-outcomes.com, a simple, easy-to-use website with a clean, Apple-like interface that makes gathering and interpreting outcome and alliance data a snap.

That’s it for now.

Until next time, best wishes,

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

Therapist Wanted: Dead or Alive

January 15, 2015 By scottdm 1 Comment

Do you get those letters about the top healthcare providers in your area?

At the beginning of the new year, our city’s local magazine publishes a list of the top healthcare providers. It’s a big deal. Organized by location and specialty, the issue contains full-page photos, glossy spreads, and breezy write-ups. Impressive stuff with a wide and hungry readership anxious to sort the best from the rest.

So, how do the publishers separate the proverbial “wheat from the chaff?” The answer, depending on whether you are a provider or potential patient, may alternately surprise or frighten you.

Not long ago, Abigail Zuger received one of those letters. In it, she learned that a relative of hers had been named “one of the worlds top physicians in his area of expertise.” Ordinarily, she would have been proud. There was only one problem. Her now esteemed relative was dead–and not just recently. He’d been dead 16 years!

Abigal Zuger is a physician and professor of medicine at Columbia University. The story about her experience appeared in the New York Times. In it, she notes the temptation to become cynical, to dismiss the Top Doc lists, “as just so much advertisement and avarice.” She concludes, however, that a “more nuanced and charitable view is…[that] these services may simply be trying, valiantly if not clumsily, to remedy the single biggest mystery in all of health care…what makes a top doctor…[and] how to find one.”

Three methods dominate among list makers: (1) culling names and addresses from phone directories; (2) polling healthcare providers; and (3) collating patient online ratings. Said another way, consulting available lists lets you know if your healthcare provider once had a phone, was liked by their colleagues, or managed not to piss off too many of the people they treated!

Remarkably absent from the criteria used to identify top providers is any valid and reliable measure of their effectiveness!

Determining one’s effectiveness as a mental health professional is not as difficult or time consuming as it was not long ago. Whether you work with individuals, groups, or families, in inpatient, residential, or an outpatient setting, a simple set of tools is available for monitoring both the outcome and the quality of the services you provide. The tools take minutes to administer and score and are free.

If you are worried about statistics, don’t be. A variety of electronic solutions exist which not only will administer and score the measures but provide normative comparisons for assessing individual client progress and sophisticated analyses of provider, program, and agency effectiveness levels. I’ll be reviewing each system in an upcoming series of blogposts, so stay tuned.

To see what’s possible, check out the Colorado Center for Clinical Excellence. There, clinicians not only measure their effectiveness, but set benchmarks for superior performance and report clinician outcomes transparently on the agency website.

It’s easy to get started. First, download the free tools. Second, join colleagues from around the world in a four-part online webinar and learn how to use the tools to inform and improve your practice. We’ll be covering everything you need to know to integrate outcomes into your clinical work. In the process, as Dr. Zuger pointed out, we’ll be solving “single biggest mystery in all of health care.”

Look forward to connecting with you online!

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

Clinical Support Tools for the ORS and SRS

November 20, 2012 By scottdm 1 Comment

I have so much to be grateful for at this time. Most of all, I’m happy to be home with my family. As we have in the past, this year we’ll be spending the holiday at the home of our long time friends John and Renee Dalton. The two always put out a fantastic spread and our son, Michael, is fast friends with their two kids.

I’m also grateful for the International Center for Clinical Excellence (ICCE) community. Currently, ICCE has over 4200 members located around the world, making the organization the largest, web-based community of professionals, educators, managers, and clinicians dedicated to using feedback to pursue excellence in the delivery of behavioral health services. Recently, the site was highlighted as one of the best resources for practitioners available on the web. Articles, how-to videos, and discussion forums are available everyday, all day–and for free! No come-ons for books or webinars and no “cult of personality”–just sharing among peers. If you are not a member, you can join at: www.centerforclinicalexcellence.com

A special thanks goes to several ICCE senior advisors and associates, including Susanne Bargmann, Jason Seidel, Cynthia Maeschalck, Bob Bertolino, Bill Plum, Julie Tilsen, and Robbie Babbins-Wagner. These folks are the backbone of the organization. Together, they make it work. Most recently, we all joined together to create the ICCE Feedback Informed Treatment and Training Manuals, a cutting edge series covering every aspect of FIT–from the empirical foundations to implementation–in support of our application to SAMSHA for recognition as an “evidence-based practice.”

As a way of supporting everyone using the ORS and SRS, I wanted to make a couple of clinical support tools available. If you are using the measures, the first item will need no introduction. It’s a 10 cm ruler! Save the file and print it off and you also have a ready reminder of the upcoming Achieving Clinical Excellence conference, coming up in May 2013. Like last time, this will feature the latest inforamtion about feedback informed practice! The second item is a reliable change graph. If you are using the paper and pencil measures, rather than one of the existing web based systems (www.fit-outcomes.com, www.myoutcomes.com), you can use this tool to determine whether a change in scores from session to session is reliable (that is, greater than chance, the passage of time, and measurement error [and therefore, due to the care being provided]) or even clinically significant (that is, both reliable and indicating recovered). The last item is an impressive summary of various systems for monitoring progress in treatment.

In addition ACE Health have developed openFIT, a plug-in which seamlessly integrates the ORS, SRS and associated algorithms into any existing Electronic Health Record, Case Management System of eMental Health application.

I wish everyone a peaceful and rewarding Thanksgiving holiday.

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

November 5, 2012 By scottdm 9 Comments

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

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

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

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

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

Cutting Edge Feedback

November 22, 2011 By scottdm Leave a Comment

Earth | Time Lapse View from Space, Fly Over | NASA, ISS

Using feedback to guide and improve the quality and outcome of behavioral health services is growing in popularity. The number of systems available for measuring, aggregating, and interpreting the feedback provided by consumers is increasing. The question, of course, is, “which is best?” And the answer is, “it depends on the algorithms being used.”

Over a decade ago, my colleagues and I developed a set of mathematic equations that enabled us to plot the “expected treatment response” or ETR of a client based on their first session Outcome Rating Scale (ORS) score. Although the math was complicated, the idea was not: therapists and clients could compare outcomes from session to session to the benchmark provided by the ETR. If too much or too little progress were being made, client and therapist could discuss what changes might be made to the services being offered in order to insure more effective or durable progress. It was a bold idea and definately “cutting edge” at the time–after all, 10 years ago, few people were even measuring outcomes let alone trying to provide benchmarks for guiding clinical practice. The formulas developed at that time for plotting change in treatmentare still being used by many around the world with great effect. At the same time, it was merely a first attempt.

I am proud and excited to be able to announce the development and launch of a new set of algorithms–the largest and most sophisticated to date–based on a sample of 427,744 administrations of the ORS, in 95,478 unique episodes of care, provided by 2,354 different clinicians. Unlike the prior formulas–which plotted the average progress of all consumers successful and not–the new equations provide benchmarks for comparing individual consumer progress to both successful and unsuccessful treatment episodes. Consider an analogy to the field of medicine. No one would be interested in a test for the effectiveness of a particular cancer treatment that compared an individual’s progress to to the average of all patients whether they lived or died. People want to know, “will I live?” And in order to answer that question, the ETR of both successful and ultimately unsuccessful treatments must be determined and the individual clients progress compared to both benchmarks. Adjustments can be made to the services offered when the client’s session by session outcomes fit the ETR of treatments that ended unsuccessfully.

An example of the type of feedback provided by the new algorithms is found below. The graph displays three zones of potential progress (or ETR’s) for a client scoring 15 on the ORS at intake. Scores falling in the “green” area from session to session are similar to treatments that ended successfully. As might be expected, those in the “red” zone, ended unsuccessfully. Finally, scores in the “yellow” zone had mixed results. In each instance, both the client and therapist are provided with instant feedback: green = on track, red = off track, yellow = concern.

The new algorithms will be a major focus of the upcoming “Advanced Intensive in Feedback-Informed Treatment (FIT)” scheduled for March 19th-22nd, 2012. All those subscribing to the event also receive the newly released series of FIT treatment manuals. Space is limited, as always, to 35 people and we are filling fast so please don’t wait. So many exciting developments!

Now, if you haven’t already done so, click on the video at the start of this post. I was floored by these satellite images. In some way, I hope that the new algorithms, FIT training manuals, and the ICCE community can inspire a similar sense of perspective!

Making History in Delft, Holland: The Launch of the first Consumer-Driven Outcome Management App

October 18, 2011 By scottdm Leave a Comment

Dateline: October 18, 2011
Chicago, Illinois USA

Last week I was in Europe: three days in Norway, a week in Sweden, and a day in Holland. In a day or two, I’ll say more about developments in Norway and the launch of the largest study in history on FIT in Sweden. Meanwhile, I’m pleased to announce the lauch of the first, truly “consumer-driven” outcome management application: M2FIT. Briefly, this smart phone based technology empowers consumers of behavioral health services to provide feedback to clinicians regarding the quality and outcome of treatment services. Unlike existing applications, M2FIT is owned, operated, and managed by the consumer. It’s on their phone–not the therapists. The application further provides tips and encouragement between visits as well as appointment reminders.

As the pictures above indicate, the M2FIT application is simple, straightforward, and intuitive. Most important, it puts the power of feedback in consumers’ hands.

For more information, or to obtain a copy, visit the M2FIT website at: www.M2FIT.com. In the meantime, here’s a brief video shot during my visit!

Leading Outcomes in Vermont: The Brattleboro Retreat and Primarilink Project

November 8, 2009 By scottdm 4 Comments

For the last 7 years, I’ve been traveling to the small, picturesque village of Brattleboro, Vermont to work with clinicians, agency managers, and various state officials on integrating outcomes into behavioral health services. Peter Albert, the director of Governmental Affairs and PrimariLink at the Brattleboro Retreat, has tirelessly crisscrossed the state, promoting outcome-informed clinical work and organizing the trainings and ongoing consultations. Over time, I’ve done workshops on the common factors, “what works” in therapy, using outcome to inform treatment, working with challenging clinical problems and situations and, most recently, the qualities and practices of super effective therapists. In truth, outcome-informed clinical work both grew up and “came of age” in Vermont. Indeed, Peter Albert was the first to bulk-purchase the ASIST program and distribute it for free to any provider interested in tracking and improving the effectiveness of their clinical work.

If you’ve never been to the Brattleboro area, I can state without reservation that it is one of the most beautiful areas I’ve visited in the U.S.–particularly during the Fall, when the leaves are changing color. If you are looking for a place to stay for a few days, the Crosy House is my first and only choice. The campus of the Retreat is also worth visiting. It’s no accident that the trainings are held there as it has been a place for cutting edge services since being founded in 1874. The radical idea at that time? Treat people with respect and dignity. The short film below gives a brief history of the Retreat and a glimpse of the serene setting.

Anyway, this last week, I spent an entire day together with a select group of therapists dedicated to improving outcomes and delivering superior service to their clients. Briefly, these clinicians have been volunteering their time to participate in a project to implement outcome-informed work in their clinical settings. We met in the boardroom at the Retreat, discussing the principles and practices of outcome-informed work as well as reviewing graphs of their individual and aggregate ORS and SRS data.

It has been and continues to be an honor to work with each and every one in the PrimariLink project. Together, they are making a real difference in the lives of those they work with and to the field of behavioral health in Vermont. If you are a clinician located in Vermont or provide services to people covered by MVP or PrimariLink and would like to participate in the project, please email Peter Albert. At the same time, if you are a person in need of behavioral health services and looking for a referral, you could do no better than contacting one of the providers in the project!