Improving reten-on and outcomes: The Partners of Change Outcome Management System NAADAC webinar: June 18, 2015; 3pm– 4:30pm George S. Braucht, LPC Email: [email protected] Improving Retention and Outcomes: The
Partners for Change Outcome Management
System (PCOMS)
Misti Storie, MS, NCC
Director of Training
Presented by George S. Braucht, LPC
NAADAC, the Association for Addiction Professionals
www.naadac.org
[email protected]
June 18, 2015
www.naadac.org/webinars
Produced By
NAADAC, the Association for Addiction Professionals
www.naadac.org/webinars
www.naadac.org/partnersforchange
Cost to Watch:
Free
CE Hours
Available:
1.5 CEs
CE Certificate for
NAADAC
Members:
Free
CE Certificate for
Non-members:
$20
CE Certificate
To obtain a CE Certificate for the time you spent
watching this webinar:
1.  Watch this entire webinar.
2.  Pass the online CE quiz, which is posted at
www.naadac.org/partnersforchange
3.  If applicable, submit payment for CE certificate
or join NAADAC.
4.  A CE certificate will be emailed to you within 21
days of submitting the quiz.
1 Improving reten-on and outcomes: The Partners of Change Outcome Management System NAADAC webinar: June 18, 2015; 3pm– 4:30pm George S. Braucht, LPC Email: [email protected] Webinar Learning Objectives
Using GoToWebinar – (Live Participants Only)
§  Control Panel
1
2
3
§  Asking Questions
Explain the researchbased factors
responsible for peer/
client change that cut
across professional
disciplines and
preferred treatment
models
§  Audio (phone preferred)
§  Polling Questions
Assess the peer/client’s
vital perceptions of recovery
progress and satisfaction so
that services can be
empirically tailored to the
individual’s characteristics,
circumstances, and
resources
Use the simple yet feasible,
valid, and reliable Partners
for Change Outcome
Management System
(PCOMS) tools to gather
practice-based evidence of
service process and
outcome effectiveness
Webinar Presenter
George S. Braucht, LPC
Brauchtworks Consulting
The Governor’s Office of Transition,
Support & Reentry
Website: www.brauchtworks.com
Email: [email protected]
Dr. Barry
Duncan
www.
heartandsoul
ofchange.com
Adult, children and
young children versions
2 Improving reten-on and outcomes: The Partners of Change Outcome Management System NAADAC webinar: June 18, 2015; 3pm– 4:30pm George S. Braucht, LPC Email: [email protected] Partners for Change Outcome
Management System (PCOMS)
Peer/client-directed
Recovery-oriented
Outcome-informed
Goal: Collect practice-based evidence of
Goal: using an evidence-based practice
effectiveness using evidence-based practices
Meta-Analytic Research
Treatment factors:
o  7% due to alliance factors (or
54% of effects due to treatment)
o  1% due to model and technique (or 8%
of effects due to treatment)
Audience Polling Question #1
13%
Which factor accounts for most of the changes that occur during
counseling or therapy?
87%
Extra-therapeutic or client
factors
Wampold, B. (2001). The Great Psychotherapy Debate. New York: Lawrence Erlbaum.
The Wheel of Change:
Factors That Account for Successful Outcome
Client/Extra-therapeutic
40.0%
Relationship
30.0%
Models/Techniques
15.0%
Placebo/Hope/Expectancy
15.0%
Lambert Challenged the Sanctity of the Model
Ø  Lambert bravely differentiated the
elements of successful
psychotherapy according each
factor’s contribution to outcome
Ø  Opened a new vista for
understanding models and
their relative importance to
success
Lambert, M. (1986). Implications of Psychotherapy Outcome Research for Eclectic Psychotherapy.
In J. Norcross (Ed.) Handbook of Eclectic Psychotherapy. New York: Brunner/Mazel.
3 Improving reten-on and outcomes: The Partners of Change Outcome Management System NAADAC webinar: June 18, 2015; 3pm– 4:30pm George S. Braucht, LPC Email: [email protected] Empathy, Genuineness & Positive Regard:
Rogers, C. (1957). The necessary and sufficient conditions for
therapeutic personality change
Lambert (2013):
þ  Empathy: Meta-analysis (MA) of 57 studies
found r of .31
Audience Polling Question #2
þ  Positive Regard: MA of 18 studies found r of .27
Empathy, genuineness and positive regard are the necessary and
sufficient conditions for change.
þ  Genuineness: MA of 16 studies found r of .24
F  Each is more powerful than any model/technique:
Model differences a d of .20
Lambert, M. (2013). Efficacy and effectiveness in psychotherapy. In Bergin &
Garfield’s Handbook of psychotherapy and behavior change.
Over 1000 Studies of the Helping Alliance
Goals,
Meaning
or
Purpose
Client/Peer’s
Theory of Change
Means,
Tasks or
Methods
Relationship enhancement skills
and peer/client feedback are
essential contributors
to your outcomes!
View of the Helping Relationship
PCOMS Performance Support:
Promoting currently experienced
and cumulative career growth
Audience Polling Question #3
I just want to
help people.
I know what percentage of my peers/clients transition or discharge
successfully.
4 Improving reten-on and outcomes: The Partners of Change Outcome Management System NAADAC webinar: June 18, 2015; 3pm– 4:30pm George S. Braucht, LPC Email: [email protected] Dr. Michael Lambert
Brigham Young University
youtube.com/watch?v=-5laIowDL-o
On average:
40-61% don’t change,
3-14% deteriorate,
20-30% improve &
9-20% achieve recovery
Audience Polling Question #4
I know which peers/clients are likely to succeed.
Few counselors/therapists can accurately
predict who!
How to Improve Outcome:
Integrate Formal Peer/Client Feedback
Beginning of session
End of session
Outcome
Rating Scale
Session
Rating Scale
Audience Polling Question #5
Who’s view of the therapeutic alliance is most correlated with
outcome?
How to Improve Outcome: The ORS
Give when
schedule first
visit and at the
beginning of
each visit
Peer/client
places a hash
mark on the line
Each line 10 cm
(100 mm)
Score to the
nearest whole
number (cm)
Add the four
scales together
for the total
score
Clinical cutoff =
25 (28, 32)
Introducing the Outcome Rating Scale
https://heartandsoulofchange.com/content/resources/viewer.php?resource=video&id=113
Two main points: The ORS is used
across interactions to…
1.  Ensure that the peer/client's voice is
not only heard but remains central
2.  Collaboratively track outcome
5 Improving reten-on and outcomes: The Partners of Change Outcome Management System Video: PCOMS in Action
NAADAC webinar: June 18, 2015; 3pm– 4:30pm George S. Braucht, LPC Email: [email protected] PCOMS Performance Support:
Three key progress indicators
1. Valid initial Outcome Rating Scale (ORS); Duncan, 2014
!  35+: Invalid initial score – why come to see you?
Ø  ORS average, 500,000+ administrations: 18-20
Ü  Goal: Less than 1/3rd over the Clinical Cutoff (25, 28, 32)
2. Reliable change index (RCI*)
6+ point ORS increase from the initial score
3. Clinically significant change index (CSCI*)
6+ and cross the Clinical Cutoff
*Jacobson & Truax, (1991) & Jacobson et al, (1999)
Reviewing Graphs: First things
first
Johnny R. Good
9
15 14 19
20
14
23
26
µ  Clinical Cutoff
µ  Reliable change = 6+ points
µ  Clinically significant change = 6+ and cross the clinical cutoff
8 point
change!
Provider Variation:
Feedback Improves Effectiveness
Counselor's Outcomes
Mean Effect Size for all Cases
2
(n
=9
(n 4)
=
3 74
(n )
=
4 67)
(n
=
5 65
(n )
=
6 59
(n )
=
7 58
(n )
=
8 55
(n )
=
9 50)
(n
10 =4
(n 8)
11 =4
(n 8)
12 =4
(n 7)
13 =4
(n 7)
14 =4
(n 1)
15 =41
(n )
16 =4
(n 0)
17 =3
(n 9)
18 =3
(n 7)
19 =3
(n 5)
20 =34
(n )
21 =3
(n 1)
22 =3
(n 1)
=3
0)
1.8
1.6
1.4
1.2
1
0.8
0.6
0.4
0.2
0
1
Effect size
(n=30 or more cases)
Counselor
Clinical Nuances: ORS & SRS are not
perfunctory pieces of paper
1.  Administers ORS but Peer/Client/Therapist/
Recovery
Supporter Doesn’t Understand the Two Purposes.
Monitoring outcome, privileging the peer/client’s
perspective); Helpers must understand & convey
the purposes otherwise, no data integrity
Miller, Duncan, Sorrell, & Brown. (2005). The Partners for Change Outcome
Management System. Journal of Clinical Psychology, 61(12), 199-208.
6 Improving reten-on and outcomes: The Partners of Change Outcome Management System NAADAC webinar: June 18, 2015; 3pm– 4:30pm George S. Braucht, LPC Email: [email protected] Clinical Nuances: ORS & SRS are not
perfunctory (cont.)
2. Administers ORS, Using Some
Aspects.
a.  Not explaining the clinical
cutoff or graphing numbers…
no continuity; limits data
integrity
b. Not connecting marks to the
peer/client’s experience or
reasons for service; no data
integrity
Connecting Outcome Rating Scale marks to the
service reasons/lived experience:
https://heartandsoulofchange.com/content/resources/viewer.php?resource=video&id=115
Clinical Nuances: ORS & SRS are not
perfunctory (cont.)
3. Administers the SRS, but sees it as reflecting the
helper’s competence rather than as an alliance
building tool; no value added
Audience Polling Question #6
I experience immediate growth and cumulative career development
during or after most peer/client interactions.
PCOMS Performance Support: Four steps to
currently experienced and cumulative growth
1.  Start by looking at all graphs or lists of client
ORS scores. Job One: ensure valid use of the
measures & data integrity
2.  Spend the most time on at-risk clients: shape
discussion and brainstorms options; look for
over-utilization
PCOMS Performance Support: Four steps to
currently experienced and cumulative
growth (cont.)
3.  Review stats & discuss ways to improve;
Encourage reflection and action
4.  Mentor via skill building, client teachings, &
ongoing reflection
7 Improving reten-on and outcomes: The Partners of Change Outcome Management System Partners for Change Outcome
Management System (PCOMS)
Webinar Learning Objectives
1
Explain the researchbased factors
responsible for peer/
client change that cut
across professional
disciplines and
preferred treatment
models
2
Assess the peer/client’s
vital perceptions of recovery
progress and satisfaction so
that services can be
empirically tailored to the
individual’s characteristics,
circumstances, and
resources
NAADAC webinar: June 18, 2015; 3pm– 4:30pm George S. Braucht, LPC Email: [email protected] 3
Use the simple yet feasible,
valid, and reliable Partners
for Change Outcome
Management System
(PCOMS) tools to gather
practice-based evidence of
service process and
outcome effectiveness
Peer/client-directed
Recovery-oriented
Outcome-informed
Goal: Collect practice-based evidence of
Goal: using an evidence-based practice
effectiveness using evidence-based practices
Resources
George S. Braucht, LPC
Brauchtworks Consulting
The Governor’s Office of Transition,
Support & Reentry
Website: www.brauchtworks.com
Email: [email protected]
THANK YOU for YOUR
ATTENTION and PARTICIPATION
www.naadac.org/partnersforchange
Cost to Watch:
Free
CE Hours
Available:
1.5 CEs
CE Certificate for
NAADAC
Members:
Free
CE Certificate for
Non-members:
$20
CE Certificate
To obtain a CE Certificate for the time you spent
watching this webinar:
1.  Watch this entire webinar.
2.  Pass the online CE quiz, which is posted at
www.naadac.org/partnersforchange
3.  If applicable, submit payment for CE certificate
or join NAADAC.
4.  A CE certificate will be emailed to you within 21
days of submitting the quiz.
8 Improving reten-on and outcomes: The Partners of Change Outcome Management System Upcoming Webinars
NAADAC webinar: June 18, 2015; 3pm– 4:30pm George S. Braucht, LPC Email: [email protected] www.naadac.org/webinars
August 26, 2015
July 30, 2015
3-4pm ET (2 CT/1 MT/12 PT)
Counseling Adolescent and Minority
Clients with Substance Use Disorders
3-4pm ET (2 CT/1 MT/12 PT)
Developing Cultural Humility
September 23, 2015
November 4, 2015
3-4:30pm ET (2 CT/1 MT/12 PT)
3-4pm ET (2 CT/1 MT/12 PT)
Counseling Clients with Co-Occurring
Disorders
ACA and Addiction Treatment and
Recovery: What Every Addiction
Professional Needs to Know
Free CEs for
Members
Levels:
Professional
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