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

  • About
    • About Scott
    • Publications
  • Training and Consultation
  • Workshop Calendar
  • FIT Measures Licensing
  • FIT Software Tools
  • Online Store
  • Top Performance Blog
  • Contact Scott
scottdmiller@ talkingcure.com +1.773.454.8511

Intake: A Mistake

September 4, 2015 By scottdm 1 Comment

bad idea

 

 

 

 

Available evidence leaves little doubt.  As I’ve blogged about previously, separating intake from treatment results in:

• Higher dropout rates;
• Poorer outcomes;
• Longer treatment duration; and
• Higher costs

And yet, in many public behavioral health agencies, the practice is commonplace. What else can we expect?

Chronically underfunded, and perpetually overwhelmed by mindless paperwork and regulation, agencies and practitioners are left with few options to meet the ever-rising number of people in need of help. Between 2009 and 2012, for example, the number of people receiving mental health services increased by 10%. During the same period, funding to state agencies decreased $4.35 billion. Not long ago, in my own home town of Chicago, the city shuttered half—50%–of the city’s mental health clinics, forcing the remaining, already burdened, agencies to absorb an additional 5,000 people in need of care.

crowd

 

 

 

Simply put, the practice of separating intake from treatment is little more than a form of “crowd management”–and an ineffective one at that.

feedback keyboard

 

 

 

 

Adding to the growing body of evidence is a new study investigating the impact of computerized intake on the consumer’s experience of the therapeutic relationship and continuation in care. Not only did researchers find that therapist use of a computer had a negative impact on the quality of the working relationship—one of the best predictors of outcome–but clients were between 62 and 97% less likely to continue in care!

domino

 

 

 

 

It’s not hard to see how these well-intentioned—some would argue, absolutely necessary—solutions actually end up exacerbating the problem. Money is wasted when the paperwork is completed but people don’t come back; money that would be better spent providing treatment. Those who do not return don’t disappear, they simply access services in other ways (e.g., the E.R., police and social services, etc.)—after all, they need help! The ones who do continue after intake, experience poorer outcomes and stay longer in care, a cost to both the consumer and the system.

What to do?

solution

 

 

 

 

In addition to pushing back against the mindless regulation and paperwork, there are several steps practitioners and agency managers can take:

  • Stop separating intake from treatment

The practices does not save time and actually increases costs. Consider having consumers complete as much of the paperwork as possible before the session begins. The first visit is critical. It determines whether people continue or drop pout. Listen first. At the end of the visit, review the paperwork, filling in missing data, and completing any remaining forms.

  • Begin monitoring outcome

Research to date shows that routinely monitoring progress reduces dropout rates and the length of time spent in treatment while simultaneously improving outcome. Combined, such results work to alleviate the bottleneck at the entry point of services.

  • Begin monitoring the quality of the therapeutic relationship:

Engagement and outcomes are improved when problems in the relationship are identified and openly discussed. Even when intake is separated from treatment, feedback should be sought. Data to date indicate that the most effective clinicians seek and more often receive negative feedback, a skill that enables them to better meet the needs of those they serve.

Getting started is not difficult. Indeed, there’s an entire community of professionals just a click away who are working with and learning from one another. The International Center for Clinical Excellence is the largest, web based community of mental health professionals in the world. It’s ad free and costs nothing to join.

Sign up for the ICCE Fall Webinar. You will learn:

  • The Empirical Basis for Feedback Informed Treatment
  • Basics of Outcome and Alliance Measurement
  • Integrating Feedback into Practice & Creating a Culture of Feedback
  • Understanding Outcome and Alliance Data

Register online at: https://www.eventbrite.ie/e/fall-2015-feedback-informed-treatment-webinar-series-tickets-17502143382. CE’s are available.

Finally, join colleagues and friends from around the world for the Advanced and FIT Supervision courses are held in March in Chicago. We work and play hard. You will leave with a thorough grounding in feedback-informed principles and practice. Registration is limited, and the courses tend to sell out several month in advance.

Until then,

Scott

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

Scott D. Miller - Australian Drug and Alcohol Symposium

 

Filed Under: Behavioral Health, evidence-based practice, Feedback, Feedback Informed Treatment - FIT, ICCE

Comments

  1. Matthew says

    September 14, 2015 at 7:53 pm

    HI Scott

    I do hope you are having fun where ever you might be at the moment teaching. I read your blog this morning and couldn’t agree more about the nasty intake process. It is definitely used as crowd control. In Taranaki its used to screen out people and the drop off is large, not to mention the delay in being seen is long. I have noticed that even with my connections its extremely hard to get someone into the adult mental health service and to be honest, I have stopped trying now….

    Instead we are trying to make it easier for clients to come to us..

    Anyway, enjoy where you are. I was trying to get to one of your training sessions but we are expecting another baby soon so travel is frowned upon..

    Best wishes

    Matthew Manderson

    Reply

Leave a Reply Cancel reply

Your email address will not be published. Required fields are marked *


The reCAPTCHA verification period has expired. Please reload the page.

SEARCH

Subscribe for updates from my blog.

loader

Email Address*

Name

Upcoming Training

Oct
01

Training of Trainers 2025


Nov
20

FIT Implementation Intensive 2025

FIT Software tools

FIT Software tools

LinkedIn

Topics of Interest:

  • behavioral health (5)
  • Behavioral Health (112)
  • Brain-based Research (2)
  • CDOI (14)
  • Conferences and Training (67)
  • deliberate practice (31)
  • Dodo Verdict (9)
  • Drug and Alcohol (3)
  • evidence-based practice (67)
  • excellence (63)
  • Feedback (40)
  • Feedback Informed Treatment – FIT (246)
  • FIT (29)
  • FIT Software Tools (12)
  • ICCE (26)
  • Implementation (7)
  • medication adherence (3)
  • obesity (1)
  • PCOMS (11)
  • Practice Based Evidence (39)
  • PTSD (4)
  • Suicide (1)
  • supervision (1)
  • Termination (1)
  • Therapeutic Relationship (9)
  • Top Performance (40)

Recent Posts

  • Agape
  • Snippets
  • Results from the first bona fide study of deliberate practice
  • Fasten your seatbelt
  • A not so helpful, helping hand

Recent Comments

  • Dr Martin Russell on Agape
  • hima on Simple, not Easy: Using the ORS and SRS Effectively
  • hima on The Cryptonite of Behavioral Health: Making Mistakes
  • himalaya on Alas, it seems everyone comes from Lake Wobegon
  • himalayan on Do certain people respond better to specific forms of psychotherapy?

Tags

addiction Alliance behavioral health brief therapy Carl Rogers CBT cdoi common factors conferences continuing education denmark evidence based medicine evidence based practice Evolution of Psychotherapy excellence feedback feedback informed treatment healthcare holland icce international center for cliniclal excellence medicine mental health meta-analysis Norway NREPP ors outcome measurement outcome rating scale post traumatic stress practice-based evidence psychology psychometrics psychotherapy psychotherapy networker public behavioral health randomized clinical trial SAMHSA session rating scale srs supershrinks sweden Therapist Effects therapy Training