| Date post: | 07-Dec-2014 |
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https://heartandsoulofchange.com August, 2014
Partners for Change Outcome Management System
An Empirical, Client Driven Alterative to Diagnosis
Barry Duncan, Psy.D. heartandsoulofchange.com561.239.3640 [email protected]
https://heartandsoulofchange.com August, 2014
No Need to Remind This Group ofthe Pitfalls of Psychiatric DiagnosisNo Need to Remind This Group ofthe Pitfalls of Psychiatric Diagnosis
Not Reliable or ValidNot Related to
OutcomeDoes Not Help
Select Treatment Colonizes Diversity And Perhaps the
Worst…the Killer Ds
Not Reliable or ValidNot Related to
OutcomeDoes Not Help
Select Treatment Colonizes Diversity And Perhaps the
Worst…the Killer Ds
DysfunctionDisorderDisabilityDisease DeficitDamaged
The Killer D’s of
Client Diminishment
https://heartandsoulofchange.com August, 2014
But…Let’s Not Replace
But…Let’s Not Replace
One Expert Driven System with Another
Instead, Partner with Clients Using TheirAssessment of TheirLives and What TheyWant to Change in TheirPersonal Well Being, Relationships, and Social Functioning
One Expert Driven System with Another
Instead, Partner with Clients Using TheirAssessment of TheirLives and What TheyWant to Change in TheirPersonal Well Being, Relationships, and Social Functioning
Clients Are the Lions of ChangeAccount for Most of Variance
Until lions have their historians, tales of hunting will always glorify the hunter.
African Proverb
https://heartandsoulofchange.com August, 2014
•Client’s rating of the alliance the best predictor of engagement and outcome.
•Client’s subjective experience of change early in the process the best predictor of success for any particular pairing.
Empirical, Client Driven AlternativeBased on Predictors of Outcome
Baldwin, S., Berkeljon, A., Atkins, D., Olsen, J., & Nielsen, S. (2009). Rates of change in naturalistic psychotherapy: Contrasting dose-effect and good-enough level models of change. Journal of Consulting and Clinical Psychology, 77(2), 203-211.
N=4676; 77% attended 8 or less, and 91% 12 or less
Note that even for the clients who take longer, change starts early…just is flatter
https://heartandsoulofchange.com August, 2014
•Add the four scales together for the total score.
•Clients indicate where the problem lies and where benefit will be recognized
•Give at the beginning of the visit; Client places a mark on the line.
•Each line 10 cm (100 mm) in length.
•Reliable, valid, feasible
Becoming BetterMeasuring Outcome
Becoming BetterMeasuring Outcome
ClientsThe Heart of Change
ClientsThe Heart of Change
Client outcome feedback makes consumers the historians of their own change
Partnering w/clients to monitor outcome engages most the potent factor (the heart) of change
Client outcome feedback makes consumers the historians of their own change
Partnering w/clients to monitor outcome engages most the potent factor (the heart) of change
https://heartandsoulofchange.com August, 2014
•Client’s rating of the alliance the best predictor of engagement and outcome.
40 Years of Data say…
•Client’s subjective experience of change early in the process the best predictor of success for any particular pairing.
The Alliance: Over 1000 Research Findings
Quality of the alliance more potent predictor of outcome than orientation, experience, or professional discipline
Empathy, Positive Regard, and Authenticity each more powerful than any technique one could ever yield
Carl Rogers was on to something!
https://heartandsoulofchange.com August, 2014
The Session Rating Scale Measuring the AllianceThe Session Rating Scale Measuring the Alliance
•Give at the end of session;
•Centers Client Voice about the Alliance
•Reliable, valid, feasible
Translates Bordin’sClassic Definition of the Alliance
The Alliance The Soul of Change
The Alliance The Soul of Change
Alliance feedback enables a fit between client expectations, preferences, and services
Alliance deserves far more respect—applying over 1000 studies showing the relationship of the alliance to positive outcomes
https://heartandsoulofchange.com August, 2014
PCOMS: Operationalizes Client Privilege
PCOMS: Operationalizes Client Privilege Problems & paths for solution (dx
& tx selection) defined by the client in conversation w/therapist.
Identifies non-responding clients so that the lack of progress is addressed & new directions collaboratively sought
Meta-analysis: PCOMS group had 3.5 higher odds of experiencing reliable change (now 4 RCTs)
Problems & paths for solution (dx & tx selection) defined by the client in conversation w/therapist.
Identifies non-responding clients so that the lack of progress is addressed & new directions collaboratively sought
Meta-analysis: PCOMS group had 3.5 higher odds of experiencing reliable change (now 4 RCTs)
Lambert, M. J., & Shimokawa, K. (2011). Collecting client feedback. Psychotherapy, 48, 72-79.
Also Can Be Linked to ReimbursementWhen Things Are Changing
•See clients morefrequently when the slope of change is steep.•Begin to space the visits as the rate of change lessens.•See clients as long as there is meaningful change & they desire to continue.
https://heartandsoulofchange.com August, 2014
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Instead of pathologizing clients when changeisn’t happening, discuss alternatives,and ultimately, move on to different provider or service if no change persists
When Change Isn’t Happening
with a consumer-driven, culturally-responsive process that privileges and empowers the voices of diverse clientele. And finally,
PCOMS Provides a Way to Replace the Empirically And Morally Bankrupt DSM
Brings consumers into the inner circle, partnersin defining services & monitoring its benefit
