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
info@scottdmiller.com 773.404.5130

Routine Outcome Monitoring and Deliberate Practice: Fad or Phenomenon?

March 26, 2019 By scottdm 1 Comment

new-improved-newspaper-headline-better-product-update-upgrad-headlines-announcements-upgrade-60079897Would you believe me if I told you there was a way you could more than double the chances of helping your clients?  Probably not, eh?  As I’ve documented previously, claims abound regaring new methods for improving the outcome of psychotherapy.  It’s easy to grow cynical.

And yet, findings from a recent study document when clinicians add this particular practice to their clinical work, clients are actually 2.5 times more likely to improve.  The impact is so significant, a review of research emerging from a task force of the American Psychological Association concluded, “it is among the most effective ways available to services to improve outcomes.”feedback effects

That said, there’s a catch.

The simple nature of this “highly rated,” transtheoretical method belies a steep learning curve.  In truth, experience shows you can learn  to do it — the mechanics — in a few minutes.

But therein lies the problem.  The empirical evidence makes clear successful implementation often takes several years.  This latter fact explains, in part, why surveys of American, Canadian, and Australian practitioners reveal that, while being aware of the method, they rarely integrate it into their work.

What exactly is the “it” being referred to?

Known by the acronym FIT,  feedback-informed treatment (FIT) involves using standardized measures to formally and routinely solicit feedback from clients regarding progress and the quality of the therapeutic relationship, and then using the resulting information to inform and improve care.

The ORS and SRS are examples of two simple feedback scales used in more than a dozen randomized controlled trials as well as vetted and deemed “evidence-based” by the Substance Abuse and Mental Health Services Administration.  Together, the forms take less than 3 minutes to administer, score and interpret (less if one of the web-based scoring systems is used).

So why, you might wonder, would it take so long to put such tools into practice?

As paradoxical as it may sound, because FIT is really not about using measures — any more say than making a home is about erecting four walls and a roof.  While the structure is the most visible aspect — a symbol or representation — we all know it’s what’s inside that counts; namely, the people and their relationships.

On this score, it should come as no surprise that a newly released study has found a significant portion of the impact of FIT is brought about by the alliance or relationship between client and therapist.   It’s the first study in history to look at how the process actually works and I’m proud to have been involved.

Of course, all practitioners know relationships skills are not only central to effective psychotherapy, but require lifelong learning.   With time, and the right kind of support, using measurement tools facilitates both responsiveness to individual clients and continuous professional development.

Here’s the rub.  Whenever I respond to inquiries about the tools — in particular, suggesting it takes time for the effects to manifest, and that the biggest benefit lies beyond the measurement of alliance and outcome — interest in FIT almost always disappears.  “We already know how to do therapy,” a manager  replied just over a week ago, “We only want the measures, and we like yours because they are the simplest and fastest to administer.”fit training

Every so often, however, the reply is different.  “What do we have to do to make this work to improve the effectiveness of our clinical work and clinicians?” asked Thomas Haastrup, the Coordinator of Family Services for Odense Municipality in Denmark.  When I advised, planning and patience, with an emphasis on helping individual practitioners learn to use feedback to foster professional development versus simply measuring their results, he followed through.  “We adopted the long view,” Thomas recounts, “and it’s paid off.”  Now in their 5th year, outcomes are improving at both the program and provider level across services aimed at helping adults, children, and families.

In addition to the Manual 6 in the ICCE Treatment and Training manuals, the ICCE Summer Intensives offer several opportunities for helping you or your agency to succeed in implementing FIT.  First, the 2-day FIT Implementation Training — the only workshop offering in-depth, evidence-based training in the steps for integrating FIT into clinical practice at the individual, agency, and system-of-care level.  Second, the Deliberate Practice Intensive — here you not only learn the steps, but begin to set up a professional develop plan designed to enhance your effectiveness.

To help out, I’d like to offer a couple of discounts:

  1. Purchase Manual 6 at 70% off the regular price.  Click here to order.  Enter the word IMPLEMENTATION at checkout to receive the discount  (If you want to purchase the entire set, I’m making them available at 50% off the usual price.  Enter IMPLEMENTATION2 at checkout).
  2. Register for any or all of the summer intensives by May 1st and receive an additional discount off the early bird price.  Simple enter the code FITPROMOAPRIL at checkout.  Please note, registration MUST occur before May 1st.  Generally, we sell out 6 to 8 weeks in advance.

Feel free to email me with any questions.  In the meantime, as always, I’m interested in your thoughts about FIT and DP.

Until next time,

Scott

Scott D. Miller, Ph.D.
Director, International Center for Clinical Excellence
FIT Implementation Intensive Aug 2019 - ICCEFIT Training of Trainers Aug 2019 - ICCEFIT Deliberate Practice Aug 2019 - ICCE

Filed Under: evidence-based practice, excellence, Feedback, Feedback Informed Treatment - FIT, FIT

Comments

  1. Jeffrey Von Glahn says

    March 29, 2019 at 11:22 pm

    Speaking from 50 years of experience as a therapist, I am not surprised in the least about the 5 year length of time (I wonder if that’s true for both genders.) My experienced guess is that those who persist with client feedback discover that the key element that had been missing from their proficiency as a therapist was to effectively support the client’s experiencing; i.e., the client’s explicit and implicit dimensions, and particularly the latter because that’s where the “sticky” stuff is that’s been interfering with the typical client’s life.

    The implicit dimension is what the words the client say point to, that which hasn’t been verbalized. Its too easy – and here I speak from personal experience – for a therapist to feel/believe that to be effective they have to “do” something; e.g., give advice, offer an insight, direct the client’s attention to something other than what they were focused on.

    In my experience, the most effective behavior the therapist can do is to listen attentively and do their best to support what the client seems to be experiencing, especially that which has not yet been adequately verbalized.

    And this has to be done with the following proviso: Try your very best to NOT disrupt the client from her or his sense of what he or she seems to be experiencing. We all know what that’s like in everyday conversation. Most of us can easily brush it off. For a client, if it happens too often its the difference between Can I trust this person with my most problematic/upsetting feelings, or not?

    Reply

Leave a Reply Cancel reply

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

 

SEARCH

Subscribe for updates from my blog.

  

Upcoming Training

Aug
02

FIT Implementation Intensive 2021


Aug
04

Training of Trainers 2021

FIT Software tools

FIT Software tools

NREPP Certified

HTML tutorial

LinkedIn

Topics of Interest:

  • Behavioral Health (111)
  • behavioral health (4)
  • Brain-based Research (2)
  • CDOI (14)
  • Conferences and Training (67)
  • deliberate practice (28)
  • Dodo Verdict (9)
  • Drug and Alcohol (3)
  • evidence-based practice (66)
  • excellence (61)
  • Feedback (38)
  • Feedback Informed Treatment – FIT (207)
  • FIT (26)
  • FIT Software Tools (12)
  • ICCE (26)
  • Implementation (7)
  • medication adherence (3)
  • obesity (1)
  • PCOMS (11)
  • Practice Based Evidence (38)
  • PTSD (4)
  • Suicide (1)
  • supervision (1)
  • Termination (1)
  • Therapeutic Relationship (8)
  • Top Performance (39)

Recent Posts

  • Three Common Misunderstandings about Deliberate Practice for Therapists
  • Feedback Informed Treatment in Statutory Services (Child Protection, Court Mandated)
  • Do We Learn from Our Clients? Yes, No, Maybe So …
  • Developing a Sustainable Deliberate Practice Plan
  • Making Sense of Client Feedback

Recent Comments

  • Asta on The Expert on Expertise: An Interview with K. Anders Ericsson
  • Michael McCarthy on Culture and Psychotherapy: What Does the Research Say?
  • Jim Reynolds on Culture and Psychotherapy: What Does the Research Say?
  • gloria sayler on Culture and Psychotherapy: What Does the Research Say?
  • Joseph Maizlish on Culture and Psychotherapy: What Does the Research Say?

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