Clinical Support Tools for the ORS and SRS

November 20, 2012 By scottdm 1 Comment

I have so much to be grateful for at this time. Most of all, I’m happy to be home with my family. As we have in the past, this year we’ll be spending the holiday at the home of our long time friends John and Renee Dalton. The two always put out a fantastic spread and our son, Michael, is fast friends with their two kids.

I’m also grateful for the International Center for Clinical Excellence (ICCE) community. Currently, ICCE has over 4200 members located around the world, making the organization the largest, web-based community of professionals, educators, managers, and clinicians dedicated to using feedback to pursue excellence in the delivery of behavioral health services. Recently, the site was highlighted as one of the best resources for practitioners available on the web. Articles, how-to videos, and discussion forums are available everyday, all day–and for free! No come-ons for books or webinars and no “cult of personality”–just sharing among peers. If you are not a member, you can join at: www.centerforclinicalexcellence.com

A special thanks goes to several ICCE senior advisors and associates, including Susanne Bargmann, Jason Seidel, Cynthia Maeschalck, Bob Bertolino, Bill Plum, Julie Tilsen, and Robbie Babbins-Wagner. These folks are the backbone of the organization. Together, they make it work. Most recently, we all joined together to create the ICCE Feedback Informed Treatment and Training Manuals, a cutting edge series covering every aspect of FIT–from the empirical foundations to implementation–in support of our application to SAMSHA for recognition as an “evidence-based practice.”

As a way of supporting everyone using the ORS and SRS, I wanted to make a couple of clinical support tools available. If you are using the measures, the first item will need no introduction. It’s a 10 cm ruler! Save the file and print it off and you also have a ready reminder of the upcoming Achieving Clinical Excellence conference, coming up in May 2013. Like last time, this will feature the latest inforamtion about feedback informed practice! The second item is a reliable change graph. If you are using the paper and pencil measures, rather than one of the existing web based systems (www.fit-outcomes.com, www.myoutcomes.com), you can use this tool to determine whether a change in scores from session to session is reliable (that is, greater than chance, the passage of time, and measurement error [and therefore, due to the care being provided]) or even clinically significant (that is, both reliable and indicating recovered). The last item is an impressive summary of various systems for monitoring progress in treatment.

In addition ACE Health have developed openFIT, a plug-in which seamlessly integrates the ORS, SRS and associated algorithms into any existing Electronic Health Record, Case Management System of eMental Health application.

I wish everyone a peaceful and rewarding Thanksgiving holiday.

Are Mental Health Practioners Afraid of Research and Statistics?

September 30, 2011 By scottdm Leave a Comment

A few weeks back I received an email from Dr. Kevin Carroll, a marriage and family therapist in Iowa. Attached were the findings from his doctoral dissertation. The subject was near and dear to my heart: the measurement of outcome in routine clinical practice. The findings were inspiring. Although few graduate level programs include training on using outcome measures to inform clinical practice, Dr. Carroll found that 64% of those surveyed reporting utilizing such scales with about 70% of their clients! It was particularly rewarding for me to learn that the most common measures employed were the…Outcome and Session Rating Scales (ORS & SRS)

As readers of this blog know, there are multiple randomized clinical trials documenting the impact that routine use of the ORS and SRS has on retention, quality, and outcome of behavioral health services. Such scales also provide direct evidence of effectiveness. Last week, I posted a tongue-in-cheek response to Alan Kazdin’s broadside against individual psychotherapy practitioners. He was bemoaning the fact that he could not find clinicians who utilized “empirically supported treatments.” Such treatments when utilized, it is assumed, lead to better outcomes. However, as all beginning psychology students know, there is a difference between “efficacy” and “effectiveness” studies. The former tell us whether a treatment has an effect, the latter looks at how much benefit actual people gain from “real life” therapy. If you were a client which kind of study would you prefer? Unfortunately, most of the guidelines regarding treatment models are based on efficacy rather than effectiveness research. The sine qua non of effectiveness research is measuring the quality and outcome of psychotherapy locally. After all, what client, having sought out but ultimately gained nothing from psychotherapy, would say, “Well, at least the treatment I got was empircally supported.” Ludicrous.

Dr. Carroll’s research clearly indicates that clinicians are not afraid of measurement, research, and even statistics. In fact, this last week, I was in Denmark teaching a specialty course in research design and statistics for practitioners. That’s right. Not a course on research in psychotherapy or treatment. Rather, measurement, research design, and statistics. Pure and simple. Their response convinces me even more that the much talked about “clinician-researcher” gap is not due to a lack of interest on practitioners’ parts but rather, and most often, a result of different agendas. Clinicians want to know “what will work” for this client. Research rarely address this question and the aims and goals of some in the field remain hopelessly far removed from day to day clinical practice. Anyway, watch the video yourself:

Why is this man laughing?

May 4, 2011 By scottdm 3 Comments

May 4th, 2011
Copenhagen, Denmark

Just finished my first day of a two week trip covering spots in Denmark and Holland. Yesterday, I traveled to Copenhagen from Hilo, Hawaii where I was presenting for the Hawaiian Association of Marriage and Family Therapy. Dr. Gay Barflied (pictured on the far left above) spent years lobbying to bring me to the “Big Island” for the conference, where I spoke about the latest research on expertise and excellence in the field of behavioral health. I met so many dedicated and talented clinicians in Hilo, including marriage and family therapist, Makela Bruno-Kidani (pictured in the middle photo above) who started the day off with a traditional Hawaiian chant and then presented me with two beautiful lei to wear during the event.

On a break, Gay mentioned an article that appeared in the May/June 1995 issue of AHP Perspective. In it, she said, Maureen O’Hara, president of the Association for Humanistic Psychology, quoted one of the first articles me and my colleagues wrote on the common factors, “No More Bells and Whistles” (I’ll upload a copy to the “publications and handouts” section of the website as soon as I’m back in the States). Carl Rogers, she said, would have been laughing (happily, that is) had he read the findings we cited documented the lack of differential efficacy of competing treatment approaches. We had, in essence, proved him right!

“It turns out,” OHara wrote, “that Miller, Hubble, and Duncan come to similar conclusions. Carl Rogers was right. After all our forays into the dizzing arcana of paradoxical interventions, inner children, narrative therapy, EMDR, behaviorism, psychopharmacology, bioenergetics, TA, Jungian analysis, psychodrama, Gestalt, and so on down the entire list of hundred brand named therapies, what actually creates change is the…creation of a relationship between client and therapist…”.

I’d never seen the article before. It brought back very positive memories about the journey that has led most recently to the study of excellence. Indeed, as we point out in the lead article in the upcoming May/June 2011 issue of the Psychotherapy Networker, relationships are not only the “sine qua non” of healing for clients but are responsible for the professional growth for therapists.