Day3BarryDuncanJonathanHuntGlassman

www.heartandsoulofchange.com June 19, 2010 Supervision for a Change In Clients and Counselors Jonathan Hunt-Glassman www.MyOutcomes.com Hunt- Barry Duncan, Psy.D. www.heartandsoulofchange.com What’s Up • MyOutcomes • Helping Clients and Accelerating Therapist Growth • The Nuts and Bolts of Outcome Informed Supervision 1

www.heartandsoulofchange.com June 19, 2010 Supervision for a Change – in Clients and Counselors Jonathan Hunt-Glassman Product Manager MyOutcomes MyOutcomes & Supervision • MyOutcomes empowers providers and supervisors to systematically incorporate consumer feedback into service delivery, clinical supervision, and career development. 2

www.heartandsoulofchange.com June 19, 2010 MyOutcomes • MyOutcomes is a Web-based consumer-driven outcomes management system that improves effectiveness and increases efficiency in behavioral health services. Customers 3

www.heartandsoulofchange.com June 19, 2010 MyOutcomes’ Heart & Soul • Continuous consumer feedback • Proven predictors of success – Benefit from services – Alliance • Valid & reliable measures • Feasibility MyOutcomes’ Core • ORS & SRS Administration • Real-time graphing • Empirically-based feedback • Statistical analysis 4

www.heartandsoulofchange.com June 19, 2010 MyOutcomes’ Appendages • Additional Feedback Resources • Couples • Skipped Sessions • Paper Transfer • Client Transfers • Data Correction • Data Export MyOutcomes’ Backbone • On-demand service • Customization & integration • HIPAA-compliant 5

www.heartandsoulofchange.com June 19, 2010 Benefits • Improves service outcomes • Boosts revenues and efficiencies by reducing no-shows, dropouts, length of stay, and overutilization • Gets provider participation because client feedback process is fast, easy and relevant • Provides automated, quantifiable results to validate performance • Empowers client with a voice in the service process MyOutcomes & Supervision • Key Effectiveness Indicators • Case Alerts • Utilization Measurement • Report Filtering 6

www.heartandsoulofchange.com June 19, 2010 Becoming Better at What We Do More of a Calling • That smart, creative indvs make the sacrifices for advanced degrees only to earn far less than others says something • Required servitude w/o the promise of rags to riches only makes sense b/c it is more of a calling than a job—a quest for meaning & fulfillment Supervision Helps Therapists Fulfill their Calling • Holds agencies together in the face of funding, production pressures & stresses re working w/folks in dire straights. • Provides team building, camaraderie, grins, & support—it prevents helper burnout and creates a context for currently experienced growth. 7

www.heartandsoulofchange.com June 19, 2010 Isomorphism in Supervision Is It Mission Impossible? What the Heck Is Isomorphism or Parallel Process a. New kind of sex therapy b. One-to-one correspondence b/w two mathematical sets c. New sci fi blockbuster d. Patterns & relationships in supervision reproduced b/w therapists and clients e. Doing sup. the the way you want the clinical work done-- Facilitating change in both the therapist and the client 8

www.heartandsoulofchange.com June 19, 2010 General Considerations Walk the Walk • Inviting supervisees’ voices encourages therapists to invite their clients’ voices • Collaborative relationships with supervisees translate to better client alliances Becoming Better Recapture Your At Risk Clients • Feedback tailors therapy based on response, provides an early warning system to prevents dropouts & negative outcomes, & solves therapist variability—feedback improves performance and quickens development… 9

www.heartandsoulofchange.com June 19, 2010 How Therapists Develop Orlinsky & Rønnestad • Three Sources of Healing Involvement: • Cumulative Career Development; Theoretical Breadth, and the most important, Currently Orlinsky, D. E., Rønnestad, M. H. (2005). How psychotherapists develop: Washington, DC: APA. Experienced Growth How Do We Attain Currently Experienced Growth • Experiential learning thru clinical work • Beyond cliché, therapists believe that clients are the best teachers—our primary access to Growth 10

www.heartandsoulofchange.com June 19, 2010 Clients Are The Best Teachers But Invoked Here Differently • Feedback shapes our behavior until we get it right. Collaborative focus on the benefit & fit of therapy, clients can teach us to do more effective work, session by session basis…but we have to be open to it: Ariely Translating Therapist Development to Supervision • Client feedback monitors outcome & plots cumulative career development. • Tailoring services leads to theoretical breadth to serve more clients. • Securing client feedback places therapists in accelerated courses of development in the front of the class to see and hear the lessons of the day—to experience currently experienced growth. 11

www.heartandsoulofchange.com June 19, 2010 The Three Sources Isomorphic (Parallel) to CDOI Supervision • Tracking CCD like tracking client progress. Working w/therapists re plans to enhance dev. akin to collaboration re the tasks of tx • Helping sup. expand TB helps them be more responsive to client ideas. Teaches there is no inherent validity to theory • Norway therapist—feedback enables experience of CEG. Your curiosity about these experiences will enhance their curiosity to learn from clients. Cumulative Career Development ASIST and MyOutcomes.com • The single bit of information that tells you the most is the % of who reach target—the % who reach the 50th percentile trajectory for clients entering services with the same intake score. 12

www.heartandsoulofchange.com June 19, 2010 Cumulative Career Development Now You Are Ready • Track effectiveness by quarter and/or, if you are using MyOutcomes, current v. inactive clients. • Allows the planned consideration of therapist development and the strategic implementation of ideas, practices, and models to improve effectiveness. Skill Building/Deliberate Practice Becoming Client Directed 3 Skills of Client Directed or Common Factors Practice 1. Recruiting Client Resources *Telling Heroic Stories *Listening for a Change 2. Reliance on the Alliance *Close to the Client’s Exp. *Validation *Work on the Client’s Goals 3. Client’s Theory of Change 13

www.heartandsoulofchange.com June 19, 2010 Currently Experienced Growth and Morale • Closely associated with work morale. Energizes therapists to apply their skills & understandings • Remoralizes, repairs abrasions & stressors of the work. • Combats routinization, disillusionment, & loss of empathy. Helping Supervisees Learn from Clients • Therapist experiences of their current development are influenced mainly by the quality of their clinical experiences w/clients. • Supervision can help therapists make the best of it. 14

www.heartandsoulofchange.com June 19, 2010 Isomorphic Supervision Just the Facts Ma’am • The nuts & bolts of isomorphic, client directed, outcome informed supervision. CDOI Supervision: Key to Client Benefit & Therapist Growth • Based on outcome data not theory or pontification. • Oriented to common factors of change and the skills of outcome-informed services. • Aimed at early identification of clients at risk so services can be modified. • Offers feedback, support, training for those who aspire to become better therapists 15

www.heartandsoulofchange.com June 19, 2010 Supervision Four Steps • Supervisees bring dashboard printout (or graphs) of all clients falling below 40th percentile • Supervisor reviews graphs, looks for over/under utilization of services, spends time on at risk clients, brainstorms options • Supervisor reviews stats & discusses ways to improve • Skill building, theoretical breadth, focus on client teachings Dashboard Printouts /Graphs Red Flags • Not bringing them • Not using…attributes to clients • Not able to describe how measures are used. • Use seems perfunctory • Long-term relationships without progress • SRS scores reflect problems in joining or perfunctory use • Views as more paperwork or as bookends to real work 16

www.heartandsoulofchange.com June 19, 2010 X X X X 17

www.heartandsoulofchange.com June 19, 2010 Supervision Four Steps • Supervisees bring dashboard printout (or graphs) of all clients falling below 40th percentile • Supervisor reviews graphs, looks for over/under utilization of services, spends time on at risk clients, brainstorms options • Supervisor reviews stats & discusses ways to improve • Skill building, theoretical breadth, focus on client teachings Reviewing Graphs First Things First • Squeamishness • Percentiles and Trajectories • Clinical Cut Off • Session and Service Targets 18

www.heartandsoulofchange.com June 19, 2010 Reviewing Graphs Over Utilization Creates wait lists, iatrogenic effects. First way is when the client continues in service in the absence of benefit. Reviewing Graphs Over Utilization • When max benefit reached, talk about stepping down; not discharge, but planning for continued recovery out of tx. • If not stepped down, graphs look like a saw, rising and falling with everyday life; clients are disempowered • ORS represents life in general instead of client's perceptions connected to the purpose of the service. 19

www.heartandsoulofchange.com June 19, 2010 Review Checkpoint Or Last Chance Discussions X X X X X 20

www.heartandsoulofchange.com June 19, 2010 Brainstorming Options Don’t Forget the Client • Consider client resources, ideas, and basic needs; what about the alliance— is client engaged? • People, places, things: Colleague or sup. consult; someone else from client support network; community support; faith based; peer recovery; or different provider Supervision Four Steps • Supervisees bring dashboard printout (or graphs) of all clients falling below 40th percentile • Supervisor reviews graphs, looks for over/under utilization of services, spends time on at risk clients, brainstorms options • Supervisor reviews stats & discusses ways to improve • Skill building, theoretical breadth, focus on client teachings 21

www.heartandsoulofchange.com June 19, 2010 Reviewing the Stats: What the Heck Do They Mean? • Average Raw Change is converted to an effect size (ES). The ES offers a quick look at how things are going with clients compared to a normative data base. An ES of 1 means progressing better than 1 SD above the average. Also allows comparison to RCTs. Uncorrected” because it treats all intake scores equally. Sadistics • The ES is “corrected” because it takes into account the client’s intake score. It is a measure of progress compared with clients with the same intake score. A positive number indicates that progress has exceeded expectations 22

www.heartandsoulofchange.com June 19, 2010 23

www.heartandsoulofchange.com June 19, 2010 Collaboratively Form a Plan Improve/Foster Development • Discuss stats openly and ask for supervisee’s ideas • Co-develop a plan and implement; evaluate quarter by quarter; modify if outcomes not improving • Foster continued professional reflection Supervision Four Steps • Supervisees bring dashboard printout (or graphs) of all clients falling below 40th percentile • Supervisor reviews graphs, looks for over/under utilization of services, spends time on at risk clients, brainstorms options • Supervisor reviews stats & discusses ways to improve • Skill building, theoretical breadth, focus on client teachings 24

www.heartandsoulofchange.com June 19, 2010 Learning from Clients Ongoing Reflection • Discuss with others • Note & articulate changes • Note how it was done • Make before/after distinctions • Reflect about continuing the change • Reflect about the new chapter in your dev. as a therapist Leave Time in Each Meeting Continual Professional Reflection • Skill Building: Practice well the skill of the craft— the alliance, for the sake of the craft itself. At some point, craftsmanship becomes art. • Expanding Theoretical Breadth by playing “On the other hand…” • Learn from Clients: Tease out what is working and what is not using client outcome as a guide. 25

www.heartandsoulofchange.com June 19, 2010 You’ll Have Them When… CEG Kicks In • They have conversations with clients in ways not seemed possible before • They experience that first client who benefits • They recapture success with clients who would have ended negatively • They learn from clients and experience their current growth 26

Day3BarryDuncanJonathanHuntGlassman

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