Training and Coaching

Client Directed - Outcome Informed Methods

Becoming Client-Directed, Outcome-Informed in Your Organization

Our Director, Michael D. Clark, MSW has been named an “associate” for the Center for the Study of Therapeutic Change (ISTC).

Michael has joined this Chicago-based group as he is actively involved in bringing these client-directed, outcome-informed strategies to the work with court-mandated (involuntary) clients. For more information, see http://www.talkingcure.com/index.asp?id=47

This Center advocates strategies that can increase your organization’s effectiveness by 65% with no additional training in treatment approaches or service interventions. This claim is made asclient directed, outcome informed methods harness the power of client engagement in the behavior change process.

♦ The “Good News” is that the majority of helpers are effective and efficient most of the time. Average treated clients accounts for only 7% of expenditures*

♦ The “Bad News” is that drop-out rates average 47%. Helping staff frequently fail to identify failing cases. 1 out of 10 clients account for 60-70% of expenditures*

(In mandated work, clients are offenders or those court-ordered toparticipate in services. This population does not have the option ofdropping out of services—at least not without a some sort of sanction.Instead of dropping out, what this population ends up doing is turning into“sleepers” or those who just take up a space, not caring about change andjust “going through the motions.”)

♦ The “Good News” is that treatment is effective! Indeed, available research provides strong evidence for the overall effectiveness of therapy. Most studies, for example, find the average treated person is better off than 80 percent of those without the benefit of therapy (Asay & Lambert, 1999; Wampold, 2001)*

The “Bad News” is that many in our field have come to belief in a false assumption:They believe that change comes from our treatment models and intervention approaches.Not true. The greatest share of change does not come from our treatment models.*

*ISTC


Todetermine if this training initiative has merit for your organization, consider these critical points forwarded by the ISTC and information detailed in their recent publication, [Duncan, B. & Miller, S., Sparks, J., (2004). The Heroic Client: A Revolutionary Way to Improve Effectiveness Through Client-Directed, Outcome-Informed Therapy. San Francisco: Jossey-Bass]

POINT 1:

The real engine to change is the client.

At the center of a rising debate is: What (or who) is responsible for this effectiveness (for positive behavior change)? Most current theories would have you believe it’s the treatment models we use. Client-directed, outcome informed research believes we’ve missed it—the real engine to change is the client!

Data from forty years (40) of outcome research provide strong empirical support for privileging the client's role in the change process (Hubble et al., 1999b). In short, clients, not agency or court staff, make our helping services work. As a result, services should be organized around their resources, perceptions, experiences, and ideas. Staff should be taking direction from clients: following their lead; adopting their language, worldview, goals, and ideas about the problem; and acknowledging their experiences with, and inclinations about, the change process.

The CSBS has integrated these important objectives inwork with mandated clients. A complicated scenario given that some behaviors cannot be negotiated (i.e., further criminal behavior, lack of compliance to court orders, etc.) and many enterour departments with great resistance ("get off my back!") or passive indifference ("who cares?").Contact our Center to gain more information of how this landmark researchhas beenapplied tomandated populations who are expected to comply with court-ordered conditions.

POINT 2:

We don’t know or we can seldom prove what we do is working

Organization staff must also be capable of proving that their work is effective and efficient. Traditionally, the effectiveness of agency services (symptom reduction or cure) has been left up to the judgment of the provider of the service. This training session will proposesomething very different: proof of effectiveness can emerge from the systematic recruitment of the client's perception and experience of outcome as a routine part of their taking part in serivces—enlisting the client as a full partner in both thebehavior changeand accountability process.

POINT 3:

Being competent at our work is not the same as being effective.

Medical doctors in the 1600’s bled sick clients and were thought to be competent in this medical intervention! However, they did not have any way to gain effectiveness feedback. Here is one example of the confusion surrounding the two terms of “competence” and “effectiveness” in the helping professions.

Consider the continuing education workshops staff must attend to maintain their professional licenses. In theory, the continuing education requirement is designed to ensure that clinicians stay abreast of developments that enhance treatment outcome. In practice, however, the vast majority of approaches taught at these workshops do not include any systematic method for evaluating the effectiveness of the approach. Rather, workshop leaders place sole emphasis on the attendees becoming proficient at using the skills or techniques of a particular brand or style of treatment. In the world of training and continuing education, "competency is king."

This emphasis on competence versus outcome is significant. Itdecreases effectiveness and efficiency, and it limits the growth of individual staff members. This workshop focuses on outcome measures thatyour staffing group can implementto prove to the generalpublic (or any stakeholders/payers) that progress is occuring.

POINT 4:

With all the scientific advances we have experienced over the last 50 years, treatment and therapeutic services have not improved at the same rates.

This training will review the irony thatthe effectiveness of psychotherapy (as well as services in child welfare, juvenile justice and community corrections-probation and parole services) havenot improved one scintilla, not one percentage point, despite this exponential growth of new treatment technologies and the purported advantages of the so-called scientifically validated approaches. In truth, treatment services areno more effective now then they were inthe 1960s.

This workshop will demonstrate how to improve services and increase an individual staff member's effectiveness as detailed bynew meta-analytic research.

POINT 5:

Extensive research points to common factors (not specific models of treatment) that lie at the heart of what’s helpful

Recall that forty years of outcome data show that clients and their strengths, resources, relational supports—all that is available to them inside and outside of therapy—account for 40 percent or 87 percent (depending on the analysis used) of change (Asay & Lambert, 1999; Wampold, 2001).

The data point to the inevitable conclusion: the engine of change is the client (Tallman & Bohart,1999).The implication is that our time might be more wisely spent gaining experience on ways to employ the client in the process of change. Join this workshop to find out how this can occur--without additional training in new models,treatment appraoches or mandated service delivery.

You can access more information on the “common factors research that spans 40 years of outcome data from a short web-based article: (May, 15, 2001) Clark, Michael. "Common Factors Research" Internet article – Addiction Exchange. Mid-Atlantic Addiction Technology Transfer Center, Richmond, Virginia (USA) - Vol.3(8) Click here to download the full article

POINT 6:

We need to know sooner rather than later wethera pairing between staff/counselor and thier client is making progress—yet most organizations have no reliable and consistent measure of the staff/client relationship or “real-time” measures of productivity.

More recently, researchers have found that early improvement—specifically, the client's subjective experience of meaningful change in the first few visits—is a robust predictor of whether a given pairing of client and staff person will result in a successful outcome (Haas et al., 2002; Lambert et al., 2001).

Similarly, in a study of more than two thousand therapists and thousands of clients, researchers Brown et al. (1999) found that therapeutic relationships in which no improvement occurred by the third visit did not on average result in improvement over the entire course of treatment. This study further showed that clients who worsened by the third visit were twice as likely to drop out than those reporting progress.

The conclusion to be drawn from the foregoing research is clear: Feedback from clients is essential and even improves success.

This training workshop will present the “how to’s” for gaining this feeback and makes the argument for practice-based evidence—that is, evidence that comes from “on-the-spot” feedback of staff/client sessions. This allows staff to make adjustments in real-time should the pairing not be productive. Learn about the new axiom:

“Don’t wait until it’s too late – find out now if you need to change the how.”

Such a process of becoming outcome informed, we believe, fits with how most staff prefer to think of themselves: sensitive to client feedback and interested in results. Becoming outcome-informed not only amplifies the client’s voice but also offers the most viable, research-tested method to improve clinical effectiveness.

**Contact the Center for Strength-based Strategies (CSBS) for more information on this training initiative. The CSBS takes a special focus on those staffing groups working with court-mandated clients.