Or, at least that’s what I said in response to his question. The look on his face made clear my words caused more confusion than clarity.
“But then, how will I found out which of the therapists at my agency are effective?” he asked.
“The purpose of FIT,” I replied, “is not to profile, but rather help clinicians respond more effectively to their clients.”
And I’ve found myself giving similar advise of late — in particular, actively counseling practitioners and clinic directors against using the ORS and SRS.
Here’s another:
“We need a way to meet the new Joint Comission/SAMHSA requirement to use a standardized outcome measure in all therapeutic work.”
My reply?
FIT is purposefully designed — and a significant body of evidence indicates it does — help those in treatment achieve the best results possible. Thus, while integrating measures into care has, in some countries, because a standard of care, using them merely to meet regulatory requirements is de facto unethical. Please don’t use my scales.
One more?
“I don’t (or won’t) use the scales with all my clients, just those I decide it will be clinically useful with.”
What do I think?
The evidence clearly shows 
clinicians often believe they are effective or aligned with clients when they are not. The whole purpose of routinely using outcome and alliance measures is to fill in these gaps in clinical judgement. Please don’t use my scales.
Last, as I recently blogged about, “The scales are really very simple and self-explanatory so I don’t think we really need much in the way of training or support materials.”
My response?
We have substantial evidence to the contrary. In sharp contrast to the mere minutes involved in downloading and learning to administer measures, actual implemention of FIT takes considerable time and support — more than most seem aware of or willing to invest.
PLEASE DON’T USE MY SCALES!
While I could cite many more examples of when not to use routine outcome measures (e.g., “we need a way to identify clients we aren’t helping so we can terminate services with them and free up scarce clinical resources” or “I want to have data to provide evidence of effectiveness to funding sources”) — I will refrain.
As one dedicated FIT practitioner recently wrote, “Using FIT is brutal. Without it, it’s the patients’ fault. With fit, it’s mine. Grit your way through . . . because it’s good and right.”
I could not have said it any better.
Until next time,
Scott
Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
Sir –
Your words are always so much more deliberate than my brain sometimes thinks. I think you are saying that if you are using these reasons as your SOLE reason for the scales, then this is wrong. We are using them to help the patient.
I think that all of these things are benefits of using the scale, but I might be mistaken.
For instance:
The ORS is a great metric for JC. I don’t need to use complicated OQ45 or PHQs for progress anymore.
It does identify those who are flailing in therapy and if we are helpful. Transfer of these patients to another service should our changes not lead to improvement would save expenditures.
Now…I think using them to identify which therapists are more effective than others is a ridiculous use of these things. Though it does do this, the goal then for that supervisor is to figure out how to get those less effective therapists to improve.
Those are my thoughts on this post (I don’t tend to post on blogs), but I want to make sure I am understanding properly.
I cannot imagine anymore not using this scale in my day-to-day practice anymore.
This is a great example of learning from experience. I hate to admit it, but you come painfully close to some of the mistakes I’ve made with the measures over the past 15 years. I know I over simplified the process at first and that there is still much I have to learn. The more I learn about FIT, the more aware I become of what I don’t know.
“…the goal then for that supervisor is to figure out how to get those less effective therapists to improve…”
So true. Sometimes it is the factors surrounding the therapist and client that need addressing for improvent to occur.
In working through this process recently, it was clear that there were enviromental factors that were impacting on the client-therapist relationship.
We changed our clients access to our service to a “soft entry”. Client comes to our multidisciplinary service, for an appointment without the whole world knowing they are there to see a therapist because of problems.