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Using Feedback Informed Treatment to Improve Medication Adherence and Reduce Healthcare Costs

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persontakingpill

Medication adherence is a BIG problem.  According to recent research, nearly one-third of the prescriptions written are never filled.  Other data document that more than 60% of people who actually go the pharmacy and get the drug, do not take it as prescribed.

What’s the problem, you may ask?  Inefficiency aside, the health risks are staggering.  Consider, for example, that the prescriptions least likely to be filled are those aimed at treating headache (51 percent), heart disease (51.3 percent), and depression (36.8)percent).

medication adherence

When cost is factored into the equation, the impact of the problem on an already overburdened healthcare system becomes even more obvious.  Research indicates that not taking the medicines costs an estimated $290 billion dollars per year–or nearly $1000 for every man, woman, and child living in the United States.  It’s not hard to imagine more useful ways such money could be spent.

What can be done?

Pringle_Photo 2013

Enter Dr. Jan Pringle, director of the Program Evaluation Research Unit, and Professor of Pharmacy and Therapeutics at the University of Pittsburgh. As I blogged about back in 2009, Jan and I met at a workshop I did on feedback-informed treatment (FIT) in Pittsburgh.  Shortly thereafter, she went to work training pharmacists working in a community pharmacy to use the Session Rating Scale ([SRS] a four-item measure of the therapeutic alliance) in their encounters with customers.

It wasn’t long before Jan had results.  Her first study found that administering and discussing the SRS at the time medications were dispensed resulted in significantly improved adherence (you can read the complete study below).

She didn’t stop there, however.

reading

Just a few weeks ago, Jan forwarded the results from a much larger study, one involving 600 pharmacists and nearly 60,000 patients (via a special arrangement with the publisher, the entire study is available by clicking the link on her publications page of the University website).

Suffice it to say that using the measures, in combination with a brief interview between pharmacist and patient, significantly improved adherence across five medication classes aimed at treating chronic health conditions (e.g., calcium channel blockers, oral diabetes medications, beta-blockers, statins, and renin angiotemsin system antagonists).  In addition to the obvious health benefits, the study also documented significant cost reductions.  She estimates that using the brief, easy-to-use tools would result in an annual savings of $1.4 million for any insurer/payer covering at least 10,000 lives!

Prior to Jan’s research, the evidence-base for the ORS and SRS was focused exclusively on behavioral health services.  These two studies point to exciting possibilities for using feedback to improve the effectiveness and efficiency of healthcare in general.

The tools used in the pharmacy research have been reviewed and deemed evidence-based by the Substance Abuse and Mental Health Services Administration.

PCOMSLogoKnown as PCOMS, detailed information about the measures and feedback process can be found at www.whatispcoms.com.  It’s easy to get started and the measures are free for individual healthcare practitioners!

Public Attitudes Toward Mental Health Services: A Change for the Worse

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Here it is

The results are not encouraging.  A recent meta-analysis found that public attitudes toward psychotherapy have become progressively more negative over the last 40 years.  The impact on practitioners is staggering.  Between 1997 and 2007, use of psychotherapy declined by 35%.  Not surprisingly, clinicians’ incomes also suffered, dropping 15-20% over the last decade.

So, if not psychotherapy, what do consumers of mental health services really want?

Well, if you trust the study I’ve cited, the answer seems clear: drugs.  During the same time period that talking fell out of favor, use of pharmaceuticals increased a whopping 75%!  Some blame society’s short attention span and desire for a “quick fix.”  Such an argument hardly seems credible, however, given that psychotherapy works to alleviate distress as fast or faster than most psychotropics.

Others, including the authors of the meta-analysis, blame public education campaigns and pharmacological marketing aimed at “convincing the public that mental disorders have a neurobiological etiology that require biological treatments” (p. 103).  At first glance, this idea is compelling.  After all, every year, the pharmaceutical industry spends $5 billion dollars on direct-to-consumer advertising.

And yet, what is it the drug companies are really selling in those ads?  In one of the most well-known TV commercials for a popular antidepressant, less than 7 seconds is spent on the supposed neurobiological cause.  Instead, the majority of the time is spent depicting the positive results one can expect from the product.   It’s marketing 101: focus on the benefits not the features of whatever you’re selling.

What do consumers want?  The answer is: results.  Your training, degree, certification, and treatment approach are irrelevant, mere features most consumers could care less about.  Your rate of effectiveness is another matter entirely–its the benefit people are looking for from working with you.

So, how effective are you?  Do you know?  Not a guess or a hunch, but the actual number of people you treat that are measurably improved?  If not, its easy to get started.  Start by downloading two, simple, free, SAMHSA-approved scales for measuring progress and quality of mental health services.  Next, visit www.whatispcoms.com to learn how individual practitioners and agencies can use these tools to monitor and improve outcome and retention in treatment, as well as communicate results effectively to consumers.

To see how outcomes attract consumers, just take a look at the Colorado Center for Clinical Excellence website.   This Denver-based group of practitioners is a model for the future of clinical practice.

Is Supervision Important to you?

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ShowMeTheData-Howl-1

How valuable is clinical supervision to you?  In their massive, long-term international study of therapist development, researchers Orlinsky and Rønnestad (2005) found that “practitioners at all experience levels, theoretical orientations, professions, and nationalities report that supervised client experience is highly important for their current and career development” (p. 188).

Despite the value most of us place on the process, the latest review of the literature found no empirical evidence, “that psychotherapy supervision contributes to patient outcome” (Watkins, 2011).  Said another way, supervision does not produce more effective clinicians.  The result?  In the US, at least, opportunities for clinical supervision are in the decline, replaced by growing documentation requirements and administrative oversight–a trend destined to continue if the dearth of evidence persists.

What can be done?  Simply put, solicit formal feedback from clients regarding their experience of progress and the therapeutic relationship.  Such information, in turn, can be used to guide supervision, providing both a focus for the consultation and data supporting its effectiveness.  After all, multiple studies already document that the process improves outcomes while simultaneously decreasing drop out and deterioration rates (Miller, 2013 ).

Getting started is not difficult.  First, access two, free, easy-to-use scales for monitoring client progress and the relationship.   Second, join colleagues in the largest, online community of behavioral health professionals in the world.  It’s free–no hidden costs or secret levels of premium content.  On the ICCE, you can connect and consult with practitioners who are using feedback to improve the quality and outcome of treatment and supervision.  If you are new to feedback-informed work (FIT)–a SAMHSA certified evidence-based practice–you can get a thorough introduction at: www.whatispcoms.com .

Finally, get the  Feedback-Informed supervision manual and newly released, two-hour DVD.  Both provide step-by step instructions and examples of integrating feedback into supervision.  While you are at it, join us for our Feedback-Informed Supervision Intensive.  Last time around, it sold out months advance.  Registration is now open for our next training in March 2015.

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

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“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.”

Anna Graham Anderson
Anna Graham Anderson

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 each of the six treatment and training manuals, FIT, or feedback-informed treatment, 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 therapeutic relationship and outcome of care and using the resulting information to inform and tailor service deliver.”

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 is the one I no longer use.  For me, it had always 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.  Overtime, the acronym, PCOMS, began to be used as an overall term referring to the ORS, SRS, and norms for interpreting the scores.  In February 2013, the Substance Abuse and Mental Health Service Adminstration (SAMHSA) formally recognized PCOMS as an evidence-based practice.  You can read more about PCOMS at: www.whatispcoms.com.

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.

What can therapists learn from the CIA? Experts versus the "Wisdom of the Crowd"

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Central psychotherapy agency

What can we therapists learn from the CIA?  In a phrase, “When it comes to making predictions about important future events, don’t rely on experts!”

After a spate of embarrassing, high-profile intelligence failures, a recent story showed how a relatively small group of average people made better predictions about critical world events than highly-trained analysts with access to classified information.  The four-year study, known as the Good Judgment Project, adds to mounting evidence regarding the power of aggregating independent guesses of regular folks–or what is known as, “the wisdom of the crowd.”

When it comes to therapy, multiple scientific studies show that inviting the “wisdom of the crowd” into treatment as much as doubles effectiveness, while simultaneously cutting drop out and deterioration rates.

Whatever your profession, work setting, or preferred therapeutic approach, the process involves formally soliciting feedback from clients and then comparing the results to empirically established benchmarks.   Getting started is easy:

You can learn more at: www.whatispcoms.com.  Plus, the ICCE–the world’s largest online community of professionals using feedback to enhance clinical judgment–is available at no cost to support you in your efforts.

While you’re at it, be sure and join fellow practitioners from the US, Canada, Europe, and Australia for the “Training of Trainers” or two-day FIT Implementation Intensive coming up this August in Chicago.  You’ll not only learn how to use the measures, but also tap into the collective wisdom of clients and practitioners around the globe.   Space is limited, and we are filling up quickly, so don’t wait to register.

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

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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, we’ve integrated the research on implementation into all training events, including a special, two-day intensive workshop on implementing Feedback-Informed Treatment (FIT).  Based on the five, scientifically-established steps, clinicians, supervisors, and agency directors will learn how to both plan and execute a successful implementation of this potent evidence-based practice. 

You can register today by clicking on the link above or the “FIT for Management” icon below.  Feel free to e-mail me with any questions.  In the meantime, hope to see you this summer in Chicago!

Fit Imp 2014

Do you do psychotherapy?

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You know psychotherapy works. Forty years of research evidence backs up your faith in the process. And yet, fewer and fewer people are seeking out the services of professionals. Between 1998 and 2007, psychotherapy use decreased by 35%. People still sought help, they just went elsewhere to get it. For instance, use of psychotropic drugs is up 40% over the last decade.

A recent article in Popular Science traced the decline and outlined 3 provocative steps for saving the field. If you provide psychotherapy, it’s worth a read. The article is dead serious when recommending:

1. It’s time to GO BIG;

2. Getting a cute commercial; and

3. Dropping the biology jargon.

You’ve got to admit that the field’s fascination with biology is curious. A mountain of evidence points instead to the relationship between the provider and recipient of care. Other research shows that psychotherapy promotes more lasting change, at less cost and with fewer side effects than medication.

How to get the message out?

Many people and organizations are making a valiant effort. Ryan Howe almost single-handedly established today, September 25, as National Psychotherapy Day.  The American Psychological Association published a rare, formal resolution on the efficacy of psychotherapy.

Frankly though, the best commercial for psychotherapy is our results. Consider the approach taken by the Colorado Center for Clinical Excellence. They don’t merely cite studies supporting psychotherapy in general, they report their actual results!

You can begin doing the same by downloading two free, simple to use measures here.

Then, learn how to use the scales to determine your effectiveness at an upcoming Feedback Informed Treatment Intensive (FIT) training.

There, you’ll also learn how to use the data to improve both the quality and outcome of your services. That’s why the Substance Abuse and Mental Health Services Administration (SAMHSA) recently listed FIT on the National Registry of Evidence Based Programs and Practices!

So, now is the time GO BIG by joining us. The next training is coming up in March! Register now at: http://ai2014.eventbrite.ie/.

AIMarch2014 FITSupervisionMar2014

 

 

Evidence-based Practice is a Verb not a Noun

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Evidence-based practice (EBP).  What is it?  Take a look at the graphic above.  According to American Psychological Association and the Institute of Medicine, there are three components: (1) the best evidence; in combination with (2) individual clinical expertise; and consistent with (3) patient values and expectations.  Said another way, EBP is a verb.  Why then do so many treat it as a noun, continually linking the expression to the use of specific treatment approaches?  As just one example, check out guidelines published for the treatment of people with PTSD by the National Institute for Clinical Excellence (NICE)–the U.K.’s equivalent to the U.S. Substance Abuse and Mental Health Services Administration (SAMHSA).  Despite the above noted definition, and the lack of evidence favoring one treatment over another, the NICE equates EBP with the use of specific treatment approaches and boldly recommends certain methods over others.

Not long ago, ICCE Senior Associate, and U.K.-based researcher and clinician, Bill Andrews, addressed the problems with the guidelines in a presentation to an audience of British practitioners.  He not only addresses the inconsistent use of the term, evidence-based practice, in the development of guidelines by governing bodies but also the actual research on PTSD.  After watching the clip, take some time to review the articles assembled below, which Bill cites during his presentation.  The main point here is that clinicians need not be afraid of EBP.  Instead, they need to insist that leaders and officials stick to the stated definition–a definition I’m perfectly content to live with mas are most practitioners I meet.  To wit, know what the evidence says “works,” use my expertise to translate such findings into practices that fit with the values, preferences, and expectations of the individual consumers I treat.

Click here to read the meta-analysis that started it all.  Don’t stop there, however, make sure and read the response to that study written by proponents of the NICE guideliness.  You’ll be completely up-to-date if you finish with our response to that critique.

What to Pay Attention to in Therapy?

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A week or so ago, I received an email from my friend, colleague, and mentor Joe Yeager.  He runs a small listserve that sends out interesting and often provocative information.  The email contained pictures from a new and, dare I say, ingenious advertising campaign for Colgate brand dental floss.  Before I give you any of further details, however, take a look at the images yourself:

All right.  So what caught your attention?  If you’re like most people–including me–you probably found yourself staring at the food stuck in the teeth of the men in all three images.  If so, the ad achieved its purpose.  Take a look at the pictures one more time.  In the first, the woman has one too many fingers on her left hand.  The second image has a “phamtom arm” around the man’s shoulder.  Can you see the issue in the third?

The anomalies in the photos are far from minor!  And yet, most of us, captured by the what initially catches our eye, miss them.

Looking beyond the obvious is what Feedback Informed Treatment (FIT) is all about.  Truth is, much of the time therapy works.  What we do pay attention to gets results–except when it doesn’t!  At those times, two things must happen: (1) we have to know when what we usually do isn’t working with a given person; and (2) look beyond the obvious and see a bigger picture.  Doing this takes effort and support.    What can you do?

1. Download two free, brief, simple to use tools for tracking outcome and engagement in care (the ORS and SRS) and begin using them in your work;

2. Join the International Center for Clinical Excellence, the world’s largest, free, online, non-denominational organization of behavioral health professionals;

3. Read the six cutting-edge treatment and training manuals on feedback-informed treatment–a series which helped earn FIT the highest ratings from the Substance Abuse and Mental Health Services Administration (SAMHSA);

4. Attend a training in Chicago or abroad.

 

S.A.M.S.H.A. designates Feedback-Informed Treatment an "Evidence-based Practice"

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February 2, 2013
Chicago, Illinois USA

I am honored to announce that Feedback-Informed Treatment (FIT) has been added to SAMSHA’s official database of evidence-based practices (EBP) known as NREPP (the National Registry of Evidence-based Programs and Practices).  Briefly, NREPP is a searchable online registry of behavioral health interventions that have been reviewed and rated by independent reviewers.  The purpose of the registry is to assist the public, payers, and practitioners in identifying approaches that have both empirical support and materials available to facilitate implementation.

The Institute of Medicine and American Psychological Association define EBP as, “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences (see American Psychologist, May 2006).  The principles and practices of feedback-informed treatment (FIT) are not only consistent with but provide practitioners with a simple and practical method for operationalizing EBP in their daily work.  To wit, routinely and formally soliciting feedback from consumers regarding the therapeutic alliance and outcome of care and using the resulting information to inform and tailor service delivery.  As reviewed many times on this blog, multiple, carefully-controlled, randomized clinical trials document that FIT improves outcomes while simultaneously decreasing the risk of drop out and deterioration in care.

Scientific evidence is one matter; being able to support practitioners, agencies, and systems of care in implementing an EBP is another.  On this subject, I am proud to say that FIT received perfect ratings (see, “Readiness for Dissemination” tab).  Unlike other similar approaches, “no weaknesses” were identified by reviewers.  Instead, the summary noted, “ICCE…has an array of comprehensive, well-organized, and high-quality materials to support…implementation…The steps for successful implementation are clear and accompanied by tools and guidance to support the entire process, from the determination of organizations readiness through evaluation.”

Such high marks would not been possible without the contribution of ICCE Senior Associates who worked tirelessly to create the materials and complete the application.   A big thanks to Jason Seidel, Psy.D., Bob Bertolino, Ph.D., Susanne Bargmann, Cynthia Maeschalck, Rox Axsen, Bill Robinson, Robbie Babbins-Wagner, Ph.D., and Julie Tilsen, Ph.D..

The formal recognition of FIT as an EBP is a watershed moment in the history of the International Center for Clinical Excellence, further enabling the organization to achieve it’s mission of improving the quality and outcome of behavioral health services.

Feedback Informed Treatment as Evidence-Based Practice

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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.

The Outcome and Session Rating Scales: Support Tools

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Japan, Sweden, Norway, Denmark, Germany, France, Israel, Poland, Chile, Guam, Finland, Hungary, Mexico, Australia, China, the United States…and many, many more.  What do all these countries have in common?  In each, clinicians and agencies are using the ORS and SRS scales to inform and improve behavioral health services.  Some are using web-based systems for administration, scoring, interpretation and data aggregation (e.g., myoutcomes.com and fit-outcomes), many are accessing paper and pencil versions of the measures for free and then administering and scoring by hand.

Even if one is not using a web-based system to compare individual client progress to cutting edge norms, practitioners can still determine simply and easily whether reliable change is being made by using the “Reliable Change Chart” below.  Recall, a change on the ORS is considered reliable when the difference in scores exceeds the contribution attributable to chance, maturation, and measurement error. Feel free to print out the graph and use it in your practice.

To learn how to get the most out of the measures, be sure and download the six FIT Treatment and Training Manuals.  The six manuals cover every aspect of feedback-informed practice including: empirical foundations, basic and advanced applications (including FIT in groups, couples, and with special populations), supervision, data analysis, and agency implementation. Each manual is written in clear, step-by-step, non-technical language, and is specifically designed to help practitioners and agencies integrate FIT into routine clinical practice. Indeed, the manuals were submitted as part of ICCE’s application for consideration of FIT as an “evidence-based practice” to the National Registry of Evidence-Based Programs and Practices

ORS Reliable Change Chart

Feedback-Informed Treatment as Evidence-based Practice: APA, SAMSHA, and NREPP

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What is evidence-based practice?  Visit the UK-based NICE website, or talk to proponents of particular theoretical schools or therapeutic models, and they will tell you that being “evidence-based” means using the approach research has deemed effective for a particular diagnosis  (e.g., CBT for depression, EMDR for trauma).  Over the last two decades, numerous organizations and interest groups have promoted lists of “approved” treatment approaches–guidelines that clinicians and funding bodies should follow when making practice decisions.  Throughout the 1990’s, for example, division 12 within the American Psychological Association (APA) promoted the idea of “empirically supported treatments.”

However, when one considers the official definition of evidence-based practice offered by the Institute of Medicine and the APA, it is hard to fathom how anyone could come to such a conclusion.  According to the APA, evidence-based practice is, “the integration of the best available research with clinical expertise in the context of patient characteristics, culture, and preferences.” (see American Psychologist, May 2006).  Nothing here about “empirically supported treatments” or the mindless application of specific treatment protocols.  Rather, according to the APA and IOM, clinicians must FIT the treatment to the client, their preferences, culture, and circumstances.  And how can one do that?  Well, conspicuously absent from the definition is, “consult a set of treatment guidelines.”  Rather, 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.”

The principles and practices of feedback-informed treatment (FIT) are not only consistent with but operationalize the American Psychological Association’s (APA) definition of evidence-based practice.  To wit, routinely and formally soliciting feedback from consumers regarding the therapeutic alliance and outcome of care and using the resulting information to inform  and tailor service delivery.  And indeed, over the last 9 months, together with Senior Associates, I completed and submitted an application for FIT to be reviewed by NREPP–SAMSHA’s National Registry of Evidence-based Practices and Approaches!  As part of that application and ICCE’s commitment to improving the quality and outcome of behavioral health, we developed a list of “core competencies” for FIT practice, a series of six detailed treatment and implementation manuals, a gap assessment tool that organizations can use to quickly and expertly assess implementation and fidelity problems, and supportive documentation and paperwork.  Finally, we developed and rigorously tested training curricula and administered the first standardized exam for certifying FIT practitioners and trainers.  We are in the final stages of that review process soon and I’m sure I’ll be making a major announcement right here on this blog shortly.  So, stay tuned.

In the meantime, this last Saturday, clinicians located the globe–Canada, New Zealand, Australia, the US,a nd Romania–sat for the first administration of ICCE “Core Competency” Exam.  Taking the test is the last step in becoming an ICCE “Certified Trainer.”   The other requirements include: (1) attending the “Advanced Intensive” and “Training of Trainers” workshops; and (2) submitting a training video on FIT for review.  The exam was administered online using the latest technology.


The members, directors, and senior associates of ICCE want to congratulate (from top left):

  • Eeuwe Schuckard, Psychologist, Wellington, New Zealand;
  • Aaron Frost, Psychologist, Brisbane, Australia;
  • Cindy Hansen, BA-Psych, HHP, Manager Myoutcomes;
  • David Prescott, Director of Professional Development, Becket Family of Services, Portland, Maine;
  • Arnold Woodruff, LMFT, Clinical Director, Home for Good, Richmond, Virginia;
  • Bogdan, Ion, Ph.D., Bucharest University, Bucharest, Romania;
  • Daniel Buccino, Clinical Supervisor, Community Psychiatry Program. Johns Hopkins;
  • Dwayne Cameron, Outreach Counselor, Prince Albert, Saskatoon, Canada;
  • Mark Goheen, the Clinical Practice Lead at Fraser Health, British Columbia.

If you are not yet a member of the ICCE community, please join the largest, fastest growing, and friendly group of behavioral health professionals today at: www.centerforclinicalexcellence.com.