Feedback

‘I Didn’t See That Coming!’: How a Feedback System Transforms Therapy

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An article by Margarita Tartakovsky, M.S., details the client feedback experiences of Dr. Jason Seidel, PsyD, founder and director of the Colorado Center for Clinical Excellence. Seidel has been using a client feedback system to inform his method of treatment in private practice since 2004. This, according to him, “involves routinely and most importantly formally soliciting feedback from clients about the process of therapy, working relationship (with the therapist) and overall well-being.”

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Feedback Informed Treatment in Group Settings

The heart of Feedback-Informed Treatment (FIT) is using information generated though routine monitoring of the therapeutic relationship and progress in treatment to adjust service delivery.

With MyOutcomes® the standard Outcome Rating Scale (ORS) is used to measure progress reported by group members. To monitor the quality of the alliance, the Group Session Rating Scale (GSRS) has been developed and has proven to be a reliable and valid measurement tool, capable of predicting early treatment response (a known determinant of engagement and outcome).

The following cartoon is based on a video excerpt from MyOutcomes FIT eLearning Program. It provides an example of strategies for introducing and administering the GSRS.

 

When a client’s response to treatment is measured using the GSRS the interpretation of the measures, the meaning and use of the client’s response pattern in general indicates:


• GSRS scores that start and remain low are associated with higher dropout rates and poor or negative treatment outcomes;

• GSRS scores that start and remain high are associated with positive treatment outcomes;


• GSRS scores that start low but improve are associated with lower dropout rates and superior outcomes;


• GSRS scores that start high but decrease are associated with higher dropout rates and poorer treatment outcomes.


The key to using the GSRS effectively in groups is ensuring that the process facilitates open discussion among the members. MyOutcomes not only offers the tools needed to simplify the collection of client outcome and session ratings, we also offer Nationally accredited training in Feedback-Informed Treatment.

To learn more visit: https://www.myoutcomes.com/fit-elearning

I Can See Clearly From High Up On a Rocky Mountain Top

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therapy effectiveness

How therapists can attain their summit by regularly taking client feedback

The other day, I told my wife that the two most important things I learned in graduate school were: 1) how little I know; and that 2) I had doomed myself to a life of perpetual student-hood. Put another way, every time I reached a perceived intellectual summit, I discovered that there were much higher summits of knowledge on the distant horizon. Unless I was content with achieving and remaining at the level of mediocre expertise that I had just attained, I would have to set forth and climb the next mountain. And then, there would be the next mountain, and the next, and so forth, and so on. There would never be a final summit to climb because there is always something more to learn. And to acquire that knowledge, one must remain a student, with a student's endless list of questions.

I believe this experience and perspective is common to most, if not all, of those who strive for an advanced degree in any field. There are, of course, those few who may feel that they can set aside the student cap and robes and rest on their laurels. But it won't take long before they are left behind in the proverbial dust of their rapidly progressing field. They become intellectual dinosaurs, largely forgotten and ignored except by curious schoolchildren on a field trip that allows them to escape the tedious boredom of their classroom. I know that this might sound depressing, but the truth is that it is depressing. And, potentially dangerous.

An attitude that a diploma indicates that learning has been completed is particularly dangerous in fields where the primary purpose is to help people. There is nothing potentially more hazardous than someone trying to apply ideas that are not supported by the evidence. This is why the medical field adopted the evidence-based practice as its standard bearer. Not long after, for much the same reasons, the field of psychotherapy adopted its own version of evidence-based practice. According to the American Psychological Association, a psychotherapy practice needs to use the best available research and clinical expertise “in the context of patient characteristics, culture, and preferences” in order to be considered as evidence-based.

MyOutcomes, with its web-based Outcome Rating Scale (ORS) and Session Rating Scale (SRS), is included in SAMHSA's National Registry of Evidence-based Programs and Practices because it helps the therapist integrate the client's characteristics and preferences. The ORS and the SRS provide the client a voice to provide constant feedback to the therapist about the progress being made and the therapist-client relationship.

Being a student in psychotherapy can be challenging. Not only does the therapist need to keep up with the research and continually hone their clinical skills, but they need to be constantly learning about their client, who is not a single-dimensional cut-out of a human being. Rather, the client is a multidimensional person with characteristics that are in a state of flux as well as being relatively constant over time. When you include the therapist's characteristics, culture and preferences, you have a very complex situation with multiple factors that have the potential of affecting whether successful outcomes will be achieved or not.

Two such important factors are early change and the therapeutic alliance. If change does not begin early and/or there isn't a strong alliance between the therapist and the client, the chances of the client deteriorating or dropping out of treatment are increased.

Obviously, there are various variables that can influence these two factors. Things such as empathy, group cohesion, goal consensus and collaboration, coping style, counter-transference, genuineness, and positive regard are among a long list of variables that can impact the therapeutic alliance and affect the direction of therapeutic change.

But before the therapist can respond and make appropriate alterations to how any of these variables come into play, the therapist needs to  know that something needs to be changed. Stated differently, before the therapist can bring any needed change to their therapeutic approach, they need to know that the desired change isn't happening or that the therapeutic alliance is threatened or non-existent.  By providing information regarding changes in the client's subjective experience of distress or the strength of the therapeutic alliance, the ORS and the SRS, respectively, can alert the therapist to the very real possibility that the client isn't showing any improvement or the therapeutic alliance is deteriorating.

As students, particularly if we're lucky, we have good teachers and mentors to help guide us and provide us insight into the challenges we need to surmount in order to achieve our goals. For many psychotherapists who desire to continue improving their effectiveness, teaching and mentoring comes in the form of clinical supervision. Although case notes, diagnostic scores, the supervisor's knowledge of the research and the supervisor's clinical skills play a valuable role in clinical supervision, little to nothing of the client's preferences, expectations and views of the therapeutic process and their own progress might ever find its way into supervision, even though these factors have been demonstrated to play a vital role in successfully achieving the therapeutic goals. Of course, if MyOutcomes has been effectively integrated into the therapist's practice, this information is available. By using MyOutcomes, the client's ORS and SRS scores can play a vital role in directing clinical supervision and help all those involved in identifying at-risk clients prior to those clients dropping out.

Ultimately, MyOutcomes' value lies in its ability to facilitate the therapist reaching the summit.

For more information please visit www.myoutcomes.com or call us on 1-877-763-4775

Improve Outcomes

Face to Face or Remote Counselling? MyOutcomes Client Level Access

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Whether face-to-face counselling is the best way to treat patients, or newer, technology enabled techniques like tele-psychiatry or web-based counselling (remote counselling) can work just as well is an ongoing debate.

But one thing that can be said without a doubt and substantiated with facts, is that the popularity of telephone and web-based talk therapy has continued to grow over the years, and the reasons can be the many benefits it brings with it.

Some of the major benefits of remote counselling:

  • It reaches people in remote places and in rural areas who would otherwise have no access to such facilities
  • People who are housebound due to disability or other reasons can also avail the benefits of expert counselling
  • It is much more accessible as it can be accessed from any place of convenience
  • The perceived privacy that comes with visiting a “shrink” online as compared to physically visiting a clinic is important for some
  • Some people are more comfortable discussing their mental health issues behind the veil of technology as opposed to face-to-face, and may help the mental health practitioner understand the situation better
  • For web-based treatment, the client may be more objective while discussing the issues as s/he is writing it down in order to communicate, which may provide an opportunity for them to be able to view the problem without associating it directly with their emotions
  • The client also feels a bit more involved as s/he enjoys a greater degree of ownership of the process

Since it is equally, or perhaps even more important, to measure feedback in remote counselling, therapists need a tool that can do it for them. It is for this reason that MyOutcomes, added the option for the clinicians to give their client remote access to the Outcomes Rating Scale (ORS, CORS) and Session Rating Scale (SRS, CSRS,GSRS). In 2019, we released MyOutcomes Mobile®, a free app for clients to download from iTunes or Google Play onto their smartphone or tablet, making it easier than ever for clients to complete these measures. This remote access feature enables providers to create a user ID and password that they can give the client to log in on their own home computer, phone or tablet and record their current ORS and SRS responses.

The client will then see a field for them to take the appropriate scale (ORS/CORS/SRS/CRSR/GSRS). That's it! As soon as the client has completed the scales, the therapist will be able to see the results on their own device in real time.

 

 

 

MyOutcomes’ Apt App

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“MyOutcomes’ apt app can be easily downloaded onto any number of electronic devices a client might use”

It is my recollection that when the first computers began appearing in the business world and the health professions, they were promoted as reducing paperwork and saving time. Of course, they really did neither. Software tended to be complicated and time consuming. Hard copies were printed for use or as backups. Plus it was easier to read the hard copies than the electronic versions. But, the world changes and,along with it, so does technology.

With such things as better monitors and video cards, we have been able to adapt to spending our time reading documents on a screen, rather than in a printed manual, journal, or newspaper. The Cloud has provided a safe and secure way of storing our data, thereby reducing the need for printing out hard copies. And, of course, email has dramatically cut into the raison d’etre for the postal services. There has been one possible holdout…the jury is out as to whether this technology actually saves time.

MyOutcomes, the web-based application for the Partners for Change Outcome Management System (PCOMS), has long established itself as the ideal clinical tool that reduces paperwork. Although users can easily print out hard copies of each client's data, users can just as easily and rapidly access that same data electronically via the internet for viewing on a variety of devices.

Now, in keeping with its goal at staying at the forefront of integrating modern technology with modern psychotherapeutic best-practices, MyOutcomes is fulfilling the promise of the computer age to save time…that ephemeral substance that seems to disappear far too rapidly. Time is important to the therapist and the client. Every minute is valuable. It is understandable that therapists are jealous of the time they have to spend with their clients. It is also understandable that therapists are reluctant to give up any of those minutes to something that doesn't seem to be directly related to what is viewed as the traditional therapeutic process.

Of course, it has been well established that MyOutcomes®, with its SRS (Session Rating Scale) software and its ORS (Outcome Rating Scale) software, plays a central role in successfully achieving therapeutic goals when meaningful use of the data is achieved. Furthermore, the ORS and SRS each take less than a minute to administer and score. That translates to a lot of therapeutic power for a very small investment of time.

Now, MyOutcomes introduces a new way for the therapist to recover even that administrative time, while making that administration easier. The MyOutcomes mobile or web app can be easily downloaded onto any number of electronic devices a client might use. The therapist can then provide the client with an access ID and password to MyOutcomes so that they can take, say, the ORS prior to arriving for their appointment.

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It's really very simple. The client needs to download the free MyOutcomes app from iTunes or Google Play onto their smartphone or tablet. Once the client is set up, the therapist goes to their MyOutcomes Provider page. In the column headed “Action,” there is a link titled “Give Access.” The therapist selects the client they wish to provide access to and clicks on that link. A temporary (24 hrs) password will be generated. The therapist needs to communicate this password and the clients ID to the client (security tip-if the therapist plans to communicate by email and is not yet using a secure email application then for security purposes the clients User ID and temporary password should be shared in separate emails.

The client will open the app on their device, then select whether they are a client based in the U.S., Canada, or International, enter the ID and password in the appropriate fields and click the login button. Then, the client will see a field for them to take the appropriate scale (ORS/CORS/SRS/CRSR/GSRS). When they click on the take button, they will see the same instructions that are provided when the scale is administered on a computer. At the top of the screen are navigational arrows to move backward and forward between the pages. Moving forward through the next four pages will take the client through each of the sub-measures. After finishing scoring the sub-measures, the client will come to a page summarizing their input. The client has the option of making adjustments before hitting the “Submit” arrow at the top of the screen. The next two pages will show the expected treatment response graph and the related feedback messages, respectively. That's it! As soon as the client has completed the scale, the therapist will be able to see the results on their own device.

In today's technological world, there are many apps available. They are available for play. They are available for work. They are available for health. Many of the apps for health, promise so much and do so little. There are apps that do a lot, but they cost a lot. The MyOutcomes app, on the other hand, delivers the power and promise of MyOutcomes and, just as importantly, it is free.

To know more about this latest app or to know about how MyOutcomes can help you achieve effectiveness in therapy, contact us toll free on 1-877-763-4775 or visit www.myoutcomes.com/

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Therapists need their clients’ help just as clients need theirs

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Advancing Outcome Informed Therapy Video Series

Video #5 of 6 (2:14 min.)

Therapists need client feedback in order to increase therapy effectiveness

Research has proven that systematic formal client feedback can improve results dramatically – sometimes doubling treatment effectiveness. Did you know that a major study on client feedback led to the national adoption of standards for outcome rating and session rating scales? For more on this check out the following video.

I'm Walking, Yes Indeed. I'm Talking, ‘Bout MyOutcomes and Me

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The importance of therapy feedback for successful outcomes

Walking from one end of a room to some specific point on the opposite side of the room would be a simple task for most individuals. Even adding a couple of obstacles to step over or around wouldn't make the task that much more difficult. But what strikes us as a seemingly simple task is, in reality, a very difficult and complex task.

Basic walking involves muscles specializing in flexion, extension, abduction, and adduction. We might use rotator muscles for stepping around objects or we might use elevator and depressor muscles for stepping over objects. If that wasn't complicated enough, we have to keep our torso from significantly wobbling to either side, thereby causing us to change our trajectory to the left or the right or, even worse, falling down.

The perfect timing for the contraction and relaxation of all of these muscle groups is maintained by signals sent from our brain to the neuromuscular junctions. And once the initial command to move to the other side of the room is given, what controls everything is…feedback. To maintain our balance, we use feedback from our equilibrioceptors. The beginning and end of muscle contraction and relaxation is influenced by feedback from our proprioceptors. Keeping on target and knowing when we approach obstacles if provided by visual feedback. Other important feedback about our environment may be provided by our tactile senses.

Without this continuous feedback, we would find it very difficult to successfully walk to a target point across the room. Feedback is critical to so many parts of our lives.

That inner voice for many of us is important because it acts as a moral compass that alerts us if we are wandering off our path of doing what's right. When our behaviors are socially inappropriate, others in our social group will provide feedback with various mechanisms such as frowning, comments and ostracization.  When we learn a musical instrument, a martial art, mathematics or golf, we get feedback to tell us how we are doing and give us an opportunity to improve. This feedback may come by soliciting it from those more skilled than our selves or we may simply look at how our behaviour impacts other factors in our environment and compare our actual performance to our ideal performance. One thing we aren't good at is providing ourselves with feedback. We need measurements that don't depend upon our own personal impressions.

Technically, those teaching evaluations that college and university students fill out at the end of each semester are supposed to provide feedback to the professors. In an ideal world, the feedback is supposed to help the professor develop their courses and their teaching of the material. The majority of the time, however, these evaluations are seen as and used as nothing more than “customer satisfaction” surveys. The university administration only looks at them to insure that instruction is being provided, while professors hope to read comments like “A brilliant teacher” or “The best class I've ever had” rather than comments like “The professor dressed poorly” or “The professor looked stoned.”

Two other pseudo-feedback measures used by businesses are exit surveys and suggestion boxes. Although not all businesses provide such opportunities to their customers, those that do neither actively nor consistently attempt to get their customers to provide information about their experiences. The truth is that the exit surveys and suggestion boxes are nothing more than customer satisfaction measures that allow customers to vent their frustrations or express their happiness. Customer satisfaction measures aren't designed to help individuals improve or achieve their goals.

Even those who are the best at what they do, need to continually work to maintain and improve their skills. Olympic skiers continually practice and seek feedback before any competition. Musicians continually practice and get feedback before a performance. Put another way, those that excel never rest on their laurels, but they continue doing those things that helped them to excel in the first place.

As part of their training, all students, who aspire to become psychotherapists, receive feedback on their skills from various sources. Those psychotherapists, who strive for excellence, continue seeking feedback throughout their careers to help them achieve their goal. After completing their training program, their internship and their residencies, obtaining feedback, however, becomes difficult.

The one person who is ideally situated to provide the therapist with feedback is the person that the therapist works with. In other words, the therapist's client is the ideal source for feedback. This is so obvious that it is mindboggling that it has only recently begun to be realized. It seems strange that other therapists, e.g. physiotherapists, solicit feedback about their clients' progress and physical pain, but psychotherapists, who work hard at developing equally important but significantly more subtle skill sets, don't. But that has begun to change. The leader in this change is the Partners for Change Outcomes Management System (PCOMS). PCOMS is not a customer satisfaction measure. Instead, if used correctly, it is a powerful feedback tool that consistently measures the client's progress and the management of their psychological pain.

MyOutcomes, which is the web-based application for PCOMS, is the ideal system for administering the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS), thereby bringing the client's voice into therapy. For those psychotherapists, who want to successfully cross the room or develop Olympic-level skills, MyOutcomes is the best partner for soliciting that necessary feedback that they will be able to use to achieve those goals.

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It Takes Three to Tango: The Client, the Therapist and MyOutcomes

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Feedback Informed Therapy tools make therapy more successful

Therapeutic sessions are a complex combination of singular psyches, social interactions and situational factors. Some of these are essential to the process of psychotherapy, whereas, with varying degrees, others are less so.

Obviously, the most critical element in psychotherapy is the client. Without the client, there is no purpose. It is some pain-inducing dysfunction in the client's psychological, emotional and/or social world that is the beginning point and the end point of the psycho-therapeutic process. The clients enter psychotherapy to rid themselves of the pain, while they leave psychotherapy when the pain is gone. At least, that is the ideal sequence. Sometimes, clients remain in therapy long after the need is gone. Sometimes, clients leave therapy long before the pain is healed.

Another key part of psychotherapy is the psychotherapist. It is, after all, the psychotherapist to whom the client is turning to in their time of need. It is the psychotherapist that holds the promise of finding a solution or, bar that, a means for coping. Psychotherapists bring to the session their education, training and experience. Most importantly, the psychotherapist brings their desire to help. Using all of these assets as a framework, the therapist and the client explore what has motivated the client to seek help. The process of the therapist's personal thoughts, self-communication and analysis is recorded in the psychotherapy notes.

The third critical element of psychotherapy is the therapeutic context. The context consists of those things that are essential in the therapeutic process but largely remain in the background or superficially seem to play only an incidental role. Take for example the environment that therapy takes place in. It is, for the most part, a stage reflecting the image the therapist wants clients to see. This stage may be comprised of a mixture of therapist idiosyncrasies, theoretical leanings and traditional stereotypes.  In most cases, the environment is meant to assure the client of the competency of the therapist and help the client relax.

The therapeutic context also consists of diagnostic tools, clinical tests, medication, and, if the therapist has an evidence-based practice, possibly tools capable of measuring progress. Without such tools as those that measure progress, of course, one only has one's gut feelings (a tremendously unreliable measure) to determine if progress is being made, let alone if success has been achieved. All of the data from these various tools and other forms of objective, measurable aspects of treatment comprise the progress notes. Writing progress notes can take up a large chunk of the therapist's valuable time.  Time, it should be added, that the therapist could be devoting directly to their clients.

Consider for a moment the issue of the client's progress. Unless a clinician has adopted an evidence-based practice, it will be difficult, if not outright impossible, for the clinician to accurately and objectively measure progress. It is in these situations where you are likely to find clients remaining in therapy long after they have achieved their therapeutic goals or, even worse, there is a failure to see that the client isn't making any meaningful progress and, therefore, might benefit from an adjustment in the therapeutic approach.

On the other hand, a psychotherapist, who has developed an evidence-based practice, may have already incorporated the feedback-informed approach into therapy sessions. Such a therapist may be using the paper and pencil versions of the Outcome Rating Scale (ORS), an ultra-brief tool that actually measures the client's progress and the Session Rating Scale (SRS), an ultra-brief tool that measures the strength of the therapist-client alliance.

Although the pencil and paper versions of the ORS and the SRS can be effective in improving the therapist's ability to help their clients achieve successful outcomes, the pencil and paper versions can prove to be time consuming. The therapist has to create, or at least print out, the scales, administer the scales, score the scales, calculate the client's score, and create and maintain some record of all of this activity as part of the progress notes. Although using the scales themselves can take less than a couple of minutes, the clinician's involvement is much lengthier. Unless…

There is a solution for the psychotherapist who wants to expend their energy and time helping their clients. MyOutcomes is the automated, web-based application for the ORS and SRS. Once the therapist has created a client's file, it can take less than a minute to administer the ORS or SRS, obtain the scores and have a graphical representation of the client's session-by-session scores, while at the same time be able to compare the client's performance to the scores derived from the average of a large database of individuals who began therapy at a comparable level of psycho-emotional adjustment.

Because MyOutcomes keeps the records of the client's progress, all the therapist needs to do is click a link to view that progress or click another link to print out a hard copy of that progress.  Not only are the progress notes for an individual therapist's clients kept, but, if you are an agency, the progress notes for all of your therapists and their clients are stored for easy access. And, for those funding applications or those funding justification reports, MyOutcomes can produce an easy to follow aggregate stats report that is readily integrated into any report.

The truth of the matter is that MyOutcomes not only helps therapists be more successful in helping their clients achieve their therapeutic goals in less time, but MyOutcomes can help take care of the paperwork. This means more time for the therapist do what they do best: help their clients.

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Feedback Sources & Aggregate Stats

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A behavioral health practitioner's workload is increasing dramatically as a result of today's increased demand for mental health services. With limited time and with other things interfering with the ability to help clients achieve their therapeutic goals, it is imperative to be able to find information quickly and get results at the click of a button. Therefore, in order to improve your ability to create and access reports as well as make appropriate comparisons between critical individuals, MyOutcomes version 11 has this aggregate stats feature that plots multiple feedback source trajectories on a single graph. Outcome Rating Scale (ORS) and Session Rating Scale (SRS) data from two or more sources can be seen on the same ORS – SRS client graph.

It is also possible to export this data on your device and in order to ease this export in a csv or xls format, extra column is added to help the practitioner identify if ORS or Couple Outcome Rating Scale was used. Other information like assessment date, birth date, gender etc. is also included. Language has been simplified and on screen pop-ups added for greater clarity, ease of use and to help save the behavioral health practitioner's time.

Listen as I describe how Version 11 improves your ability to compare feedback sources with the client and improves the ease of viewing and interpreting the Aggregate Stats.

Feedback in Therapy and Technology

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With the advent of new technology and web-enabled devices like smart phones, iPads, tablets etc. the way we do things and store data has drastically changed. Healthcare in general and behavioral healthcare per se is also keeping up with this trend with more and more practitioners preferring electronic records over paper. The benefits are galore with the biggest one being stated as the improvement in quality of healthcare provided due to the ready availability of information wherever and whenever. Some of the other benefits of maintaining electronic records are:

–          Increase in patient participation

–          Quick and easy retrieval of information

–          Better coordination between various healthcare providers

–          Increase in efficiency

–          Reduction in storage space requirement

–          Cost savings in the long run

As part of its partnership with practitioners and with the aim of improving outcomes, MyOutcomes, a web-based tool for measuring feedback in therapy, provides an ease of access for its users that is unparalleled. The staff at MyOutcomes takes this partnership seriously and is, therefore, committed to keeping at the forefront of technology. The newly launched version 11 is browser-friendly and multi-platform compatible. It has been optimized for iPad and android tablets and supports Internet explorer 9 and 10, Firefox, Google Chrome and Safari's latest versions. Not only practitioners, but even patients love completing the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) on the electronic device.

MyOutcomes' Vice-President, Cindy Hansen, introduces the many new platforms that are compatible with MyOutcomes

For more information contact MyOutcomes on (250) 763-4775 or 1 877 763-4775 (international toll-free)