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How Cool is Kuhl? A Man with Vision on a Mission

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This week, my colleague and friend, Dr. David Mee-Lee, sent me a link to a blogpost written by Don Kuhl.  Actually, I was already a subscriber to Don’s Minful MIDweek blog (you should be too), but my travel this week had prevented me from reading his latest installment.  His posts always leave me inspired and give me something to think about.  This week was no different.  More on that in a moment.

In the meantime, let me tell you about Don.  He is the founder and CEO of The Change Companies, a company whose mission is to create tailored materials and programs to support behavioral change for special populatons.  And create they do.  Hundreds of bright, attractive, highly readable publications and guided workbooks for use by professionals and the people they serve.  Their material is exhaustive and comprehensive, including adult behavioral health, criminal justice, education and prevention, clinical assessment, and faith-based programs.  A side note, it was Don and his skillful team at The Change Companies that produced the ICCE Feedback Informed Treatment and Training Manuals.  If you’ve not seen them, you should.  They are the cutting edge of information about FIT.

What is most striking about Don, however, is his passion.  I met him at a conference in San Francisco nearly a decade ago.  On several occasions, he flew to Chicago from his home base in Carson City, Nevada just to meet, talk, and share ideas.  The photo above is from one of the meetings he arranged.  Don is devoted to improving the quality and experience of behavioral health services for professionals and clients alike.  Simply said, Don Kuhl is cool.

In his blogpost this week, Don wrote about that meeting with Jim Prochaska, David Mee-Lee, me, and Bill Miller.  He referred to it as a “highlight” of his recent professional life, a lucky event resulting from his mindful pursuit of relationships with “people who have smiles on their faces and goodness in their hearts.”

My thought?  I was and am the lucky one.  Thanks Don.  Thanks Change Companies.  Keep up the good work.

What is the Real Source of Effectiveness in Smoking Cessation Treatment? New Research on Feedback Informed Treatment

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When it rains, it pours!  So much news to relay regarding recent research on Feedback Informed Treatment (FIT).  Just received news this week from ICCE Associate Stephen Michaels that research using the ORS and SRS in smoking cessation treatment is in print!   A few days prior to that, Kelley Quirk sent a copy of our long-awaited article on the validity and reliability of the Group Session Rating Scale.  On that very same day, the editors from the journal Psychotherapy sent proofs of an article written by me, Mark Hubble, Daryl Chow, and Jason Seidel for the 50th anniversary issue of the publication.

Let’s start with the validity and reliability study.  Many clinicians have already downloaded and been using Group Session Rating Scale.  The measure is part of the packet of FIT tools available in 20+ languages on both my personal and the International Center for Clinical Excellence websites.   The article presents the first research on the validity and reliability of the measure.  The data for the study was gathered at two sites I’ve worked with for many years.   Thanks to Kelley Quirk and Jesse Owen for crunching the numbers and writing up the results!   Since the alliance is one of the most robust predictors of outcome, the GSRS provides yet another method for helping therapists obtain feedback from consumers of behavior health services.

Moving on, if there were a Nobel Prize for patience and persistence, it would have to go to Stephen Michaels, the lead author of the study, Assessing Counsellor Effects on Quit Rates and Life Satisfactions Scores at a Tobacco Quitline” (Michael, Seltzer, Miller, and Wampold, 2012).  Over the last four years, Stephen has trained Quitline staff in FIT, implemented the ORS and SRS in Quitline tobacco cessation services, gathered outcome and alliance data on nearly 3,000 Quitline users, completed an in-depth review of the available smoking cessation literature, and finally, organized, analyzed, and written up the results.

What did he find?  Statistically significant differences in quit rates attributable to counselor effects.  In other words, as I’ve been saying for some time, some helpers are more helpful than others–even when the treatment provided is highly manualized and structured.  In short, it’s not the method that matters (including the use of the ORS and SRS), it’s the therapist.

What is responsible for the difference in effectiveness among therapists?  The answer to that question is the subject of the article, “The Outcome of Psychotherapy: Yesterday, Today, and Tomorrow” slated to appear in the 50th anniversary issue of Psychotherapy.  In it, we review controversies surround the question, “What makes therapy work?” and tip findings from another, soon-to-be-published empirical analysis of top performing clinicians.  Stay tuned.

Implementation Science, FIT, and the Training of Trainers

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The International Center for Clinical Excellence (ICCE) is pleased to announce the 6th annual Training of Trainers event to be held in Chicago, Illinois August 6th-10th, 2012.  As always, the ICCE TOT prepares participants provide training, consultation, and supervision to therapists, agencies, and healthcare systems in Feedback-Informed Treatment (FIT).  Attendees leave the intensive, hands-on training with detailed knowledge and skills for:

  1. Training clinicians in the Core Competencies of Feedback Informed Treatment (FIT/CDOI);
  2. Using FIT in supervision;
  3. Methods and practices for implementing FIT in agencies, group practices, and healthcare settings;.
  4. Conducting top training sessions, learning and mastery exercises, and transformational presentations.

Multiple randomized clinical trials document that implementing FIT leads to improved outcomes and retention rates while simultanesouly decreasing the cost of services.

This year’s “state of the art” faculty include: ICCE Director, Scott D. Miller, Ph.D., ICCE Training Director, Julie Tilsen, Ph.D., and special guest lecturer and ICCE Coordinator of Professional Development, Cynthia Maeschalck, M.A.

Scott Miller (Evolution 2014)

tilsencynthia-maeschalckJoin colleagues from around the world who are working to improve the quality and outcome of behavioral healthcare via the use of ongoing feedback. Space is limited.  Click here to register online today.  Last year, one participants said the training was, “truly masterful.  Seeing the connection between everything that has been orchestrated leaves me amazed at the thought, preparation, and talent that has cone into this training.”  Here’s what others had to say:

 

Feedback informed treatment (FIT) takes center stage in Sweden

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Just sweden-mapa short entry to highlight recent developments in Sweden…

On November 17th and 18th, over 500 politicians, agency directors, and service managers gathered together to discuss “the future of alcohol and drug treatment” in Sweden.  High on the agenda?  Feedback Informed Treatment!

Psychologist and ICCE Associate, Gun-Eva Langdahl and the rest of the talented crew at Radgivingen Oden, were featured in a video documenting the impact of feedback on retention and outcome of drug and alcohol treatment services.

You may recall, last spring I was on my way to visit this talented group of practitioners when the volcano in Iceland erupted, forcing me to take a long and complicated series of “trains, buses, and automobiles” to get to the beautiful, northern Swedish town of Skelleftea.

Anyway, thanks to the work of the team, the town and surrounding area are something of a hotbed of feedback informed treatment.  For those practitioners, policy makers, and agency directors living and working in Scandinavia, the professionally produced video provides an excellent introduction to the process and benefits of feedback informed work.  You can also read about the work in a feature article that appeared in the daily newspaper, Folkbladet.

In the meantime, take a look at these videos where Gun-Eva Langdahl explains both why clinicians should begin seeking feedback from their clients as well as how to get started.

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

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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.

Implementing Consumer-Driven, Outcome-Informed (CDOI) Behavioral Health Services: The ICCE and 2010 Training of Trainers Event

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This week I’m in Calgary, Canada. Last week, I was in Charleston, South Carolina. Next week, I’ll be in Marion, Ohio and Bay City, Michigan. In each instance, I’m working with the management and staff of public behavioral health agencies that are busy implementing consumer-driven, outcome-informed clinical work.

Some of the groups are just beginning the process.  Others, as reported here on my blog, have been at it long enough to document significant improvements in outcome, retention, and productivity (i.e., in Ohio and Virginia).  All have told me that implementing the seemingly simple ideas of outcome-informed practice is incredibly hard work–impacting nearly every aspect of agency life.  Being able to access the expertise and experience of fellow clinicians and agency directors in real time when questions and challenges arise is, I’ve also learned, critical in maintaining the momentum necessary for successful implementation.

Enter the ICCE: The International Center for Clinical Excellence.  Briefly, the ICCE is a web-based community of clinicians, researchers, agency managers, and policy makers dedicated to excellence in behavioral health.  Many of the groups I’m working with have joined the site providing them with 24/7/365 access to a deeply knowledgeable world-wide community.  In addition to the numerous topic-specific discussion groups and member-generated videos, organizations can set up private forums where management and clinicians can have confidential discussions and coordinate implementation efforts.

If you are a clinician or agency director and are not already a member, you and/or your organization can access the ICCE community today by visiting the website at: www.centerforclinicalexcellence.com.  Membership is free.  In the video below, I talk with Arjan Van der Weijde, about groups in Holland that are meeting on on the ICCE for practitioners to discuss their implementation of feedback-informed work in the Netherlands.  Check it out.

I’ve also included a brief video about the upcoming “Training of Trainers” course, held each year in August in Chicago.  As in prior years, professionals from all over the world will be joining me and the state-of-the-art faculty for four intensive days of training.  Agencies both public and private, in the U.S. and abroad, are sending staff to the event to learn the skills necessary to lead transformation projects.  Space is already limited so register soon.

The Training of Trainers

After the Thrill is Gone: Sustaining a Commitment to Routinely Seeking Feedback

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Helsingor Castle (the setting for Shakespeare’s Hamlet)

Dateline: May 8th, 2010, Helsingor, Denmark

This weekend I’m in Denmark doing a two-day workshop on “Supershrinks” sponsored by Danish psychologist and ICCE Senior Associate and Trainer Susanne Bargmann.  Just finished the first day with a group of 30 talented clinicians working diligently to achieve their personal best.  The challenge, I’m increasingly aware, is sustaining a commitment to seeking client feedback over time once the excitement of a workshop is over.  On the surface, the idea seems simple: ask the consumer.  In practice however, it’s not easy.  The result is that many practitioners who are initially enthusiastic lose steam, eventually setting aside the measures.  It’s a serious concern given that available evidence documents the dramatic impact of routine outcome and alliance monitoring on outcome and retention in behavioral health.

Support of like-minded colleagues is one critical key for sustaining commitment “after the thrill is gone.”  Where can you find such people?  As I blogged about last week, over a thousand clinicians are connecting, sharing, and supporing each other on the web-based community of the International Center for Clinical Excellence (If you’re not already a member, click here to request your own personal (and free) invitation to join the conversation).

In the brief interview above, Susanne identifies a few additional steps that practitioners and agencies can take for making the process of seeking feedback successful over the long haul.  By the way, she’ll be covering these principles and practices in detail in an afternoon workshop at the upcoming Achieving Clinical Excellence conference.  Don’t miss it!

Achieving Clinical Excellence: The Conference

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A few weeks ago, I announced the first International “Achieving Clinical Excellence” (ACE) conference to be held at the Westin Hotel in Kansas City, Missouri on October 20-22nd, 2010.  You can now register for this and all other ICCE events, by clicking here.  Through a variety of keynote addresses and workshops, participants will learn the “science and steps” to excellence in clinical practice.  Attendees will also meet and learn directly from internationally ranked performers from a variety of professions, including medicine, science, music, entertainment, and sports.  I do hope you’ll join us in Kansas City for three days of science, skill building, and inspiration.

In the meantime, I wanted to tell you a bit about one of the conference’s keynote speakers, K. Anders Ericsson, Ph.D. As anyone who has been following my blog knows, Dr. Ericsson is the editor of the massive and influential “Cambridge Handbook of Expertise and Expert Performance.”  He is an internationally known writer, researcher, and speaker who is commonly referred to as “the expert on experts.”

 At the ACE conference, Dr. Ericsson will bring his knowledge and experience to bear on the subject of expertise in behavioral health.  I promise you won’t want to miss it. For a flavor, give his recent article from the Harvard Business Review a read.

The Crown Jewel of Research on CDOI: Professor Jan Blomqvist receives 2.9 million crown grant for RCT on feedback in Sweden

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If you’ve been following me on Twitter, then you know that last week I was touring and teaching in different spots around Europe.  First, I presented two days in Copenhagen.  Then I keynoted the British Association of Counseling and Psychotherapy Conference in Newcastle, England.  Early Saturday morning, I flew from London to Stockholm.  My long time friend and associate, Gunnar Lindfelt picked me up at Arlanda airport and drove me back to his lovely home in the city.  There, we gorged on smoked salmon, “svensk godies” (small candies, my favorite of which is “skum bananer”–dark chocolate covered marshmellow in the shape of a banana) and Cider–a non-alcoholic fizzy apple drink that is an old time Swedish favorite.

It was Gunnar Lindfeldt, a gifted clinician and expert in the treatment of drug and alcohol problems, who first introduced me to the work of Swedish psychologist Jan Blomqvist.  In 1998, Blomqvist published a book entitled, “Beyond Treatment? Widening the Approach to Alcohol Problems and Solutions“ in which he made the provocative argument that common rather than specific factors held the key to effective care.  Since writing the book, Jan Blomqvist has continued his research and is currently a full professor at SORAD, the Centre for Social Research on Alcohol and Drugs at Stockholm University.

Anyway, I had the pleasure of meeting with Professor Blomqvist at his home in Uppsala, Sweden this last week.  Over homemade spinach soup, freshly-baked bread and cheese, we chatted about the state of the field.  The pièce de résistance, however, was hearing about the 2.9 million Swedish crown grant he had just been awarded for a 4 year long study of outcome-informed treatment of alcohol problems, called “Putting the Client in the Driver’s Seat.”

The study to be conducted by Professor Blomqvist will be the largest, most comprehensive, randomized clinical trial on client-directed outcome informed clinical work.  A centerpience of the study will be the routine use of the ORS and SRS and provision of feedback in the delivery of treatment services.  Importantly, unlike all other studies to date, this project completely avoids claims of “allegiance effects” as no developers of measures or supporters of CDOI are participating.  Stay tuned to the “Top Performance” blog for additional updates!  While you are waiting, take a moment and read Professor Blomqvist’s provocative take on “addiction” in slide viewer below.

On the Path of the Supershrinks: An Article by Bill Robinson

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Not too long ago, my colleagues and I published some preliminary thoughts and findings from our research into “Supershrinks.”

That differences in effectiveness exist between clinicians is neither surprising or new.  Indeed, “therapist effects”–as they are referred to in the research literature–have been documented for decades and rival the contribution of factors long known to influence successful psychotherapy (e.g., the therapeutic alliance, hope and expectancy, etc.).  Personally, I believe that studying these super-effective clinicians will help practitioners improve the outcome of their clinical work.

Aside from research documenting the existence of “supershrinks,” and our own articles on the subject, little additional information exists documenting how superior performing clinicians achieve the results they do.

Enter Bill Robinson, manager, counselor, and a senior supervsor with Relationships Australia based in Mandurah, Western Australia.  I’m also proud to say that Bill is one of a highly select group of clinicians that have completed the necessary training to be designated an ICCE Certified Trainer.

In any event, in the last issue of Psychotherapy in Australia–a treasure of a publication that every clinician dedicated to improving their work should subscribe to–Bill explores the topic of therapist effects, suggesting possible links between effectiveness and clinicians’ abilities to connect with the phenomenological worlds of the people they work with.  Trust me, this peer reviewed article is worth reading.  Don’t forget to post a comment, by the way, once you’ve finished!