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Are Counseling and Psychotherapy a Con? The Gauntlet is Thrown in New Zealand

February 15, 2013 By scottdm 2 Comments

Earlier this summer, I was contacted by Donna Chisholm, editor of and reporter for Metro and North & South Magazines in New Zealand.  She was doing a feature article on the effectiveness of psychological services.  The State spent scads of money on treatment.  Concerns had been raised by some that “people may be wasting their own and the taxpayers money with ineffective services, therapists, and counselling.”

“Could we talk?” she wanted to know.  After sorting the time difference between New Zealand and Chicago and working around my crazy travel schedule, we connected via Skype.  I learned that her interest in the subject of treatment outcome began when she heard fellow kiwi, and counselor, Steve Taylor , being interviewed on radio about the effectiveness of Social Services.

Over the last few years, Steve had given a number of such interviews, pointedly criticizing the system for failing to measure results.  Time and again, he highlighted popular programs for which there was either no empirical support or which the available evidence indicated did not work.

These gibes did not go unnoticed.  Once he was anonymously attacked on air while commenting on Family Court outcomes in New Zealand.  Throughout, Steve stuck to his stance, using research to make his point, arguing that providers and systems of care needed to produce evidence of real outcomes via the use of routine outcome measurement.

The article Donna wrote appeared in print this week, entitled, “Counselling: Cure or Con?”  Provocative and well-written, the piece puts “Feedback-Informed Treatment (FIT) front and center, concluding that “a profession whose practitioners spend their days analysing others, its about time they started examining themselves.”  It also provides practical, research-based advice for anyone thinking about seeing a therapist.  Anyway, read it for yourself:

North & south counselling outcomes article march 2013

 

Filed Under: Feedback Informed Treatment - FIT Tagged With: New Zealand, Paychotherapy, Social Services, Steve Taylor

Resources on Feedback-Informed Treatment, Training, & Research

January 24, 2013 By scottdm Leave a Comment

Last week, I spent a day in London working with the clinical staff of the Hertfordshire Partnership NHS Foundation Trust.  The subject?  Feedback, of course!  As soon as I stepped off my transcontinental flight, I knew it was going to be a fun day.  Every way I turned at the Heathrow airport I was greeted by a machine asking for feedback about my experience: after exiting customs, at the baggage claim area, at the duty free shops.  Amazing!

The process was as engaging as it was efficient.  Tell us about your experience…by pressing a button bearing one of four different faces.  The similarity to the ICCE Young Child Outcome Rating Scale was striking (to say the least).  I felt compelled to register my feedback at every opportunity.

From London, I travelled to Gotheburg, Sweden for the first Scandanavian Advanced Intensive Training in Feedack Informed Treatment.  The event, organized by GCK, Gothenburg’s Center for Competence Development, sold out in a week with participants coming from all over Scandanavia.  I taught the course together with ICCE Senior Associate Susanne Bargmann using a curriculum based on the FIT Treatment and Training Manuals.  The series was developed to support, in part, ICCE’s application to the US Substance Abuse and Mental Health Services Administration (SAMSHA) for designation of FIT as an evidence-based practice.  Together with the Training of Trainers (TOT) and Supervision Intensive workshops, the manuals and Advanced Intensive training provides participants with the latest, cutting-edge, evidence-based information and skills in FIT.

Back in October, I blogged about an article that reviewed the evidence regarding psychotherapy training.   In it, the author John Malouff concluded, “There appears to be no evidence that coursework and research completion…have any value to future psychotherapy clients…”.  He continued, “Training programs…carry the responsibility to show that the training they provide have positive benefits for future clients.”

Well…on that score, learning FIT, available evidence shows, leads to direct benefits to consumers of behavioral health services.  Together with New Zealand based psychologist and ICCE Senior Associate Eeuwe Schuckard, I’ve updated the review of the research supporting FIT practice (click here).

Don’t wait to learn about or deepen your understanding of and skills in feedback informed treatment.  The Advanced Intensive scheduled for March 18-321st has a few spots left.  You can register online by clicking here.

By the way, shortly after the publication of Malouff’s review in Psychotherapy in Australia, I wrote to the editor, Liz Sheehan, and asked for permission to reprint the article.  Click here to read it.

Filed Under: Conferences and Training Tagged With: feedback informed treatment, icce, New Zealand, NHS, sweden

Outcomes in New Zealand

March 23, 2010 By scottdm Leave a Comment

Made it back to Chicago after a week in New Zealand providing training and consultation.  As I blogged about last Thursday, the last two days of my trip were spent in Christchurch providing a two-day training on “What Works” for Te Pou–New Zealand’s National Centre of Mental Health Research, Information, and Workforce Development.  Last year around this same time, I provided a similar training for Te Pou for managers and policy makers in Auckland.  News spread and this year my contact at Te Pou, Emma Wood brought the training to the south island.  It is such a pleasure to be involved with such a forward thinking organization.

Long before I arrived, leadership at Te Pou were promoting outcome measurement and feedback.  Here’s a direct quote from their website:

Outcomes information can assist:

  • service users to use their own outcomes data to reflect on their wellbeing and circumstances, talk to clinicians about their support needs and inform their recovery plans
  • clinicians to use outcomes information to support their decision-making in day-to-day practice, monitoring change, better understanding the needs of the service user, and also to begin evaluating the effectiveness of different interventions
  • planners and funders to assess population needs for mental health services and assist with allocation of resources policy and mental health strategy developments through nationally aggregated data.

Indeed, using outcome to inform mental health service delivery is a key aspect of the Past, Present, and Future: Vision Paper–a review of “what works” in care and a plan for improving treatment in the future.  The site even publishes a quarterly newsletter Outcomes Matter.  Take a few minutes and explore the Te Pou website.  While you are there, be sure and download the pamphlet entitled, “A Guide to Talking Therapies.”  As the title implies, this brief, easy-to-read text provides a non-nonsense guide to the various “talk therapies” for consumers (I took several copies home with me from the workshop).

Before ending, let me say a brief hello to the Clinical Practice Leaders from the Problem Gambling Foundation of New Zealand who attended the two-day training in Christchurch.    The dedicated staff use an integrated public health and clinical model and are working to implement ongoing measurement of outcome and consumer feedback into service delivery.  The website contains a free online library including fact sheets, research, and books on the issue of problem gambling that is an incredible resource to professionals and the public.  Following the workshop, the group sent a photo that was taken of us together.  From left to right, they are Wenli Zhang, me, Margaret Sloan, and Jude West.

Filed Under: Behavioral Health, Conferences and Training, excellence, Feedback Informed Treatment - FIT Tagged With: books, evidence based practice, medicine, New Zealand, randomized clinical trial, Te Pou, Therapist Effects

Excellence on a Shoestring: The “Home for Good” Program

March 17, 2010 By scottdm Leave a Comment

Today I’m teaching in Christchurch, New Zealand. For the last two days, I’ve been in Nelson, a picturesque coastal town opposite Abel Tasman, working with the local DHB (District Health Board). If you’ve never visited, make a point of adding the country to your list of top travel destinations. The landscape and the people are second to none. (In Nelson, be sure and visit The Swedish Bakery. My 8-year old son, Michael, unequivocally states it has the best hot chocolate in the world—and, believe me, he’s an expert).

I’ve been traveling to New Zealand at least once a year for the last several years to provide training on using outcomes to inform behavioral healthcare. Interest is keen and providers and managers are working hard to deliver top-notch services. However, like many other places around the globe, economic factors are taking a toll.   On the day I arrived, one of the lead stories in the local paper (The Nelson Mail) focused on the economic crisis in healthcare.   “Complaints about money, shortages, overwork, stress and unsympathetic management…in the always-stretched hospital service,” the story began, “[indicate] a rapidly worsening situation” (p. 5, News Extra). Today, the headline of an article in section A5 of The Press Christchurch warns, “Health Ministry staff brace for job losses.”

A little over two weeks ago, I was in Richmond, Virginia working with managers and providers of public behavioral health agencies. There too, economic problems loom large. Over the last two years, for example, agencies have had to absorb across-the-board, double-digit cuts in funding. The result, in many instances, has been layoffs and the elimination of services and programs—with a few prominent exceptions.

On March 5th, I blogged about the crew at Chesterfield CSB in Virginia that were serving 70% more people than they did in 2007 despite there being no increase in available staff resources in the intervening period and, at the same time, decreasing clinician caseloads by nearly 30%.  In January, I posted text and video about agencies in Ohio that had managed to improve outcome, retention, and productivity at the same time that cutbacks had forced the furlough of staff! The common denominator in both instances is outcomes; that is, measuring the “fit and effect” of treatment on an ongoing basis and then using the data in consultation with consumers to improve service delivery.

If you’re not yet convinced, I have one more example to add to the mix: the “Home for Good” program.  Vision, commitment, and drive are words that best capture the management and staff who work at this Richmond, Virginia-based in-home behavioral health services program. Some might question the wisdom of starting a private, primarily Medicaid-funded treatment program in the worst economic climate since the Great Depression. A commitment to helping families keep their children at home—preventing placement in residential treatment centers, foster care, and detention—is what drove founder and director Kathy Levenston to take up the challenge. The key to their success says Kathy is that “we take responsibility for the results.” As in Ohio and Chesterfield, Kathy and her crew routinely monitor the alliance and results of the work they do and then use the data to enhance retention and outcome. Listen to Kathy as she describes the “Home for Good” program. I’m sure her story will inspire you to push for excellence whatever the “shoestring” budget you may be surviving on at the moment.

Filed Under: Behavioral Health, Top Performance Tagged With: cdoi, Home for Good, New Zealand

Outcomes in Oz II

November 25, 2009 By scottdm 4 Comments

Sitting in my hotel room in Brisbane, Australia.  It’s beautiful here: white, sandy beaches and temperatures hovering around 80 degrees.  Can’t say that I’ll be enjoying the sunny weather much.  Tomorrow I’ll be speaking to a group of 135+ practitioners about “Supershrinks.”  I leave for home on Saturday.  While it’s cold and overcast in Chicago, I’m really looking forward to seeing my family after nearly two weeks on the road.

I spent the morning talking to practitioners in New Zealand via satellite for a conference sponsored by Te Pou.  It was a completely new and exciting experience for me, seated in an empty television studio and talking to a camera.  Anyway, organizers of the conference are determined to avoid mistakes made in the U.S., Europe, and elsewhere with the adoption of “evidence-based practice.”  As a result, they organized the event around the therapeutic alliance–the most neglected, yet evidence-based concept in the treatment literature!  More later, including a link to the hour-long presentation.

On Friday and Saturday of this last week, I was in the classic Victorian city of Melbourne, Australia doing two days worth of training at the request of WorkSafe and the Traffic Accident Commission.  The mission of WorkSafe is, “Working with the community to deliver outstanding workplace safety, together with quality care and insurance protection to workers and employers.”  100+ clinicians dedicated to helping Australians recover from work and traffic-related injuries were present for the first day of training which focused on using formal client feedback to improve retention and outcome of psychological services.  On day 2, a smaller group met for an intensive day of training and consultation.  Thanks go to the sponsors and attendees for an exciting two days.  Learn more about how outcomes are being used to inform service delivery by watching the video below with Daniel Claire and Claire Amies from the Health Services Group.

 

Filed Under: Behavioral Health, Top Performance Tagged With: australia, evidence based medicine, evidence based practice, New Zealand, supershrinks

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