The Better Results with Scott D. Miller Live Meet Up was held yesterday.
Feedback-Informed Practitioners, from around the world, joined in to listen and participate in a discussion about Feedback-Informed Treatment and FIT Deliberate Practice. FIT Trainer and MyOutcomes Executive Director, Cindy Hansen was the host and moderator for this event.
Scott D. Miller is the co-founder of the Center for Clinical Excellence, an international consortium of clinicians, researchers, and educators dedicated to promoting excellence in behavior health. He is the author of numerous articles and co-author of the soon to be released, Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness (APA, 2020).
This opportunities to interact, one-on-one in a live training session, with Scott was part of the Better Results…with Scott D. Miller Training Series. This training is complete but a waitlist is available, for the next session this summer. you can sign up here:
This video clip covers the first question that came from Daniel Rosen, who asked, “So, we have a worldwide, real world dramatic change that we speculate has increased distress overall. Question: do we have an numbers on ORS scores changing historic patterns? Question 2: We have a real world mass movement to telehealth and remote video therapy: What is happening with SRS scores as well. I hope the number crunchers have something here!”
Do you want to know Scott’s answer? I know I did.
Listen and see if you agree. Love to hear your comments.
MyOutcomes Mobile is here to help you track and improve client outcomes, anytime, anywhere!
MyOutcomes, the first web-based version of the Outcome and Session Rating Scales (ORS & SRS), was launched in 2007 as a simple routine outcome monitoring system. Popularized due to the broad application of the ultra-brief, progress and alliance monitoring tools, today MyOutcomes is used in all kinds of service settings, with all kinds of clients, in 28 countries around the world.
Provider and Client user interface now available in English, Spanish, French, Norwegian, Swedish, Danish, Dutch & German.
More survey options! Now clients can complete the measures in English, Spanish, French, Norwegian, Swedish, Danish, Dutch, German, Italian or Chinese.
MyOutcomes Mobile is the perfect clinical tool to help you manage patient outcomes. Want to try it out? Download it now for free. MyOutcomes Login credentials for MyOutcomes Providers and Clients can be used to access MyOutcomes Mobile. Don’t have Login credentials? Follow the prompts to create a Provider ID, add your clients and use it for free with up to five clients.
Are you sheltering in place? Feeling Locked down? A few weeks ago Scott was asked in a group chat if he could offer some kind of live support, now that his workshop and training events have for now all been postponed or cancelled. Since he can’t come to you, the ICCE has begun offering this chance to connect and meet with colleagues from around the world in a live web event.
Feedback Informed Treatment & Deliberate Practice Meetup THREE is a free discussion/question and answer sessions on Feedback Informed Treatment and FIT Deliberate Practice.
Apr 29, 2020
Time: 12:00 PM in Central Time (US and Canada)
Scott D. Miller, Director and co-Founder of the International Center for Clinical Excellence, will be taking your questions from ICCE Director of Professional Development, and ICCE trainer…since its inception, Cynthia Maeschalck.
As before, no cost. Space is limited for this live event.
MyOutcomes offers accredited training in Feedback-Informed Treatment for only $179.00. Whether you’re an individual practitioner or part of a larger organization, FIT eLearning helps you develop a culture of feedback and incorporate the Outcome & Session Rating Scales (ORS&SRS) into your clinical practice.
No one could have anticipated how our world circumstances would change, and with it our mode of how we operate in it. In order to protect each other, we need to do things differently, and fast. For most, if not all, distance therapy will need to be the norm for some time.
In a recent blog post, Telehealth Options for Feedback-Informed Practitioners, I shared some tutorials MyOutcomes has made to help ease the transition to online therapy, but soon I was asked, “What about when the client doesn’t have internet access or a data plan on their cell phone, and a line line is the only form of communication?”
Last week, Karl Peuser, PhD, published a video specifically on how to collect ORS and SRS feedback over the phone. Today FIT Trainers, Brooke Mathewes and Stacy Bancroft published guidance for Oral administration of the Outcome Rating Scales and the Session Rating Scale. For your reference the documented Oral scripts are included below.
In addition to tutorials, thought leaders in our field are also reaching out to help.
Scripting for Oral Version of the Outcome Rating Scale
I’m going to ask some questions about four different areas of your life, including your individual, interpersonal, and social functioning. Each of these questions is based on a 0 to 10 scale, with 10 being high (or very good) and 0 being low (or very bad). Thinking back over the last week (or since our last conversation), how would you rate: How you have been doing personally? (On the scale from 0 to 10). If the client asks for clarification, you should say “yourself,” “you as an individual,” “your personal functioning.”If the client gives you two numbers, you should ask, “which number would you like me to put?” or, “is it closer to X or Y?”. If the client gives one number for one area of personal functioning and offers another number for another area of functioning, then go with the lowest score.
How have things been going in your relationships? (On the scale from 0 to 10). If the client asks for clarification, you should say “in your family,” “in your close personal relationships.” If the client gives you two numbers, you should ask, “which number would you like me to put?” or, “is it closer to X or Y?” If the client gives one number for one family member or relationship type and offers another number for another family member or relationship type, then go with the lowest score.
How have things been going for you socially? (on the scale from 0 to 10). If the client asks for clarification, you should say, “your life outside the home or in your community,” “work,” “school,” “church.” If the client gives you two numbers, you should ask, “which number would you like me to put?” or, “is it closer to X or Y?”. If the client gives one number for one aspect of his/her social functioning and then offers another number for another aspect, then go with the lowest score.
So, given your answers on these specific areas of your life, how would you rate how things are in your life overall?. The client’s responses to the specific outcome questions should be used to transition into counselling. For example, the counselor could identify the lowest score given and then use that to inquire about that specific area of client functioning (e.g., if the client rated the items a 7, 7, 2, 5, the counsellor could say, “From our responses, it appears that you’re having some problems in your relationships. Is that right?) After that, the counselling proceeds as usual.
Scripting for Oral Administration of Session Rating Scale
I’m going to ask some questions about our session today, including how well you felt understood, the degree to which we focused on what you wanted to talk about, and whether our work together was a good fit. Each of these questions is based on a 0 to 10 scale, with 10 being high (or very good) and 0 being low (or very bad). Thinking back over our conversation, how would you rate: On a scale of 0-10, to what degree did you feel heard and understood today, 10 being completely and 0 being not at all? If the client gives you two numbers, you should ask, “which number would you like me to put?” or, “is it closer to X or Y?”. If the client gives one number for heard and another for understood, then go with the lowest score.
On a scale of 0-10, to what degree did we work on the issues that you wanted to work on today, 10 being completely and 0 being not at all? If the client asks for clarification, you should ask, “did we talk about what you wanted to talk about or address? How well on a scale from 0 – 10?”. If the client gives you two numbers, you should ask, “which number would you like me to put?” or, “is it closer to X or Y?”
On a scale of 0-10, how well did the approach,the way I/we worked, make sense and fit for you? If the client gives you two numbers, you should ask, “which number would you like me to put?” or, “is it closer to X or Y?”. If the client gives one number for make sense and then offers another number for fit, then go with the lowest score.
So, given your answers on these specific areas, how would you rate how things were in today’s session overall, with 10 meaning that the session was right for you and 0 meaning that something important that was missing from the visit? If the client gives you two numbers, you should ask, “which number would you like me to put?” or, “is it closer to X or Y?”
How MyOutcomes’ simple web-based tool helps therapists achieve greater efficacy and success in therapy
I always enjoyed introducing my students to the concept of a good scientific theory, because it was an opportunity to introduce Ockham’s razor. I have always felt an affinity with William of Ockham and his argument that the best explanation was the one that held the least amount of assumptions. My affinity is probably due largely to my contraire nature and the tendency of so many around me to gravitate towards extremely convoluted explanations. Sometimes it gets so that I feel as if I am a simple scientist adrift in a sea of lawyers.
The discussion with my students was also an opportunity to point out that elegance is found in simplicity. For example, I would say, consider Carmen Miranda with her fruit basket hats and then consider a woman in a black, strapless evening gown with only a pearl necklace draped around her neck. Which of the two women would be considered more elegant, Carmen Miranda in her complex outfits or the woman who was simply dressed? Clearly, only a guy, who enjoys wearing purple zoot suits, would consider Carmen to be more elegant. However, simple elegance shouldn’t be viewed as lacking complexity. Both Carmen Miranda and the other woman equally encompass the complexity found in any human female. It’s just that the woman in the evening gown is presented more simply and, therefore, more elegantly.
Like the woman in the evening gown, the most elegant theories are also those that are more simply dressed. And, like with the woman in the evening gown, one shouldn’t confuse simple elegance with simple-mindedness. A case in point would be Einstein’s Theory of Relativity; so elegant in its mathematical simplicity, yet so powerful in its predictive ability.
There are many things in our world where we can see the application of Ockham’s razor. Take for example, Partners for Change Outcome Management System (PCOMS). PCOMS, with its conceptually simple Outcome Rating Scale (ORS) and Session Rating Scale (SRS), brings elegant power into the therapeutic setting. Its simplicity of presentation belies its powerful predictive ability. The ORS and SRS are simply-wrapped tools that, with effective training, can help therapists take their practice to the top.
MyOutcomes, the web-based tool for administering PCOMS, is the natural ally of psychotherapists helping their clients achieve their therapeutic goals. MyOutcomes has repeatedly demonstrated its innovativeness in its goal of helping psychotherapists improve their success.
To understand how to use the ORS and SRS to improve the effectiveness of the treatment you provide check out these training opportunities coming up this summer in Chicago:
An RCT reporting reliable and clinically significant change instills a high degree of confidence in the results. So why does strictly adhering to a manualized EBP, with multiple published RCT’s in top tier journals, often fail to translate into even noticeable improvements in clinical settings? Experience suggests that the real world is more heterogeneous than the world imagined by RCTs and it can be confusing and disappointing when individuals you are trying to help fail to benefit.
MyOutcomes® is a response to these findings, offering a way to identify when treatment is and is not working with an individual person. Back in 2007, when MyOutcomes first began offering the convenience of digital administration and reporting treatment outcomes, we used a set of mathematic equations that plotted the expected treatment response or ETR of a client based on their Outcome Rating Scale (ORS) score. At the time is was cutting edge, few people were even measuring outcomes let alone trying to provide benchmarks for guiding clinical practice. For the first time therapists and clients had a simple and feasible way to compare outcomes from session to session to the ETR benchmark.
Originally, the ETR plotted the average progress of all clients, since then we have upgraded several times, today offering equations that provide benchmarks for comparing individual progress to both successful and unsuccessful treatment episodes. In MyOutcomes modeling system, predictions are made at the individual level, versus feedback delivered in the form of an Average ETR, providing a far more accurate assessment of reliable and clinically significant change at the individual client level. If your clients are all average than by all means use a Reliable Change Index, if they are not and your EBP has let you down too many times, consider adding a patient-centred measure of treatment effectiveness like MyOutcomes. If you have already been using MyOutcomes and are ready to raise your effectiveness to the next level; Improve your ability to engage, retain, and help a more diverse clientele then consider joining me this March in Chicago for the Advanced FIT Intensive. It will help you develop and sustain a lifelong, professional development plan.
It is inevitable that at least one of your clients will want to, at least one time, revise their ORS (Outcome Rating Scale) and/or SRS (Session Rating Scale) score. The mechanisms for doing this in the web application are probably familiar to most folk. What you may not be aware of is that there two mechanisms available in the Mobile App itself for revising scores. Using either of these mechanisms can help you avoid the need to log into your web account via the MO Web icon at the bottom of the Mobile app page.
The first mechanism available to your clients is also the simplest. After completing either the ORS or the SRS, the client will have a page to review their choice for positioning of each item slider. If they want to change, they can backspace and readjust the sliders for each item. If they agree with the positions, they can commit their selection, and they will see the graph/summary. This opportunity to change the values prior to committing is available whether they are using your device (logged into your account) or if they log into their own devices, using the login credentials that you have provided to them.
The second mechanism is only available when you, the provider, are logged into the Mobile app. After the initial ORS (first session) has been completed, the icon with the curved arrow will become availableâ€¦just as what happens in the web app. The appearance of this icon indicates that, other than that initial ORS survey, you now have available the option to delete the previous â€˜session.' In other words, if your client decides during their session, or some later time, that they want to change their ORS, they will be able to do so if you delete that session. Deleting the session means that your client will then be able to redo the ORS. If they haven't completed the SRS at the time that the issue of changing the ORS arises, you can access the Skip SRS function by clicking on the curved arrow icon. Once the app shows that the next ORS session is available, click the curved arrow icon and then select delete previous session. Both the SRS (skipped or otherwise) and the ORS that your client wants to be changed will be removed. They can then complete the ORS for the original session as they wish and then complete the SRS.
If you have any functionality questions, please don't hesitate in contacting our customer support team. Our goal is to provide unparalleled service.
Thousands of agencies, practitioners, and their clients have found MyOutcomes' web-based application of the Outcome Rating Scale (ORS) to be a powerful tool. The process is simple. Using MyOutcomes' extensive database, the feedback of all clients with the same initial intake score is used to predict an expected course of therapeutic progress. Deviations from the predicted path of successful treatment alert the therapist of issues needing to be addressed.
As the client's predicted progress is predicated on the initial intake score, the first score is crucial in interpreting client change during the therapeutic process. Errors involving this first score can lead to erroneous conclusions and ill-advised decisions.
There are two types of errors involving the initial intake score that warrant correcting. One is an administrative error that occurs when scores are entered manually. These errors can be corrected by MyOutcomes' IT staff. A second error involves the client deciding their first ORS score is wrong. For example, during the second session, the client may realize that they didn't completely understand how to use MyOutcomes the first time. They may feel that the initial score doesn't accurately reflect their reality. This type of error can also be fixed by MyOutcomes' IT staff.
Practitioners may see errors where there are no errors. For example, mandated clients typically enter the therapeutic context not seeing themselves having any problems or issues. Their initial ORS score, therefore, is usually high. After a few sessions, however, the client becomes engaged in the therapeutic process and their ORS scores drop.
Therapists may want to â€œcorrectâ€ this â€œmeasurement error,â€ using the lower ORS score as the new initial baseline. A therapist may believe that such a change more accurately reflects the client's psychological state. Alternatively, a clinician might be concerned that this drop might be seen by others as a poor reflection on their clinical skills. Neither of these notions are accurate nor are they beneficial to the client. Regardless of the motivation, changing the intake score in these circumstances reflects seeing the ORS scores as only numbers, rather than seeing the ORS as the client's voice.
The client's initial ORS score and all subsequent scores are an accurate reflection of the client's psychological state. Changes in the scores reveal the process of change that the client is undergoing. This is what the clinician should work with. If the therapist changes the baseline ORS to what they think it should be, then they're imposing their beliefs on top of the client's needs. The ORS no longer reflects what is going on with the client. This completely contravenes the power of the ORS and it's ability to provide the client a voice in the therapeutic context.
It is the client's voice that's valued in feedback-informed therapy. When a mandated client reports that they are â€œokay,â€ the therapist should ask them, â€œWhy are you here?â€ When they reply that someone sent them, the therapist should set up the person as a feedback source for the client, then ask the client to complete the ORS for the feedback source. Using a â€œcollateral raterâ€ allows the therapist to honor the client's voice while at the same time acknowledging that issues exist.
If the therapist disregards what the client reports simply because they are mandated, the therapist may stop believing what the client says and ignore the client's voice. This puts the therapist at risk for doing things clinically that will lead to client deterioration, which might be misinterpreted as the client â€œself-correcting.â€
MyOutcomes IT support won't change scores in these situations. There are, of course, strong statistical reasons why they won't manipulate the data without strong theoretical reasoning to support it. If therapists could change willy-nilly any data as they wished, an unknown source of variability would be introduced into the database. Put differently, clinicians deciding on what the correct score should be would introduce an error into the database that would compromise the ability of MyOutcomes', or any similar tool, to make valid predictions. The validity of prediction models is contingent upon consistent data collection. Changing ORS baselines because the therapist doesn't feel it's correct is no different than tossing outliers from a dataset simply because you don't like them. In either situation, your predictive model is going to begin to reflect therapist's feelings rather than reflect the actual process of change clients are undergoing.
To change or not to change, that is the question. At least, according to Hamlet, it is. Although Hamlet engaged in a complicated argument regarding life and death, for MyOutcomes, the answer is quite simple. If addressing a data entry error, change is appropriate. Change is not appropriate if the driving force behind it is a whim and a feeling that ignores the client's reality.
Anyone unaware of the importance of securing personal data in the high-tech world of the 21st century has either been studying with some yogi in a cave in the Himalayas, living in a shack in the Canadian wilderness or has been lost in the Australian Outback sinceâ€¦well, since, at least, the turn of the century. Sometimes it seems that a week doesn't go by without a new revelation about the Russian government, Chinese gangsters or some hacker without a cause breaking in and stealing personal information stored on various corporate servers.
In the 1990s, we started learning about viruses, Trojan horses, and worms that could corrupt our computer's system or destroy our data. With the turn of the century we began to learn that any electronic device, with programs that could access the internet, was at risk for invasion and that there were those who were willing to crack open any computer or cell phone to get the data contained therein. Today, we have botnets to worry about along with everything else. And the list is only going to continue to grow.
Being concerned and responsible, people bought software to protect their personal computers. If people were part of a large enough entity that invested in networks, they needed more powerful software to protect their system. If they were a very large entity, they hired departments of security professionals to keep the stored data safe and sound.
In the last few years, we began to hear about something called The Cloud. The Cloud promised to transform the very concept of computing. It would do so by increasing computing power and increasing data storage. By and large, it has lived up to that promise. Of course, any place that data and programs are stored is fertile ground for hacker attacks. For many, the issue of Cloud security is resolved by contracting services with those capable of dedicating resources to fend off the attacks. For those who purchase their own â€œCloud,â€ they find it necessary to also factor in the cost of paying for additional security.
The struggle between security and those trying to bypass security is an ongoing war that is likely to extend far into the future. Although the hackers, particularly those with vast resources available, occasionally are successful, by and large, security generally emerges as the victor. And, for the most part, people feel secure. But is this sense of security justified?
Not really. As it happens, there is a third element in this modern age of data sharing that is often overlooked. Data transmitted between a Cloud-based solution and the network or computer where work is being done needs to be secured as well. Those who want to steal or do mischief know perfectly well that it is during transmission that data is at its most vulnerable. Any program that includes transmitting data between two or more points should be held accountable for insuring safe and secure transmission. It is only by using advanced encryption protocols that an individual or business has any hope of foiling those determined to cause harm.
From its inception, MyOutcomes has been keenly aware of the need to secure data where it is stored, where it is used and, once again demonstrating forward-thinking solutions, during transmission. Patient data is not only de-identified during transmission, but it is encrypted. And these security protocols are engaged whichever direction the data is traveling, as well as for whatever device the user is using.
MyOutcomes, the web-based application of PCOMS, is a leader for developing secure applications for psychotherapy. MyOutcomes enables the therapist to administer the ORS (Outcome Rating Scale) and the SRS (Session Rating Scale), secure in the knowledge that their client's data is safe. The ORS and SRS easily brings the client's voice into the therapeutic session, allowing the client to share their perception of their own functioning and the therapeutic relationship. And this can be accomplished with the therapist and client being assured that their data is being given the best protection available.
“PCOMS will remain a clinical measuring tool embedded in the complex interpersonal process called psychotherapy”
Have you ever wondered how we can tell that therapy works or whether clients are satisfied with their services?
Many clinicians and mental health organizations are asked these questions and have few answers about how to show that they are effective. Thanks to our long-standing relationship with Our Lady of the Lake University (OLLU), HGI has become involved in learning to use the Partnership for Change Outcome Management System (PCOMS). Though it is not always necessary to use paper and pen measures to talk to clients about their perceptions of and progress in therapy, the use of PCOMS ensures that these conversations are taking place. Feedback is discussed with clients from session to session. Additionally and importantly for HGI, this process insures that HGI is looking at outcomes for funders and other community stakeholders. PCOMS has been shown to reduce “no shows” and length of service, thereby reducing costs and allowing agencies to serve more clients.
The PCOMS, developed by Barry Duncan and Scott Miller in 2000 (Duncan, 2012) includes two measurements: the Outcome Rating Scale (the ORS) and the Session Rating Scale (the SRS). PCOMS has been identified as an evidence-based practice by SAMHSA, and has been normed for both adults and children as young as six years of age. The ORS looks at how the client perceives their own “well-being” using four scales that measure: 1) individual well-being/distress; 2) interpersonal functioning specific to intimate/family relationships; 3) social functioning/distress indicating issues in school/work/friend relationships, and 4) a general overall measure. The SRS also use four scales to measure the client’s perception of the session and the relationship with the therapist, often called the “alliance”. Importantly, this process lets the therapist know the client’s perception of several indicators of success in therapy: 1) the relational bond; 2) the degree of agreement between the therapist and client about the goals and tasks of therapy; 3) the fit between the therapist’s approach and the client’s expectations; and 4) how the client perceived the outcome of the session.
The implementation of these two measures is incredibly simple once the therapist has been trained, understands the underlying reason for using them and has practiced using them. At a recent workshop hosted by OLLU in San Antonio, Dr. Duncan demonstrated that each of these measures can be explained and used in less than three minutes. They become an important anchor for feedback each session, giving important information to the therapist about the progress or lack thereof, and the therapeutic relationship. Once trained, therapists can use this data, comparing it to the thousands of data points collected by Dr. Duncan and his colleagues, to have some of the difficult conversations that are critical to improving and sustaining effective therapeutic process.
To summarize in Barry Duncan’s words; “Although the over 300,000 administrations of the ORS/SRS has yielded invaluable information regarding the psychometrics of the measures, trajectories, algorithms, etc., PCOMS remains a clinical intervention embedded in the complex interpersonal process called psychotherapy [emphasis added]. For successful implementation and ongoing adherence, PCOMS must appeal to therapists in ways that the numbers or data or even the research never can.”
If you would like to know more about PCOMS or about MyOutcomes, the web-based application of PCOMS, please visit our website www.myoutcomes.com or contact us toll free on 1-877-763-4775
This article first appeared on the web on Houston Galveston Institute’s website. It was written by Sue Levin and she can be contacted by mail at email@example.com or by phone at 713 526-8390.