Using PCOMS with Youth, Couples, and Families

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These are the slides of the kick off webinar that sets the stage for the upcoming series about the Partners for Change Outcome Management System applied to youth, couples, and families. This webinar conducted by Barry Duncan examines the evidence for PCOMS with kids, identifies the key logistical and clinical considerations, and provides a big picture view of using the measures when you have more than one person in the room. The psychometrics of the Child Outcome Rating Scale and Child Session Rating Scale are also discussed.

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Using PCOMS with Youth, Couples, and Families

  1. 1. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 1Using PCOMS with Youth ,Couples, and FamiliesBarry Duncan,Barry Duncan, Psy.DPsy.D.. heartandsoulofchange.comheartandsoulofchange.com561.239.3640 barrylduncan@comcast.net561.239.3640 barrylduncan@comcast.net
  2. 2. heartandsoulofchange.com June, 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 100s ofdiagnoses. How do wefunders here… First EBPs: Good idea butthere are over 150 of themand we serve folksdiagnosed with 100s ofdiagnoses. 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!R f ROI and POV!R f Reason for concern:dropout, never-endingtreatment, and widevariability in outcomes. Demanding that outcomesb d Reason for concern:dropout, never-endingtreatment, and widevariability in outcomes. Demanding that outcomesb dbe measured. But most measures are notfeasible for everyday use.Low compliance andincomplete data the resultbe measured. But most measures are notfeasible for everyday use.Low compliance andincomplete data the result
  3. 3. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 3: A SAMHSA EBPBut Different: A SAMHSA EBPBut DifferentPCOMS is a-theoretical &therefore additiveto any therapeuticorientation,including otherc ud g o eEBPs; PCOMSapplies to clients ofall diagnosticcategoriesPCOMS Is Evidence Based at Two LevelsEvidence Based One Client at a TimePCOMS Is Evidence Based at Two LevelsEvidence Based One Client at a Time RCTs found significant benefits RCTs found significant benefitsregardless of orientation/diagnosis At the individual level. Partnershipthat monitors whether thisapproach provided by thistherapist is benefiting this clientregardless of orientation/diagnosis At the individual level. Partnershipthat monitors whether thisapproach provided by thistherapist is benefiting this clienttherapist is benefiting this client.Not relying on the past evidenceof RCTs or even your practice,but rather the present evidencew/client in your office right now.therapist is benefiting this client.Not relying on the past evidenceof RCTs or even your practice,but rather the present evidencew/client in your office right now.
  4. 4. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 4Only takesOnly takesAnd It’s Feasiblefor Everyday PracticeAnd It’s Feasiblefor Everyday PracticeOnly takes5 minutesper session!Only takes5 minutesper session!Is clinicallymeaningfulIs clinicallymeaningfulThe Problem of FeasibilityThe Problem of Feasibility Plagues youth outcomet lth li bl Plagues youth outcomet lth li blassessment—altho reliable& valid, availablemeasures present anarduous task for bothclinicians & clients.assessment—altho reliable& valid, availablemeasures present anarduous task for bothclinicians & clients. E.g., Ohio Scales & YouthOutcome Questionnaire“short” forms are 48 and30 items, respectively. E.g., Ohio Scales & YouthOutcome Questionnaire“short” forms are 48 and30 items, respectively.
  5. 5. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 5PCOMSOutcome and Alliance FeedbackPCOMSOutcome and Alliance FeedbackTheThe ORSORS TheThe SRSSRSDownload free working copies at:Download free working copies at:httphttp://heartandsoulofchange.com://heartandsoulofchange.com••Give at theGive at theBecoming BetterMeasuring OutcomeBecoming BetterMeasuring Outcome••Scored to theScored to thenearest millimeter.nearest millimeter.••Add the fourAdd the fourscales togetherscales together••Give at theGive at thebeginning of thebeginning of thevisit; Clientvisit; Clientplaces a markplaces a markon the line.on the line.••Each line 10Each line 10(100 ) i(100 ) iscales togetherscales togetherfor the total score.for the total score.cm (100 mm) incm (100 mm) inlength.length.•Reliable, valid,feasible
  6. 6. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 6CORSCORSAlpha Reliability (Test-Retest NA)ORS/SRSAlpha Reliability (Test-Retest NA)ORS/SRS Strong evidence of reliability,with alpha estimates of 93 & Strong evidence of reliability,with alpha estimates of 93 &with alpha estimates of .93 &.84 respectively. These arevery high coefficients ofreliability for such briefmeasures, comparing veryf bl ith th t t dwith alpha estimates of .93 &.84 respectively. These arevery high coefficients ofreliability for such briefmeasures, comparing veryf bl ith th t t dfavorably with that reportedfor the YOQ, suggesting theCORS and ORS tap the factorthat most if not all outcomemeasures tap, global distress.favorably with that reportedfor the YOQ, suggesting theCORS and ORS tap the factorthat most if not all outcomemeasures tap, global distress.
  7. 7. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 7Concurrent or Criterion ValidityORS/CSRSConcurrent or Criterion ValidityORS/CSRS Similar to adults & the OQ( 8) h l Similar to adults & the OQ( 8) h l(.58), the correlationbetween the CORS/ORS &YOQ caretaker was .61;the ORS and YOQcompleted by adolescents(.58), the correlationbetween the CORS/ORS &YOQ caretaker was .61;the ORS and YOQcompleted by adolescentsp yresulted in .53. CORS & SDQ; caretaker:.49 1st & .60 last;teacher: .58 1st & .69 lastp yresulted in .53. CORS & SDQ; caretaker:.49 1st & .60 last;teacher: .58 1st & .69 lastRelationship with Caregiversalso SignificantRelationship with Caregiversalso Significant Between children (.63) &adolescents ( 45) & Between children (.63) &adolescents ( 45) &adolescents (.45), &caretakers. CORS firstthat taps into childrenages 6-12. Change scoresof youth and theirt k ladolescents (.45), &caretakers. CORS firstthat taps into childrenages 6-12. Change scoresof youth and theirt k lcaretakers were alsosignificantly correlated;UK: significantrelationship between kids& caregivers on CORScaretakers were alsosignificantly correlated;UK: significantrelationship between kids& caregivers on CORS
  8. 8. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 8Children and AdolescentsClinical CutoffChildren and AdolescentsClinical CutoffThe dividing lineThe dividing linebetween a clinical& non-clinicalpopulation (25).Kids AdolescentsFor children (32);adolescents (28);caretakers (28).Kids Adolescents& CaregiversCooper, Stewart, Sparks, &Bunting, 2012Cooper, Stewart, Sparks, &Bunting, 2012 Benchmark study of 2887 11 ld t k Benchmark study of 2887 11 ld t k7-11 yr olds; caretaker-228; teacher-249; 11counselors; 28 schools7-11 yr olds; caretaker-228; teacher-249; 11counselors; 28 schools 2 fold advantage overchildren not usingfeedback as measuredon the SDQ 2 fold advantage overchildren not usingfeedback as measuredon the SDQ
  9. 9. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 9Cooper, Stewart, Sparks, &Bunting, 2012Cooper, Stewart, Sparks, &Bunting, 20122 fold advantage2 fold advantage2 fold advantageon SDQ forcaregivers (.99 v.47 & 58); for2 fold advantageon SDQ forcaregivers (.99 v.47 & 58); for.47 & .58); forteachers (.55 v..39 and .44).47 & .58); forteachers (.55 v..39 and .44)
  10. 10. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 10The Session Rating ScaleMeasuring the AllianceThe Session Rating ScaleMeasuring the Alliance••Give at the endGive at the endof session;of session;••Score in cm toScore in cm tothe nearest mm;the nearest mm;••Each line 10 cmEach line 10 cmin length;in length;•Reliable, valid,feasible••Discuss withDiscuss withclient anytimeclient anytimetotal score fallstotal score fallsbelowbelow 3636
  11. 11. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 11In the WorksRCT in the SchoolsCompletes in June: RCT of Murphy, J., &Gill A Dpintervention in the schools withchildren and adolescents withbehavioral problems300 Children and Adolescents;f fGillaspy, A., Duncan,B., Bohanske, R., &Zatoga, A. (inprocess clinicaltrial). Using clientfeedback to improveschool interventionfeedback v. non-feedback; alsoserving to further validateORS/SRS and SRS/CSRSagainst other measuresschool interventionoutcomes. Special ConsiderationsKid ates self ad lts ate kid Special ConsiderationsKid ates self ad lts ate kidWho, What, When, Where,& Why Kid rates self; adults rate kid Spoiler Alert! SometimesThey Agree But Most TimesThey Don’t! When They Don’t Agree Kid rates self; adults rate kid Spoiler Alert! SometimesThey Agree But Most TimesThey Don’t! When They Don’t Agree When They Don t Agree,Don’t Sweat It! Don’t Worry Be Happy!Sometimes the Kid Doesn’tGet It. When They Don t Agree,Don’t Sweat It! Don’t Worry Be Happy!Sometimes the Kid Doesn’tGet It.
  12. 12. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 12 Family work not for everyone;I di id l k i l Family work not for everyone;I di id l k i lSpecial ConsiderationsFamily Work Isn’t for the Faint of HeartIndividual work easier—onlyone perspective to deal with High tolerance of chaos,distress, & conflict—oneperson can’t reach theIndividual work easier—onlyone perspective to deal with High tolerance of chaos,distress, & conflict—oneperson can’t reach theperson can t reach theintensity of a couple or family Sometimes have to step inand step up in a way thatindividual never doesperson can t reach theintensity of a couple or family Sometimes have to step inand step up in a way thatindividual never doesWorking with Youth, Couples, andFamilies: Special ConsiderationsWorking with Youth, Couples, andFamilies: Special Considerations There’s A Reason ManyD ’t D It It’ There’s A Reason ManyD ’t D It It’Don’t Do It—It’sComplicated with More inthe Room So First You Have to FigureDon’t Do It—It’sComplicated with More inthe Room So First You Have to Figure So First You Have to FigureOut the Logistics of How ToDo It and Feel Comfortablewith It (paper velectronic). So First You Have to FigureOut the Logistics of How ToDo It and Feel Comfortablewith It (paper velectronic).
  13. 13. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 13 iPAD, iPHONE help but iPAD, iPHONE help butWorking with Youth, Couples, and Families:Special ConsiderationsWorking with Youth, Couples, and Families:Special Considerationsstill cumbersome toadminister to more than2 folks Paper and Pencil maymake more logisticalstill cumbersome toadminister to more than2 folks Paper and Pencil maymake more logisticalmake more logisticalsense, but must prepareand have previous graphprinted so all you have todo is add current scoresmake more logisticalsense, but must prepareand have previous graphprinted so all you have todo is add current scoresUsing PaperGraphing: A Helpful VisualUsing PaperGraphing: A Helpful Visual Adds a visualcomponent another way Adds a visualcomponent another waycomponent—another wayto focus tx At a glance tells the storyof the client’s progress.ll d fcomponent—another wayto focus tx At a glance tells the storyof the client’s progress.ll d f Allows you to dispense ofthe previous measures. Indispensable with youthand families. Allows you to dispense ofthe previous measures. Indispensable with youthand families.
  14. 14. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 14•Can easily see indv. &f il fUsing Graphs With Familiesfamily progress fromsession to session•Can comment on other’sscores in relation to own•Invites family discussionabout the next stepsabout the next steps•A visual indication of theneed for changingapproach, continuing, orending.Kid Rates Self, Adults Rate KidLearning the Hard WayKid Rates Self, Adults Rate KidLearning the Hard Way Started out by havingi th d Started out by havingi th deveryone in the room doORS for self Big mistake because if thekid is the identified client,parents can be easilyeveryone in the room doORS for self Big mistake because if thekid is the identified client,parents can be easilyparents can be easilyalienated by suggestingthey rate themselves Rating the kid fits theirview; can always add onparents can be easilyalienated by suggestingthey rate themselves Rating the kid fits theirview; can always add on
  15. 15. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 15 It’s all good It’s all goodSometimes Kids and Parents AgreeBut Mostly They Don’tSometimes Kids and Parents AgreeBut Mostly They Don’t It s all good… When they agree,comment how great itis they are on the samepage example It s all good… When they agree,comment how great itis they are on the samepage examplepage…example When they don’t agree,comment that’s the wayit usually goes down…page…example When they don’t agree,comment that’s the wayit usually goes down… Puts it all on the table in the Puts it all on the table in theWhen They Don’t AgreeDon’t Sweat It!When They Don’t AgreeDon’t Sweat It!first two minutes of session;no guessing required What’s it going to take toget your parent to view youmore like you view yourself?first two minutes of session;no guessing required What’s it going to take toget your parent to view youmore like you view yourself?more like you view yourself?Maybe that is our job here?Just talk about what can bedone to bring the views alittle closer…examplemore like you view yourself?Maybe that is our job here?Just talk about what can bedone to bring the views alittle closer…example
  16. 16. heartandsoulofchange.com June, 2013barrylduncan@comcast.net 16 Validated on 6-12 yearld b t t ll 6 7 & 8 Validated on 6-12 yearld b t t ll 6 7 & 8Sometimes the KidDoesn’t Get ItSometimes the KidDoesn’t Get Itolds but not all 6,7,& 8year olds get it—kids arehere and now critters Do what you can; still usethe measures even if theyolds but not all 6,7,& 8year olds get it—kids arehere and now critters Do what you can; still usethe measures even if theythe measures even if theydon’t get it but don’trecord the score That’s why we alwayshave an adult rating toothe measures even if theydon’t get it but don’trecord the score That’s why we alwayshave an adult rating tooThe Chaos of Family Work:PCOMS for FamiliesThe Chaos of Family Work:PCOMS for Families•Helps manage the chaos•Everything’s transparent—everyone knows what’s up; Setsthe context for all to participate.•Summarize progress as entrypoint into the meeting; Invites allp g;to interpret.•Summarize alliance as exit outof the meeting; make sureeveryone got what they want

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