Psychosocial Services The Good Study after study, Study after - PDF document

heartandsoulofchange.com; pcoms.com February 2016 What’s Up: PCOMS What’s Up: PCOMS Research, Predictors, Implications Research, Predictors, Implications The Partners for The Partners for Change Change 1. Research-proven strategy to Outcome Management System Outcome Management System address the problems of psychosocial services Eviden Evidence Based Based Practi Practice 2. Incorporates known One Client One Client at a Time at a Time predictors of ultimate outcome 3. Implications for Policy Barry Duncan, Psy.D Barry Duncan, Psy.D. . heartandsoulofchange.com heartandsoulofchange.com pcoms.com coms.com betteroutcomesnow.com betteroutcomesnow.com Psychosocial Services The Good… Study after study, Study after study, and studies of and studies of PCOMS PCOMS at a Glance t Gl studies show the studies show the t di t di h h th th average treated average treated client is better off client is better off than 80% of the than 80% of the untreated sample. untreated sample. Psychosocial Services Provider Differences Provider Differences Provider Differences Provider Differences Incredible Variation Among Providers Incredible Variation Among Providers Incredible Variation Among Providers Incredible Variation Among Providers The Bad… TDCRP: top third • Drop out rates Drop out rates psychiatrists giving placebo bested bottom third giving g g average 47% average 47% meds; clients of best counselors improve 50% • Providers Providers more & dropped out 50% less; meds useful for clients vary… a lot vary… a lot of more effective, not for less-effective McKay, K., Imel, Z., & Wampold, B. (2006). Psychiatrist effects in the psychopharmalogical treatment of depression. Journal of Depressive Disorders, 92 , 287-290. betteroutcomesnow.com 1

heartandsoulofchange.com; pcoms.com February 2016 And the Ugly More Bad: Public Behavioral Health Less than a Third Benefit Providers Don’t Know Reported a • 20-70% range • Graded their effectiveness, combined reliable A+ to F—67% said A or and clinically y better; none rated below better; none rated below significant change average; Another study: rate in everyday 85% of their clients improve & 90% saw themselves as clinical practice above the 75th percentile. just 29.1%. Over Sapyta, J., Riemer, M., & Bickman, L. Feedback to clinicians: Theory, research, and practice. Journal of Clinical Psychology: In Session, 61, 145-153 • Providers Providers don’t know how don’t know how Walfish, S., McAlister, B., O’Donnell, P., & Lambert, 70% not helped Hansen, N., Lambert, M., Forman, E. (2002). The M. (2012). An investigation of self-assessment bias psychotherapy dose-response effect and its implications in mental health providers. Psychotherapy Reports, effective they are effective they are for treatment delivery services. Clinical Psychology: 110(2), 1-6. doi: 10.2466/02.07.17 Science and Practice, 9, 329-343. Problems Spurred Interest in No More Quality Improvement Strategies Head in the Sand • Primary • Despite overall efficacy, dropouts a Approach Has problem, not everyone Been Been benefits, providers vary Transporting significantly and don’t have a clue about Evidence effectiveness, and Based outcomes in many Treatments settings are dismal. Problems with Cost and Practicality Transporting EBTs Doesn’t Make Cents • Cost of Implementing • Dodo Bird EBT; VA—20 million • Practicality Given Staff Verdict Verdict Turnover, Fidelity • Cost and • Implementing an EBT for Every Practicality Diagnoses…Over 150 EBTs and Over 400 “Everybody has won and all “Everybody has won and all must have prizes.” must have prizes.” Diagnoses betteroutcomesnow.com 2

heartandsoulofchange.com; pcoms.com February 2016 No More To The Rescue, Another QI Strategy Head in the Sand Continuous Client Feedback: PCOMS • The Primary Quality y Improvement Strategy Has Big Problems. The The ORS ORS The The SRS SRS Download free working copies at: Download free working copies at: pcoms.com coms.com or or heartandsoulofchange.com heartandsoulofchange.com Becoming Better Becoming Better Becoming Better Becoming Better Improving or Not Anker , Anker , Anker Anker , Duncan , Duncan Duncan , & Duncan , & , & Sparks , & Sparks Sparks (2009) Sparks (2009) (2009) (2009) Not Rocket Science • Feedback v TAU; • PCOMS simply identifies clients who are not Both persons responding so that the lack reliable or sig. of progress can be of progress can be change—50.5% v. h 50 5% addressed in a proactive 22.6%; ES: .50; 4 xs way that keeps clients # of clin. sig. change engaged while helpers • FU: TAU-34.2% v. collaboratively seek new 18.4% Feedback directions…but does it Anker, M., Duncan, B., & Sparks, J. (2009). Using client feedback to improve outcomes? sep./divorce rate improve couple therapy outcomes: A randomized clinical trial in a naturalistic setting. Journal of Consulting and Clinical Psychology, 77 (4), 693-704 . Reese , Norsworthy, & Rowlands (2009) A SAMHSA EBP Reese , Toland, Slone, & Norsworthy, 2010 But Different • N=148: Feedback group Reese, R., Norsworthy, L., & PCOMS is a- doubled controls (10.4 Rowlands, S. (2009). Does a continuous feedback model theoretical & improve psychotherapy vs. 5.1 pts); ES: .48 outcomes? Psychotherapy,46 , therefore additive to therefore additive to 418-431. • Like Norway study, any therapeutic Reese, R., Toland, M., Slone, N., & Norsworthy, L. (2010). Effect clients, regardless of risk orientation, including of client feedback on couple psychotherapy outcomes. status, benefit from other EBPs; PCOMS Psychotherapy, 47, 616-630. continuous feedback applies to clients of all diagnostic • 2010 study is replication categories of Norway Trial betteroutcomesnow.com 3

heartandsoulofchange.com; pcoms.com February 2016 Group, Substance Abuse, & PCOMS Meta-analysis by Lambert & Shimokawa (2011) Schuman, Slone, Reese, & Duncan , 2014 of PCOMS (the ORS and SRS) RCT of 263 returning Those in feedback group had Afghanistan and Iraq Vets 3.5 higher odds of experiencing reliable change and Soldiers about to be Deployed: improved Deployed: improved Those in feedback group had less outcomes on the ORS, than half the odds of experiencing more reliable and clinically deterioration significant change, superior clinician and Commander Feedback attained .48 ES ratings; and reduced drop Schuman, D., Slone, N., Reese, R.J. & Duncan, B. outs Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. Psychotherapy, 48, (2014). Efficacy of Client Feedback in Group Psychotherapy with Soldiers Referred for Substance 72-79. Abuse Treatment . Psychotherapy Research. Cooper, Stewart, Regarding Provider Variability Sparks , & Bunting, 2013 Feedback Improves Outcomes • Cohort study of 288 7-11 • Norway: 9 of 10 got yr olds; caretaker-228; better outcomes teacher-249; 11 • Feedback raised counselors; 28 schools l 28 h l effectiveness of the lower ones to their more successful colleagues. • 2 fold advantage over • Provider in low children not using effectiveness group Cooper, M., Stewart, D., Sparks, J., & Bunting, L. feedback as measured (2013). School-based counseling using systematic became BEST w/feedback! feedback: A cohort study evaluating outcomes and on the SDQ predictors of change. Psychotherapy Research, 23, 474–488 . But What About the Real World? PCOMS Addresses the Problems Benchmarking Studies Recaptures At Risk Clients • Compares results of • Feedback tailors services RCTs to outcomes in based on response, real world. Real world provides an early warning provides an early warning much harder to secure h h d t system to prevents drop- good outcomes outs & negative outcomes, • Comparable results & solves provider variability—feedback would suggest a viable improves performance as method of quality demonstrated in 5 RCTs improvement betteroutcomesnow.com 4