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MyOutcomesNewAlgorithms

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These slides accompany the free webinar found at https//heartandsoulofchange.com entitled, “MyOutcomes.com New Algorithms and Feedback Messages: Fitting More Clients and Therapists.“ This webinar by …

These slides accompany the free webinar found at https//heartandsoulofchange.com entitled, “MyOutcomes.com New Algorithms and Feedback Messages: Fitting More Clients and Therapists.“ This webinar by Cindy Hansen of MyOutcomes.com and Barry Duncan discusses the features of the newly released version of MyOutcomes.com. The new release includes algorithms and feedback messages based on 427K administrations that address both short term and longer term client encounters and therefore cover 97% of clients entering therapeutic services.

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  • 1. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 1MyOutcomes.com NewAlgorithms & FeedbackMessages: Fitting MoreBarry Duncan,Barry Duncan, Psy.DPsy.D.. heartandsoulofchange.comheartandsoulofchange.com561.239.3640 barrylduncan@comcast.net561.239.3640 barrylduncan@comcast.netMessages: Fitting MoreClients & Therapists
  • 2. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 2Funders Want Two ThingsFirst: Evidence Based PracticeFunders Want Two ThingsFirst: Evidence Based Practice Not trying to demonizef d h Not trying to demonizef d hfunders here… First EBPs: Good idea butthere are over 150 of themand we serve folksdiagnosed with over 400diagnoses. How do wefunders here… First EBPs: Good idea butthere are over 150 of themand we serve folksdiagnosed with over 400diagnoses. How do wed ag oses o do elearn a specific treatmentfor each disorder? How isthat practical or costefficient especiallyconsidering turnover?d ag oses o do elearn a specific treatmentfor each disorder? How isthat practical or costefficient especiallyconsidering turnover?They Also Want Return onInvestment and Proof of ValueThey Also Want Return onInvestment and Proof of Value ROI and POV! ROI and POV! They have reason forconcern: dropout, therapistand treatment variability. So they are demanding thatoutcomes be measured. They have reason forconcern: dropout, therapistand treatment variability. So they are demanding thatoutcomes be measured.outcomes be measured. But most outcomemeasures are not feasiblefor everyday front lineclinical use.outcomes be measured. But most outcomemeasures are not feasiblefor everyday front lineclinical use.
  • 3. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 3: A SAMHSA EBPBut Different: A SAMHSA EBPBut DifferentPCOMS is a-theoretical & thereforeadditive to anytherapeutic orientationincluding other EBPsincluding other EBPs,and, PCOMS appliesto clients of alldiagnostic categoriesOnly takesOnly takesAnd It’s Feasiblefor Everyday PracticeAnd It’s Feasiblefor Everyday PracticeOnly takes5 minutesper session!Only takes5 minutesper session!Is clinicallymeaningfulIs clinicallymeaningful
  • 4. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 4 PCOMS incorporates the PCOMS incorporates themost robust predictorsof therapeutic successinto an outcomemanagement systemth t t ithmost robust predictorsof therapeutic successinto an outcomemanagement systemth t t iththat partners withclients while honoringthe daily pressures offront-line clinicians.that partners withclients while honoringthe daily pressures offront-line clinicians.PartnersPartners The NREPP process is an The NREPP process is anarduous one that includesboth a research anddissemination review. All 3RCTs that enabled ourapplication for evidencearduous one that includesboth a research anddissemination review. All 3RCTs that enabled ourapplication for evidenceppbased practice status wereconducted by Partners ofthe Heart and Soul ofChange Project.ppbased practice status wereconducted by Partners ofthe Heart and Soul ofChange Project.
  • 5. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 5The 3 RCTsResulting in SAMHSA EBP StatusThe 3 RCTsResulting in SAMHSA EBP StatusLove this QuoteRalph Waldo EmersonLove this QuoteRalph Waldo Emerson “If a man (sic) will kick a fact “If a man (sic) will kick a fact( )out of the window, when hecomes back he finds it againin the chimney corner.”( )out of the window, when hecomes back he finds it againin the chimney corner.” Let’s look at the facts aboutearly change and the usualcourse or trajectory ofchange in psychotherapy. Let’s look at the facts aboutearly change and the usualcourse or trajectory ofchange in psychotherapy.
  • 6. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 6Time and Time AgainTime and Time Again From the pioneering work ofth l t K H d t t From the pioneering work ofth l t K H d t tthe late Ken Howard to currentsophisticated investigationsusing the latest statisiticalmethods, studies reveal thatthe majority of clientsthe late Ken Howard to currentsophisticated investigationsusing the latest statisiticalmethods, studies reveal thatthe majority of clientsexperience the majority ofchange in the first eight visits.This is a surprisingly resilientfinding.experience the majority ofchange in the first eight visits.This is a surprisingly resilientfinding.Sooner Rather Than LaterAB•The bulk ofchangeoccurs soonerrather thanHoward, K. et al. (1986). The dose-effect response in psychotherapy.American Psychologist, 41, 159-164.rather thanlatter
  • 7. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 7Cannabis Youth Treatment ProjectEarly change inIt’s A FactEarly Change is The RuleProject MATCHy gtreatment is arobust predictorof outcome andretention intreatmenthttp://www.chestnut.org/LI/Posters/CYT_%20MF_APA.pdfBabor, T.F., & DelBoca, F.K. (eds.) (2003). TreatmentMatching in Alcoholism. United Kingdom: Cambridge, 113.treatment.Gotta measureoutcome!The Rule: Treatment of DepressionCollaborative Research ProgramThe Rule: Treatment of DepressionCollaborative Research ProgramTDCRPConclusions: Early change is an important factor for theprediction of short- and long-term outcome.Lutz, W., Stulz, N., & Köck, K. (2009). Patterns of early change and their relationship to outcome and follow-upamong patients with major depressive disorders. Journal of Affective Disorders 118(1), 60-68.
  • 8. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 8This means that clients whoreport little or no progress earlyThe Research about Early ChangeIs a GiftThe Research about Early ChangeIs a Giftreport little or no progress earlyon will likely show noimprovement over the entirecourse of therapy, or will end upon the drop-out list—earlychange predicts engagement ing p g gtherapy and a good outcome attermination. Provides a tangibleway for us to identify folks whoare not responding so that wecan chart a new course.Regardless of How Many TimesIt Reappears in the Chimney CornerRegardless of How Many TimesIt Reappears in the Chimney Corner Rubs people the wrong Rubs people the wrongway. Some think that theresearch about earlychange predicting outcomeis an indictment againstlong term work. Simply notway. Some think that theresearch about earlychange predicting outcomeis an indictment againstlong term work. Simply notlong term work. Simply nottrue. Long term work withclients is perfectly fine aslong as they arebenefiting.long term work. Simply nottrue. Long term work withclients is perfectly fine aslong as they arebenefiting.
  • 9. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 9Early Change Doesn’t Fit My Clients!Some Clients Take LongerEarly Change Doesn’t Fit My Clients!Some Clients Take LongerIt is true that someIt is true that someu a oclients take longerthan others, butimportantly not forh t t t b tu a oclients take longerthan others, butimportantly not forh t t t b tchange to start, butrather for change toplateauchange to start, butrather for change toplateauSome clients do takelonger, but the mythologynever diesN=4676; 77% attended 8or less, and 91% 12 or lessNote that even for theclients who take longer(last curve bottom right)Baldwin, S., Berkeljon, A., Atkins, D., Olsen, J., & Nielsen, S. (2009). Rates of change in naturalisticpsychotherapy: Contrasting dose-effect and good-enough level models of change. Journal ofConsulting and Clinical Psychology, 77(2), 203-211.(last curve bottom right),change starts early…just isflatter
  • 10. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 10Sudden Epiphany? NOTSudden Epiphany? NOTMyth: Clients flat-line &th ik S li tMyth: Clients flat-line &th ik S li tthen spike. Some clientsdo take longer but changestarts right away.So the question remains:When do you start gettingthen spike. Some clientsdo take longer but changestarts right away.So the question remains:When do you start gettingWhen do you start gettingworried when clients arenot responding?I vote for sooner ratherthan later.When do you start gettingworried when clients arenot responding?I vote for sooner ratherthan later.Ave. LOS: UCC—6.5 v. 8.9More Evidence: University Counseling Clinic(UCC) V. Public Behavioral Health (PBH)for PBH; 77% at UCC came <8 while it took 12 at PHB toreach 77%. 62% < 8 at PBH.Most attended < 8 & only 1 in4 go > 8 at UCC & 12 at PBH4 go > 8 at UCC & 12 at PBH.Trajectories, then, have apretty good track record offitting most clients.
  • 11. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 11TrajectoriesThe Long and Short of ItBut, many who saw, yclients for longerperiods were notsatisfied; Some evenput off by overallput off by overalltrajectories showingmost changehappening in first 8And worse, killed the message (notan indictment of long term work butSo ManyKilled the Messengeran indictment of long term work butrather of long term ineffective work)After much deliberation, a solutioncame to me that had never beendone: trajectories based in LOS asjtherapy and change unfolded. Sowith Michael Toland & Bill Wiggin,we looked at 427 K sessions anddeveloped ETR for 8 or less and 18or less sessions
  • 12. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 12Because 18 Sessions Represented97% of the DataBecause 18 Sessions Represented97% of the Data Compared algorithms w/ Compared algorithms w/means of each intakescore across sessions (thesmell test), & the newones were born. The old ones covered 60-means of each intakescore across sessions (thesmell test), & the newones were born. The old ones covered 60- The old ones covered 6075% of clients while thenew ones cover 97%--nowincluding that 1 in 4 clientswho take a bit longer. The old ones covered 6075% of clients while thenew ones cover 97%--nowincluding that 1 in 4 clientswho take a bit longer.Using the Latest StatisticalMethodology, the 2012 AlgorithmsUsing the Latest StatisticalMethodology, the 2012 Algorithms Predict therapy outcomes Predict therapy outcomesbased on LOS (short termv. longer term encounters),thereby addressing theneeds of both clients whoattend more sessions andbased on LOS (short termv. longer term encounters),thereby addressing theneeds of both clients whoattend more sessions andattend more sessions andclinicians not working froma brief therapyperspective—covering 97%of those seeking services.attend more sessions andclinicians not working froma brief therapyperspective—covering 97%of those seeking services.
  • 13. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 132012 Algorithms AlsoCreate New Feedback Messages2012 Algorithms AlsoCreate New Feedback MessagesThat consider howThat consider howThat consider howthe client is doingrelative to the lastsession & in theThat consider howthe client is doingrelative to the lastsession & in thecontext of how he orshe is doing sinceintake.context of how he orshe is doing sinceintake.
  • 14. heartandsoulofchange.com May, 2013barrylduncan@comcast.net 14Percent of Change TargetPercent of Change Target Each intake score has an average trajectoryt d t t t (ETR) Each intake score has an average trajectoryt d t t t (ETR)or expected treatment response (ETR) Results in an ETR score each session; % ofchange target is the % of change the clientachieved in the current session v the ETR. E g intake of 20; ETR for session 2 is 23 5; ifor expected treatment response (ETR) Results in an ETR score each session; % ofchange target is the % of change the clientachieved in the current session v the ETR. E g intake of 20; ETR for session 2 is 23 5; if E.g., intake of 20; ETR for session 2 is 23.5; ifthey scored 22.1, the % of change target is60% or 2.1 divided by 3.5; ETR for session 6is 28.0; if they scored 24.6, the % of changeis 58% or 4.6 divided by 8 E.g., intake of 20; ETR for session 2 is 23.5; ifthey scored 22.1, the % of change target is60% or 2.1 divided by 3.5; ETR for session 6is 28.0; if they scored 24.6, the % of changeis 58% or 4.6 divided by 8Combined withClinical Common SenseCombined withClinical Common Sense That doesn’t That doesn’t That doesn tdenigrate slowerchange, the newmessages bringclinical nuance and That doesn tdenigrate slowerchange, the newmessages bringclinical nuance andclinical nuance andcommon sense inaddition to the newalgorithms.clinical nuance andcommon sense inaddition to the newalgorithms.

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