Nzps Elizabeth Ross

Reese Norsworthy Rowlands

The document discusses research on whether using a continuous feedback system called the Partners for Change Outcome Management System (PCOMS) can improve psychotherapy outcomes. PCOMS involves clients completing brief measures after each session to assess treatment progress and the therapeutic relationship. Studies found that clients who used PCOMS with their therapists demonstrated statistically significant treatment gains compared to those receiving usual treatment and were more likely to experience reliable change in fewer sessions.

Therapist Effects

Our recent article about therapist effects in couple therapy. So what distinguished one therapist from another? Demographics didn’t matter but 2 other things did. First, that tried and true but neglected old friend, the alliance accounted for 50% of the differences among therapists. Those who formed better alliances across clients got better outcomes. And therapist specific experience with couples accounted for 25% of the differences. So, experienced therapists can take some solace that getting older does have its advantages—as long as it is specific to task at hand.

Norway Feedback Project

DuncanPCOMS

The article discusses the development and research supporting the Partners for Change Outcome Management System (PCOMS). PCOMS uses two brief measures - the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) - to collect feedback from clients at each session on their progress and the therapeutic alliance. The ORS and SRS were developed to be brief and feasible for routine use. Research shows providing therapists feedback based on these measures improves client outcomes compared to treatment as usual. The article outlines how PCOMS was developed and refined, presents supporting research on the measures' psychometrics and clinical usefulness, and discusses examples of implementing PCOMS in behavioral health settings.

Clinical supervision its influence on client-rated working alliance and clie...

Daryl Chow

This study evaluated the impact of clinical supervision on client working alliance and symptom reduction in the brief treatment of major depression. Therapists were randomly assigned to receive either alliance skill-focused or alliance process-focused supervision, or to receive no supervision. Both supervision conditions had a significant positive effect on working alliance, symptom reduction, and treatment retention compared to the no supervision condition. However, there was no significant difference found between the two supervision conditions. The findings provide preliminary evidence that clinical supervision can improve client outcomes, but more research is still needed to separate the effects of different supervision approaches.

PCOMS in New Zealand

This study examined the effects of using client feedback, known as the Partners for Change Outcome Management System (PCOMS), with couples undergoing psychotherapy. 46 heterosexual couples were randomly assigned to either a treatment as usual (TAU) condition or to a feedback condition where therapists received feedback on client progress and the therapeutic alliance at each session via the Outcome Rating Scale (ORS) and Session Rating Scale (SRS). It was hypothesized that couples receiving feedback would have better outcomes, improve more quickly, and be more likely to meet the criteria for clinically significant change. Results from this study aimed to replicate previous research finding client feedback beneficial for couples therapy.

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DuncanReese2013

Although many of you may not be interested in the psychometric details of the ORS and SRS, it does bear importantly on whether there are seen as credible. Jeff Reese and I (Duncan & Reese, 2013) recently exchanged views with Halstead, Youn, and Armijo (2013), debating when a measure is too brief and when it is too long. Here is our paper. First regarding when a measure is too brief: There is no doubt that 45 items, 30 items, or even 19 items is psychometrically better than 4 items, and that the increased reliability and validity of longer measures likely result in better detection, prediction, and ultimate measurement of outcome. But how much better is the really the question. Are these differences clinically meaningful and do they offset the low compliance rates and resulting data integrity issues from missing data? These are the questions that require empirical investigation to determine how brief is too brief, although from my experience, the verdict has already been rendered. But when is a measure too long? The answer is simple: When clinicians won’t use it.

RecoveryToPracticeMaryHaynes

Child Outcome Rating Scale (CORS)

PCOMS: A Viable Quality Improvement Strategy for Public Behavioral Health

This is the latest from the research team of the Heart and Soul of Change Project, published in the Journal of Consulting and Clinical Psychology. This study demonstrated that PCOMS is not only a viable quality improvement strategy but also that services to the poor and disenfranchised provided in a public behavioral setting, contrary to earlier research, can be as effective as those delivered in randomized clinical trials.

The Partners for Change Outcome Management System: Duncan & Reese, 2015

Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates (Baldwin & Imel, 2013), are poor judges of negative outcomes (Chapman et al., 2012), and grossly overestimate their effectiveness (Walfish, McAlister, O'Donnell, & Lambert, 2012). Systematic client feedback offers one solution (Duncan, 2014). Several feedback systems have emerged (Castonguay, Barkham, Lutz, & McAleavey, 2013), but only two have randomized clinical trial support and are included in the Substance Abuse and Mental Health Administration’s National Registry of Evidence based Programs and Practices: The Outcome Questionnaire-45.2 System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012). This article presents the current status of the Partners for Change Outcome Management System, the psychometrics of the PCOMS measures, its empirical support, and its clinical and training applications. Future directions and implications of PCOMS research, training, and practice are detailed. Finally, we propose that systematic feedback offers a way, via large scale data collection, to re-prioritize what matters to psychotherapy outcome, reclaim our empirically validated core values and identity, and change the conversation from a medical model dominated discourse to a more scientific, relational perspective.

Session Rating Scale (SRS)

Duncan & Sparks Ch 5 of Cooper & Dryden

TeachingAccountability

This document summarizes a study on implementing a systematic client feedback protocol into a marriage and family therapy training program to improve trainee competence and accountability. The study describes how the program integrated continuous client feedback into coursework, clinical training, and supervision using an Outcome Management system. Research shows that incorporating client feedback improves client outcomes and therapist effectiveness. The program believes this approach will train therapists to be more accountable to clients and enhance services provided at their family therapy clinic.

Reeseetal2013

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PCOMS as an Alternative to Psychiatric Diagnosis (Duncan, Sparks, & Timimi, 2...

Introduction to Managing Cancer Living Meaningfully (CALM)

Global Institute GIPPEC

This document outlines the presentation for a CALM therapy simulation. It discusses the structure and key parts of psychotherapy sessions, including assessment, therapeutic alliance, intervention, and termination. It notes that the most effective intervention is the therapeutic relationship, which accounts for 45% of outcome variance. CALM therapy is then introduced as a 6-8 session semi-structured intervention that addresses symptom management, the future/mortality, changes in self-concept and relationships, and spirituality/meaning. The essential ingredients are said to be providing a reflective space, attachment security, mentalization, and double awareness.

Enhancing Psychotherapy Process With Common Factors Feedback.docx

khanpaulita

Enhancing Psychotherapy Process With Common Factors Feedback: A Randomized, Clinical Trial Andrew S. McClintock, Matthew R. Perlman, Shannon M. McCarrick, Timothy Anderson, and Lina Himawan Ohio University In this study, we developed and tested a common factors feedback (CFF) system. The CFF system was designed to provide ongoing feedback to clients and therapists about client ratings of three common factors: (a) outcome expectations, (b) empathy, and (c) the therapeutic alliance. We evaluated the CFF system using randomized, clinical trial (RCT) methodology. Participants: Clients were 79 undergradu- ates who reported mild, moderate, or severe depressive symptoms at screening and pretreatment assessments. These clients were randomized to either: (a) treatment as usual (TAU) or (b) treatment as usual plus the CFF system (TAU � CFF). Both conditions entailed 5 weekly sessions of evidence-based therapy delivered by doctoral students in clinical psychology. Clients completed measures of common factors (i.e., outcome expectations, empathy, therapeutic alliance) and outcome at each session. Clients and therapists in TAU � CFF received feedback on client ratings of common factors at the beginning of Sessions 2 through 5. When surveyed, clients and therapists indicated that that they were satisfied with the CFF system and found it useful. Multilevel modeling revealed that TAU � CFF clients reported larger gains in perceived empathy and alliance over the course of treatment compared with TAU clients. No between-groups effects were found for outcome expectations or treatment outcome. These results imply that our CFF system was well received and has the potential to improve therapy process for clients with depressive symptoms. Public Significance Statement In this study, we developed a system that provides ongoing feedback to clients and therapists about what is transpiring in therapy. Results suggest that the feedback system may help to improve the process of treatment for clients with depressive symptoms. Keywords: common factors, feedback, empathy, alliance, randomized clinical trial A growing body of research attests to the utility and effectiveness of outcome feedback (Connolly Gibbons et al., 2015; De Jong et al., 2014; Shimokawa, Lambert, & Smart, 2010). In outcome feedback systems, client progress is monitored and reviewed by therapists (and, in some cases, by clients as well) to guide ongoing treatment (Lam- bert, 2007). Specifically, these systems collect distress/symptomatol- ogy data from clients on a routine basis, and then compare these data with norms or expected treatment responses (see Lambert, 2007; Lutz et al., 2006). When a client is off-track (i.e., is projected to have a relatively poor treatment response), the therapist is alerted and is then typically provided with strategies for improving quality of care (Lambert et al., 2004; Miller, Duncan, Sorrell, & Brown, 2005). Although outcome feedback has demonstrated efficacy (e..

[Ann Emerg Med. 2009;53685-687.]Systematic Review SourceThis .docx

odiliagilby

[Ann Emerg Med. 2009;53:685-687.] Systematic Review Source This is a systematic review abstract, a regular feature of the Annals' Evidence-Based Emergency Medicine (EBEM) series. Each features an abstract of a systematic review from the Cochrane Database of Systematic Reviews and a commentary by an emergency physician knowledgeable in the subject area. The source for this systematic review abstract is: O'Brien MA, Freemantle N, Oxman AD, et al. Continuing education meetings and workshops: effects on professional practice and health care outcomes. Cochrane Database Syst Rev. 2001;(2):CD003030. The Annals' EBEM editors helped prepare the abstract of this Cochrane systematic review, as well as the Evidence-Based Medicine Teaching Points. Objective To determine the effects of continuing educational meetings on professional practice and health care outcomes. Data Sources The Cochrane Effective Practice and Organization of Care Group specialized register, MEDLINE, and the Research and Development Resource Base in Continuing Medical Education were searched. The reference list of related systematic reviews and all articles obtained were reviewed. This review was amended in 2006 from the previous one published in 2001; a formal update is currently underway. Study Selection Studies were included if they were randomized controlled trials or nonequivalent group designs with nonrandom allocation. The participants of the studies were qualified health professionals or health professionals in postgraduate training (eg, resident physicians). Studies involving only undergraduate students were excluded. All types of educational activities were included (eg, meeting, conferences, lectures, workshop, seminar), and interventions were didactic, interactive, or a mixed didactic and interactive nature. Didactic intervention offered minimal participant interaction such as lectures or presentations; interactive interventions included role play, case discussion, or hands-on training in small (<10 people), moderate (10 to 19 people), or large (>19 people) participant groups. Only the studies that objectively measured health professional practice behavior or patient outcomes in the setting in which health care was provided were included. Data Extraction Two authors independently applied inclusion criteria, assessed the quality of each study, and extracted the data. Each study was then assigned a quality rating of protection against bias according to 3 criteria: study design, blinded outcome assessment, and completeness of follow-up. Studies were analyzed according to the type of intervention, subjective assessment of complexity of targeted behaviors, and the level of baseline compliance and protection against bias. Main Results Educational Meeting Versus No Intervention Of the 32 studies with 35 comparisons between educational meeting and noninterventional control groups, 24 studies reported marked improvement in professional practice. There were statistically significant ...

2010 icmi presenation apodaca june6

The document summarizes research on the mechanisms of change and active ingredients of motivational interviewing. Key findings include: 1) Therapist use of MI-consistent behaviors and client change talk are robust predictors of positive treatment outcomes. 2) The presence of a supportive significant other can increase client change talk within motivational interviewing sessions. 3) Multiple mediators, including readiness to change, experience of discrepancy, self-efficacy, and treatment seeking, help explain how motivational interviewing leads to reduced substance use.

Do therapists improve (preprint)

This study examined whether psychotherapists' outcomes improve over time and with increased experience. The researchers analyzed data from over 6,500 patients seen by 170 psychotherapists over an average of 4.73 years. Using multilevel modeling, they found that while therapists' outcomes were generally comparable to clinical trials, there was a very small but statistically significant tendency for patient outcomes to diminish as therapists gained more experience in terms of both time and number of patients seen. However, therapists showed lower rates of early termination as their experience increased. The results suggest that while experience may not necessarily lead to better patient outcomes, it can reduce dropout rates.

Do people fill out the SRS differently IF the therapist is in the room?

This study examined how demand characteristics and social desirability may influence clients' ratings of the therapeutic alliance. 102 clients from two university counseling centers were randomly assigned to one of three conditions for providing alliance feedback: immediate feedback where ratings were discussed with the therapist, next session feedback where ratings were private and discussed later, and no feedback where ratings were private and not shared. The study found no significant differences in alliance scores across the feedback conditions and scores were not correlated with social desirability but were correlated with an established alliance measure, providing evidence that scores were not inflated due to demand characteristics.

Moyers june8-plenary

This document summarizes a study that evaluated the effects of two different motivational interviewing training conditions on clinicians and client language. Clinicians received either standard MI training or MI training with an added emphasis on eliciting change talk from clients. Preliminary results found that after training, clinicians in the change talk emphasis condition reflected less counter-change talk and asked fewer questions about the negatives of substance use. At 3-month follow up, the change talk emphasis condition showed higher ratings of evoking change talk from clients. This provides initial evidence that clinicians can be trained to influence client language and that this may be a causal mechanism of behavior change.

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This study evaluated the effectiveness of an 8-week starter group program for high-risk offenders at a New Zealand correctional facility. The study assessed 19 male offenders' readiness and responsiveness to change before and after the program using the Treatment Readiness, Responsivity and Gain Scale. Results found that offenders' readiness for treatment improved significantly from pre- to post-treatment. While improvements in responsiveness were not statistically significant, mean scores did increase, indicating the program was moving offenders in a positive direction. The study provides insights that can help facilitators better design individualized treatment plans to address offender needs.

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ApplyingOutcomeResearch

This article discusses applying research on psychotherapy outcomes, which has shown that common factors like the therapeutic relationship are more influential than theoretical approach or techniques. The article proposes intentionally using the client's frame of reference to enhance common factors and collaboration. It suggests emphasizing the client's perceptions of their relationship with the therapist and understanding of their issues over theoretical perspectives. A client-directed process is outlined that de-emphasizes theory and maximizes common factors and the client's involvement.

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This document discusses quality improvement and patient safety in anesthesia. It defines key terms like quality improvement, continuous quality improvement and differentiates it from traditional quality assurance. It outlines frameworks for improvement like the Model for Improvement and discusses tools used for quality improvement like Lean methodology, Six Sigma and PDSA cycles. It discusses important measures for quality improvement like process, outcome and balancing measures. Methods for analyzing and displaying quality improvement data like control charts and dashboards are described. Sources of quality improvement information and the importance of incident reporting are also summarized.

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Experience of BCBS Michigan in Building medical homes Based on the observed relationships for partial implementation,full implementation of the PCMH model is associated with a 3.5 percent higher quality composite score, a 5.1 percent higher preventive composite score, and $26.37 lower per member per month medical costs for adults. Full PCMH implementation is also associated with a 12.2 percent higher preventive composite score, but no reductions in costs for pediatric populations. Incremental improvements in PCMH model implementation yielded similar positive effects on quality of care for both adult and pediatric populations but were not associated with cost savings for either population. Conclusions. Estimated effects of the PCMH model on quality and cost of care appear to improve with the degree of PCMH implementation achieved and with incremental improvements in implementation.

Treatment Goals Checklist Poster

Erin Stotts

The document describes two studies that developed and validated a Treatment Goals Checklist (TGC) to measure client treatment goals. Study 1 used exploratory factor analysis of responses from 131 adult clients to identify a five factor structure to the TGC: Positive Enhancement, Harming, Change, Use of drug, and Alcohol use. Study 2 confirmed the five factor structure using confirmatory factor analysis with 124 clients and found the five factor model was a better fit than competing models. The results support the TGC as a valid multidimensional measure of client treatment goals that can help counselors effectively assess and direct treatment.

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