What’s in an Acronym? CDOI, FIT, PCOMS, ORS, SRS … all BS?

June 7, 2014 By scottdm Leave a Comment

“What’s in a name?”

–William Shakespeare

A little over a week ago, I received an email from Anna Graham Anderson, a graduate student in psychology at Aarhus University in Denmark. “I’m writing,” she said, “in hopes of receiving some clarifications.”

Without reading any further, I knew exactly where Anna was going. I’d fielded the same question before. As interest in measurement and feedback has expanded, it comes up more and more frequently.

Anna continued, “I cannot find any literature on the difference between CDOI, FIT, PCOMS, ORS, and SRS. No matter where I search, I cannot find any satisfying clues. Is it safe to say they are the same?” Or, as another asked more pointedly, “Are all these acronyms just a bunch of branding B.S.?”

I answered, “B.S.? No. Confusing? Absolutely. So, what is the difference?”

As spelled out in The Feedback Informed Treatment and Training Manual, FIT is, “a panetheoretical approach for evaluating and improving the quality and effectiveness of behavioral health services. It involves routinely and formally soliciting feedback from consumers regarding the helping relationship and outcome of care and using the resulting information to inform and tailor service delivery.”

Importantly, FIT is agnostic regarding both the method of treatment and the particular measures a practitioner may employ. Some practitioners use the ORS and SRS, two brief, simple-to-use, and free measures of progress and the therapeutic relationship–but any other valid and reliable scales could be used.

Of all the acronyms associated with my work, CDOI and PCOMS are ones I no longer use. For me, the former had always been problematic as it came precariously close to being a treatment model, a way of doing therapy. I wasn’t interested in creating a new therapeutic approach. My work and writing on the common factors had long ago convinced me the field needed no more therapeutic schools. The phrase, “client-directed, outcome-informed” described the team’s position at the time, with one foot in the past (how to do therapy), the other in the future (feedback). And PCOMS? A long time ago, my colleagues and I had a dream of launching a web-based “system for both monitoring and improving the effectiveness of treatment” (Miller et. al, 2005). We did some testing at an employee assistance program in located in Texas, formed a corporation called PCOMS (Partners for Change Outcome Management System), and even hired a developer to build the site. In the end, nothing happened.

I expect there will be new names and acronyms as the work evolves. While some remain, others, like fossils, are left behind; evidence of what has come before, their sum total a record of development over time.

How not to be among the 70-95% of practitioners and agencies that fail

April 20, 2014 By scottdm Leave a Comment

Our field is full of good ideas, strategies that work. Each year, practitioners and agencies devote considerable time and resources to staying current with new developments. What does the research say about such efforts? When it comes to the implementation of new, evidence-based practices, traditional training strategies routinely produce only 5% to 30% success rates. Said another way, 70-95% of training fails (Fixsen, Blase, Van Dyke, & Metz, 2013).

In 2013, Feedback Informed Treatment (FIT)–that is, formally using measures of progress and the therapeutic alliance to guide care–was deemed an evidence-based practice by SAMHSA, and listed on the official NREPP website. It’s one of those good ideas. Research to date shows that FIT as much as doubles the effectiveness of behavioral health services, while decreasing costs, deterioration and dropout rates.

As effective as FIT has proven to be in scientific studies, the bigger challenge is helping clinicians and agencies implement the approach in real world clinical settings. Simply put, it’s not enough to know “what works.” You have to be able to put “what works” to work. On this subject, researchers have identified five, evidence-based steps associated with the successful implementation of any evidence-based practice. The evidence is summarized in a free, manual available online. You can avoid the 70-95% failure rate by reading it before attending another training, buying that new software, or hiring the latest consultant.

At the International Center for Clinical Excellence, the research on implementation is integrated into all training events as well as The Feedback Informed Treatment and Training Manual. Based on the scientifically-established steps, clinicians, supervisors, and agency directors learn how to both plan and execute a successful implementation of this potent evidence-based practice.

More from Sweden

June 4, 2012 By scottdm Leave a Comment

Three short weeks ago, I was in Stockholm, Sweden talking about “what works” in clinical practice. As I announced at the time, my visit coincided with an announcement by the organization governing mental health practice in the country. For the better part of a decade, CBT enjoyed near exclusive status as “evidence-based.” Indeed, payment for training of clinicians and treatment of clients in other approaches disappeared as over two billion Swedish crowns were spent on in CBT.

The result? The widespread adoption of the method had no effect whatsoever on the outcome of people disabled by depression and anxiety. The conclusion? Guidelines for clinical practice were reviewed and expanded. Research on feedback is in full swing in the largest randomized clinical trial on FIT in history.

More news…

Today, I received notice from Swedish clinician and publisher, Bengt Weine, that my article, “The Road to Mastery” (written together with my long friend and collaborator, Mark A. Hubble, Ph.D.), had been translated into Swedish and accepted for publication in SFT, the Swedish Family Therapy journal. If you understand the language, click here to access a copy.

Helping clinicians and agencies along the “road to mastery” is what the upcoming Advanced Intensive and Training of Trainers events are all about. Join colleagues from around the globe for these fun, intense days of training in Chicago.

Feedback Informed Treatment as Evidence-Based Practice

May 23, 2012 By scottdm Leave a Comment

Back in November, I blogged about the ICCE application to SAMSHA’s National Registry for consideration of FIT as an official evidence-based approach (EBP). Given the definition of EBP by the Institute of Medicine and the American Psychological Association, Feedback Informed Treatment seems a perfect, well, FIT. According to the IOM and APA, evidence-based practice means using the best evidence and tailoring services to the client, their preferences, culture, and circumstances. Additionally, when evidence-based, clinicians must monitor “patient progress (and of changes in the patient’s circumstances—e.g.,job loss, major illness) that may suggest the need to adjust the treatment. If progress is not proceeding adequately, the psychologist alters or addresses problematic aspects of the treatment (e.g., problems in the therapeutic relationship or in the implementation of the goals of the treatment) as appropriate.”

In late Summer 2011, ICCE submitted 1000’s of pages of supporting documents, research studies, as well as video in support of the application. This week, we heard that FIT passed the “Quality of Research” phase of the review. Now, the committee is looking at the “Readiness for Dissemination” materials, including the six detailed treatment and implementation manuals on feedback informed treatment. Keep your fingers crossed. We’ve been told that the entire process should be completed sometime in late fall.

In the meantime, we are preparing for this summer’s Advanced Intensive and Training of Trainer workshops. Once again, clinicians, educators, and researchers from around the world will be coming together for cutting edge training. Only a few spots remain, so register now.