Archive for August, 2010

Ohio Update: Use of CDOI improves outcome, retention, and decreases “board-level” complaints

Saturday, August 21st, 2010

A few days ago, I received an email from Shirley Galdys, the Associate Director of the Crawford-Marion Alcohol and Drug/Mental Health Services Board in Marion, Ohio.  Back in January, I blogged about the steps the group had taken to deal with the cutbacks, shortfalls, and all around tough economic circumstances facing agencies in Ohio.  At that time, I noted that the dedicated adminsitrators and clinicians had improved the effectiveness and efficiency of treatment so much by their systematic use of CDOI that they were able to absorb cuts in funding and loss of staff without having to cut services to their consumers. 

Anyway, Shirley was writing because she wanted to share some additional good news.  She’d just seen an advance copy of the group’s annual report.  “Since we began using CDOI over two years ago,” she wrote, ”board level compaints and grievances have decreased!” 

In the past, the majority of such complaints have centered on client rights.  ”Because of CDOI,” she continued, “we are making more of an effort to explain to people what we can and cannot do for them as part of the ‘culture of feedback’….we took a lot for granted about what people understaood about behavioral health care prior to CDOI.”

The Crawford-Marion Alcohol and Drug/Mental Health Services Board is now into the second full year of implementation.  They are not merely surviving, they are thriving!  In this video, directors Shirley Galdys, Bob Moneysmith, and Elaine Ring talk about the steps for a successful implementation.

How to avoid psycho-therapy

Saturday, August 21st, 2010

“Hope Transcends” was the theme of the 39th Annual Summer Institute on Substance Abuse and Mental Health held in Newark, Delaware this last week.  I had the honor of working with 60+ clinicians, agency managers, peer supports, and consumers of mental health services presenting a two-day, intensive training on “feedback-informed clinical work.”  I met so many talented and dedicated people over the two days and even had a chance to reconnect with a number of folks I’d met at previous trainings– both at the Institute and elsewhere.

One person I knew but never had the privlege of meeting before was psychologist Ronald Bassman.  A few years back, he’d written a chapter that was included in my book, The Heroic ClientHis topic at the Summer Institute was similar to what he’d written for the book: harmful treatment.  Research dating back decades documents that approximately 10% of people detriorate while in psychotherapy.  The same body of evidence shows that clinicians are not adept at identifying: (a) people who are likely to drop out of care; or (b) people who are deteriorating while in care.

Anyway, you can read about Ron on his website or pick up his gripping book A Fight to BeBriefly, at age 22 Ron was committed to a psychiatric hospital.  Over the next several years, he was diagnosed with paranoid schizophrenia and forcefully subjected to a series of humiliating, painful, degrading and ultimately unhelpful “treatments.”  Eventually, he escaped his own and the systems’ madness and became a passionate advocate for improving mental health services.  His message is simple: “we can and must do better.”  And, he argues persuasively, the process begins with building better partnerships with consumers.

One way to build bridges with consumers is routinely seeking their feedback regarding the status of the therapeutic relationship and progress of any services offered.  Indeed, the definition of “evidence-based practice” formally adopted by the American Psychological Association mandates that the clinician ”monitor…progress…[and] If progress is not proceeding adequately…alters or addresses problematic aspects of the treatment (e.g., problems in the therapeutic relationship or the implementation of the goals of treatment)” (pp. 276-277, APA, 2006).  Research reviewed in detail on this blog documents significant improvement in both retention and outcome when clinicians use the Outcome and Session Rating Scales to solicit feedback from consumers.  Hope really does transcend.  Thank you Ron and thank you clinicians and organizers at the Institute.

And now, just for fun.  Check out these two new videos:

Magic trick: Do as I do

Magic Trick: Random Numbers

Error-centric Practice: How Getting it Wrong can Help you Get it Right

Saturday, August 21st, 2010

It’s an idea that makes intuitive sense but is simultanesouly unappealing to most people. I, for one, don’t like it.  What’s more, it flies in the face of the “self-esteem” orientation that has dominated much of educational theory and practice over the last several decades.  And yet, research summarized in a recent issue of Scientific American Mind is clear: people learn the most when conditions are arranged so that they have to make mistakes.   Testing prior to learning, for example, improves recall of information learned after failing the pre-test regarding that same information.  As is well known, frequent testing following learning and/or skill acquisition significantly enhances retention of knowledge and abilities.  In short, getting it wrong can help you get it right more often in the future. 
So, despite the short term risk to my self-esteem, “error-centric learning” is an evidence-based practice that I’m taking to heart.  I’m not only applying the approach in the trainings I offer to mental health professionals–beginning all of my workshop with a fun, fact-filled quiz–but in my attempts to master two completely new skills in my personal life: magic and learning to play the ukelele.  And if the number of mistakes I routinely make in these pursuits is a reliable predictor of future success, well…I should be a master ukelele-playing magician in little more than a few days.

Enough for now–back to practicing.  Tonight, in my hotel room in Buffalo, New York, I’m working on a couple of new card tricks.  Take a look at the videos of two new effects I recorded over the weekend.  Also, don’t miss the interview with Cindy Voelker and John Catalino on the implementation of CDOI at Spectrum Human Services here in Buffalo.

Trick 1

Trick 2