My Intuition Says That PCOMS EBP (Evidence-Based Practice) is The Best

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Why using PCOMS EBP is the best way forward in psychotherapy!

Most people are familiar with the thalidomide disaster of the early 1960s. Thalidomide, a drug developed in Germany and marketed as a treatment for morning sickness, had been distributed in numerous countries. It was scheduled to be released in the United States as soon as it received FDA approval, a near certainty. That is, until the responsibility for approving the drug was given to Frances Kelsey. Thalidomide had undergone what was considered to be sufficient research and testing protocols in those days and had passed with flying colors. Kelsey, who had spent her earlier career as a research scientist, noted elements of the data that reminded her of her own research and thereby raised red flags. She dragged her feet on the approval, insisting that more research was warranted. Her stance on looking at the evidence didn't earn her any popularity contests. After all, experience showed that the drug was perfectly fine. Then, the “thalidomide babies” began to appear in all of the countries where thalidomide had been approved for use. Kelsey is credited with averting a major disaster in the United States.

The thalidomide disaster resulted in the Kefauver Amendments to the Food, Drug and Cosmetic Act of 1938. By requiring more evidence, the amendments enabled the FDA to make changes to the research protocols that lead to drugs being approved for clinical use. The amendments also required drug manufacturers to provided evidence of drug efficacy.

The entire thalidomide story is a story of using evidence to make decisions. Not experience. Not gut feelings; But real, hard evidence. In so many aspects of our lives, we think nothing of expecting others to base their decisions on evidence.

When you take your car into the shop, do you want your mechanic making decisions on how to repair your automobile based upon his gut feelings? Or do you want your stock broker making decisions about your financial investments based upon her gut feelings? Most people want such decisions to be evidence-based.

For psychotherapy, this means using the best research findings to make therapeutic decisions. Using intuition to determine the progress a client is making defeats the purpose of having an evidence-based practice. Using objective forms of ongoing assessment allows the clinician to monitor client progress and make credible evaluations of the efficacy of the treatment protocol, as well determine whether changes are needed or if the therapeutic goals have been achieved. Put another way, the systematic measurement of outcomes makes any therapeutic intervention evidence-based.

There are currently two outcome measurement tools listed in SAMHSA's National Registry of Evidence-Based Programs and Practices.The Partners for Change Outcome Management System (PCOMS) and its web-based version MyOutcomes®are listed because a large body of research has demonstrated a doubling in the effectiveness of treatment while simultaneously reporting reduced dropout, deterioration rates and reduced service delivery costs. PCOMS Tran-theoretical approach has been successfully implemented in a wide variety of service settings, with diverse clinical populations, all over the world.


Introducing “Email PCOMS”

Email PCOMS client login

Email PCOMS – An innovative way to capture client feedback

Based upon the valuable suggestions and feedback from our clients, MyOutcomes introduced remote client access in its May 2014 release. For remote access to the ORS (such as when therapy is conducted via phone) the provider can now give their clients access to the ORS and SRS by clicking the Give Access link, which is found on the same row as the client's ID, under the Action column on the Provider's Home Page. By clicking on this link, the Provider instantly creates a user ID and password that they can then give the client. The client then has access to the ORS and SRS for up to 24 hours. Since January of 2015, clients have also have the option of downloading MyOutcomes Mobile (free) from iTunes or Google Play, and have been able to record their responses directly into their phone or tablet.

For Version 13 (due to be released this May 23, 2015) we have come up with even more innovative ways to capture client feedback. With “Email PCOMS”, we are introducing a way for you to send an email directly to your client with their password and login options. When they receive the email they can log in to from their computer, laptop or tablet (using Internet Explorer 8, 9, or 10, FireFox (latest version), Google Chrome (latest version), Safari (latest version), iPad or Android). The client simply clicks the link in the email, enters their user ID and temporary password and is taken to the first screen to register their responses.

For the provider, all that is required of them is to enter the client's email address, which can then be saved in the system for the next time, or it can be entered manually each time for security reasons.

With all of the client administration options now available, online administration of the ORS/CORS and SRS/CSRS for multiple clients in therapy has become feasible. As well, there is finally a way for the Group Session Rating Scale to be entered by everyone simultaneously for instant feedback and more responsive adjustments to group issues. For a demonstration of how easy it is to use the ORS and GSRS in group work watch this short video

For more information on MyOutcomes and to schedule a free demo, please click here


Is a video the best method to explain the benefits of Measuring Outcomes?

Video for therapists

Video will soon be 90% of Internet traffic. 1

Video is the most effective website initiative.2

Do you include video on your website?  Video is a very effective way to relay information about your practice and connect with visitors.  Many experts predict that video will continue to grow in popularity and sites that do not utilize this method to deliver content will be left behind.  Pointing out the benefits you offer as a therapist who utilizes MyOutcomes would be a great subject for a video.  If you are not comfortable in writing and recording your own Dr. Barry Duncan has created a video for clients explaining PCOMS and measuring outcomes.  This video is available on Heart and Soul of Change Blog for anyone to use. Continue reading…

Measuring Evidence Based Outcomes: What’s in it for Therapists? (Part 2)

Our last blog highlighted two reasons why therapists benefit when they get ahead of the evidence-based outcomes measurement curve. In an incisive and insightful article from 2011, Tony Rousmaniere, PsyD, suggested that measuring outcomes increases awareness, maximizes feedback, and helps make therapists better at what they do. He also noted that by embracing outcomes measurement, therapists end up having a stronger hand in designing the process, thus reducing the risk of having a flawed or faulty system foisted upon them.

Continue reading…

One Small Step for MyOutcomes, One Giant Leap for Therapists

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Detecting early change in therapy predicts success!

One question debated in evolutionary science is whether change occurs gradually over long periods of time or do dramatic events bring about dramatic changes in short periods of time? Resolving this question isn't simple as an incomplete geological record provides evidence for both. Given that these two explanations of change are not mutually exclusive, it may very well be that both are correct.

The scientific process typically finds answers by eliminating alternative explanations. A scientist finds support for their pet theory by searching through the “noise” to find a “signal” that other theories can't predict.

The geological record could be incomplete for two different reasons. One reason is that records have been destroyed by the destructive forces of nature. Alternatively, evolutionary scientists may not have yet been able to extract the relevant, historical signal from all of the other historical noise.

How this signal-to-noise ratio impacts the ability to detect “facts” is something that affects all sciences. Although he may not have known at the time, John Stuart Mills began addressing this problem with his Primary and Secondary Laws. Primary Laws are big, powerful laws that can be easily observed and directly measured. They can make big, powerful predictions because nothing impacts them. Until recently, physicists believed that they were studying a deterministic system which they could reduce down to laws that governed events that were the result of single, or primary, causes.

Secondary Laws, according to Mills, are the source of secondary causes. They are less easily detected, often mediating or modulating primary laws and each other. Their actions contribute to a system that is probabilistic rather than deterministic. Psychology is a science of Secondary Laws and secondary causes. This is the reason why from its scientific beginnings, researchers, such as Wundt and Helmholtz, had to develop strategies to amplify the signal and minimize the noise. This has been the challenge for psychologists ever since.

Detecting a signal in the complex mishmash of an individual's psychology is challenging. Detecting changes in that signal can be an even greater challenge. This is because changes in psychological events are not always big, powerful, Eureka moments. Although there are some events that appear to be the result of a singular, dramatic change occurring in a brief moment, other psychological states are more subtle and demonstrate small, gradual change over a period of time.

Undoubtedly, most therapists would love to be able to guide their clients into having one of those sudden epiphanies when the problem and its solution become crystal clear. Having their clients say, “Ah-ha. I get it!” would be hugely satisfying. Unfortunately, successful change can be far more subtle; typically being the result of a more gradual, time-dependent process. This can make change difficult to detect.

This difficulty in measuring change in a person's psychological experience can pose a major problem since change is critical to the therapeutic process. Early change, even if it is small and gradual, plays a major role in predicting successful outcomes. Put another way, if change doesn't occur, the client is at increased risk for dropping out before reaching their therapeutic goal.

A therapist's goal is to help their clients achieve their therapeutic goals. It stands to reason, then, that therapists will do everything they can to keep their clients from dropping out. Of course, how can they do this, if they aren't able to measure change? It is only by measuring change that one can become aware of the lack of change.

The trick is having an instrument that is capable of detecting a signal, in this case a psychological state that is changing, in the entire milieu of psychological noise. Not only does such an instrument need to be able to detect the psychological state, it needs to be sensitive enough to detect changes, no matter how small and gradual.

MyOutcomes provides that tool. The Outcome Rating Scale, or ORS, measures the client's psychological distress as well as changes in that distress. Measuring psychological distress makes sense. After all, it is the client's psychological distress that usually brings them into therapy to begin with. The logical conclusion then is that if psychological distress is reduced and/or eliminated, the client has recovered sufficiently to reclaim their life.

The power of MyOutcomes, the automated, web-based application of PCOMS, to help the therapist and the sensitivity of the ORS in measuring client change lies in its inherent simplicity. Other measurement tools attempt to measure virtually everything under the sun, sometimes to the point that they are reassessing the client every time they are administered. This can result in a poorer signal-to-noise ratio. MyOutcomes' ORS, on the other hand, is focused on measuring one thing: psychological distress. It is this simple, direct approach that allows the ORS to amplify the signal over the noise. It is also what enables the ORS to detect change, even if it is small and gradual. Being able to detect these small changes is why MyOutcomes is the ideal partner to help therapists take a giant leap in helping their clients.


Engage your website visitors immediately before they disappear! – Therapist Marketing Tip #3

webdesign, therapist marketingAfter describing how most visitors scan websites according to an “F” pattern, Therapist Marketing Tip #2 recommended taking advantage of this well-established behavior in the design and layout of your site.

Does your current homepage defy or fail to capitalize on the “F” pattern? Are you considering a redesign as a result?

If the answer is “yes,” proceed carefully. Don't do anything until you've obtained additional feedback on your online presence as it now stands. A website may not follow all the design “rules” yet still be highly effective. If — after careful review, including taking into account other people's feedback — you still want to look at site alterations, here are some important considerations you should keep in mind.

Continue reading…

Measuring Evidence Based Outcomes: What’s in it for Therapists? (Part 1)

The overwhelming consensus among industry leaders is that tracking, measuring, and reporting psychotherapy outcomes will be the norm, and even standardized, in the future. The health and wellness industry is all about results. Medical patients now routinely ask about the track records and success rates of those treating them and, over time, the clients of those seeking therapy will undoubtedly ask the the same of their prospective therapists too.

Continue reading…

Why you need an ‘F' to have an A+ website – Therapist Marketing Tip #2

Website F patternAccording to the latest research, more than 70 percent of people will go online to check out a prospective health-care practitioner before booking an appointment. What will these potential clients discover when they get to your site? Is it easy to navigate and helpful or is it difficult to navigate and uninformative?

How people interact with sites has been the subject of extensive study. This, in turn, has given rise to a set of established practices for optimizing online content and layout.

Upon initial viewing, most people will scan the page with a pattern of eye movements that somewhat resemble an ‘F.' This ‘F' is made up of the following three components:

Continue reading…

The Economic Value of Monitoring Patient Treatment Response

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How can monitoring patient treatment response lead to effectiveness in therapy?

Mental healthcare costs are soaring day by day and year after year. In any given year, one in five people in Canada experiences a mental health problem or illness, with a cost to the economy well in excess of $50 billion.

Studies have found that improved access to peer support, housing, and community-based services can improve quality of life and help to keep people who are living with mental health problems and illnesses out of hospitals and out of the criminal justice system. They have also found that preventing conduct disorders in one child through early intervention can result in a lifetime savings of $280,000.

But what are the three main problems of therapy providers that are stopping them from adopting feedback informed treatment and achieving therapy effectiveness?

Michael J. Lambert, Ph.D., Brigham Young University, highlighted the problems in his research paper titled “The Economic Value of Monitoring Patient Treatment Response”, as below.

  • Over optimism: therapists believe that 85% of patients they treat will recover.Walfish et al. found that 90% of therapists believed they were above the 75 percentile when compared to other therapists. It is this over optimism that results at times in therapists not noticing or acknowledging the patients who are deteriorating. Hatfield (2010) examined case notes of patients who deteriorated to see if therapists noted worsening and found that only 21% of therapists recognized when their patients got 14 points worse than before. This figure rose to a meager 32% when their patients got 30 points worse than before.
  • Patient treatment response is not a determinant of the treatment length, but it is determined by theory.
    Even though research shows that formally monitoring patient treatment response and providing feedback to patients and therapists makes therapy more cost effective by shortening the course of treatment for the majority of clients, it is still determined by theory
  • Inefficiency in failing to end successful treatment and in allowing treatments that have not worked well to end. Research shows that a substantial number of patients (around 25%) remain in treatment even though they are not responding. Mental health disorders have severe negative effects on the patient, their family, as well as society. It causes considerable amounts of human suffering and has a highly negative economic impact.

So what needs to be done to reduce the burden of this burgeoning cost and achieve more efficiency and effectiveness in therapy?

Lessons learned from North America show that team-based approaches and other evidence-based practices, when implemented with high fidelity, can improve outcomes in routine mental health care settings.

Mental health functioning can be briefly measured and monitored on a weekly basis, with this information instantaneously fed back to practitioners and managers.

MyOutcomes is a web-based application of PCOMS that enables instant feedback from clients. MyOutcomes provides the ORS, or Outcome Rating Scale, that can easily and quickly bring the client's voice into each therapeutic session. This allows the client to share their perception of their own functioning on a personal level, their interpersonal relationships with friends and family, and their general social interactions. With the regular use of this tool, psychotherapists can be on top of recovery. With the power of this information, therapists can make sure that therapy can end just in time and bring in more efficiency.

To learn more about MyOutcomes, please call us toll-free at 1-877-763-4775.