Improving Retention, Outcomes

and Supervision with PCOMS

Presented by George S. Braucht, LPC & CPCS

March 8, 2017

Thomas Durham, PhD

Director of Training

NAADAC, the Association for Addiction Professionals

www.naadac.org

tdurham@naadac.org

Produced By

NAADAC, the Association for Addiction Professionalswww.naadac.org/webinars

www.naadac.org/webinars

www.naadac.org/PCOMS-retention-

outcomes-supervision-webinar

Cost to Watch:

Free

CE Hours

Available:

2 CEs

CE Certificate for

NAADAC

Members:

Free

CE Certificate for

Non-members:

$25

To obtain a CE Certificate for the time you spent watching this

webinar:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at

www.naadac.org/PCOMS-retention-outcomes-

supervision-webinar

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.

CE Certificate

Using GoToWebinar – (Live Participants Only)

Control Panel

Asking Questions

Audio (phone preferred)

Polling Questions

George S. Braucht, LPC & CPCS

Email: george@brauchtworks.com

Website: brauchtworks.com

Webinar Presenter

Brauchtworks ConsultingApplying Science to Practice

Webinar Learning Objectives. Upon completion of this

session participants will be able to:

Explain four research-

based factors

responsible for client

change that cut across

professional disciplines

and preferred treatment

models.

Assess the 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 tools to

gather practice-based

evidence of service process

and outcome effectiveness.

1 32

Promoting currently experienced and cumulative career growth

I just want to help people.

Experimental-physiological psychology

Community psychology

Licensed Professional Counselor

Certified Professional Counselor Supervisor

Certified PCOMS Trainer with the Heart and

Soul of Change Project: Dr. Barry Duncan

Key References

Poll Question #1: My primary role is:

• Treatment service provider (counselor,

social worker, therapist, etc.)

• Prevention service provider

• Clinical supervisor

• Administrator

• Other

• Apparently I am in the wrong webinar

It’s never too late to be

who you might have been.

George Eliot, Middlemarch

(Mary Ann Evans, 1819-1880)

Incorporates the most robust predictors of therapeutic success into an outcome management system that partners with clients while honoring the daily pressures of front-line service providers

Compared to TAU…

Larger treatment

gains via ORS

More clients reached

reliable change

and clinically

significant change

Attended more

sessions

Compared to TAU…

More pre-post

treatment gains

More clients NOT

were retained

Achieved higher

satisfaction ratings

from therapists &

commanders

Five Randomized Controlled Trials (so far!)

Poll Question #2: Empathy, genuineness

and positive regard are the necessary

and sufficient conditions for change.

• True

• False

• Not sure

Lambert (2013) meta-analysis

Empathy: 57 studies found r of .31

Positive Regard: 18 studies found r of .27

Genuineness: 16 studies found r of .24

Each is more powerful than any technique that

you can ever wield as model differences = d of .20

Empathy, Genuineness & Positive RegardRogers, C. (1957). The necessary and sufficient conditions of

therapeutic personality change. The Journal of Consulting

Psychology, 25, 95-103.

Lambert, M. (2013). Outcomes in psychotherapy: The past and important advances.

Psychotherapy, 50 (1), 42-51.

1. Practice Intentionally Not Knowing

2. Open-ended questions

3. Affirmations/validations

4. Reflections/paraphrases

5. Summaries

6. Information-giving

Relationship Enhancement Skills

to Solicit and Provide Feedback (PINK OARSI)

See Relationship

Enhancement

Skills Overview:

PINK OARSI

at

brauchtworks.com/

Toolkit

Means or

Methods

Goals,

Meaning

or

Purpose

Over 1000 Studies of Relationship

Quality or the Therapeutic AllianceClient/Peer’s

Theory of Change

Client/Peer’s View of the Relationship

Poll Question #3: What percentage of your

clients do not change or deteriorate?

• 10%

• 20%

• 30%

• 40+%

• I don’t know

youtube.com/watch?v=-

5laIowDL-o

Dr. Michael Lambert

Brigham Young University

Look and listen for:

1. What percentage of clients:

A. Don’t change

B. Deteriorate

C. Improve

D. Achieve recovery

2. What to do about treatment

failures?

A.

B.

C.

1. Empathy

2. Positive regard

3. Genuineness

4. Feedback

Four Research-based Factors Responsible

for Change Across Disciplines and Models

Total: (0-40)

(0-10)

(0-10)

(0-10)

(0-10)

ORS

Begin interactions

Jot notes/pics in margins

If hand scoring, use the

nearest whole number

Discuss total & subscale

scores to connect last

week’s experiences to

marks on each line &

revise marks to match

described experience

O

O OO

23

2-1

28

O

Johnny B. Good

20 29 31 30 32 31 29 30 31

An eight point increase, from

the client’s point of view!

2-8 2-15 2-22 3-14 3-21

O

3-28

O

4-6

O

4-13

O O

4-20

O

4-27

O

31

Reliable change = 6+ points

Clinically significant change/recovered =

6+ points and exceeded the clinical cutoff!

5-5

18

I

5~10 minutes before session ends

35 or less = ask with gratitude, what would

make the next session better or more useful?

Relationship Rating Scale is the version for

peer recovery support service providers

Recovery Action & Progress

(RAP) Group Handout

Facilitator’s main job: Model

PINK OARSI

60 minutes: 10 or less participants

Have blank ORSs (& GSRSs)

available before group start time

Client folders for ORSs,

GSRSs, SCORE Board,

name tag/tent, Recovery

Capital Scale & Plan, etc.

Buy a new whip because the government says it is an evidence-based practice and they will give us $$$$.

Declare that, “This is the way we have always ridden dead horses” or “This is how I learned to ride dead horses and I’ve gone far so just do as I say” perhaps to “protect your check.”

Appoint a committee to study dead horses and write a white paper on “green” ways to make them faster.

Arrange visits to far off lands to see how they ride dead horses. Attend training sessions on improving dead horse riding abilities. Harness several dead horses together for increased speed. Mindfully declare that, “No horse is too dead to beat.” Provide additional funding to buy GMO-enhanced hay. Write an organizational strategic plan on, “the horse is better, faster,

and cheaper dead.” Promote the dead horse to a supervisory position.

Cherokee Tribal Wisdom says upon discovering that you

are riding a dead horse, the best strategy is to DISMOUNT and find

a new horse. Today however, we often try other strategies.

Polling Question #4: I experience

immediate growth and cumulative

career development during or after

most supervision interactions.

• True

• False

• I don’t know or rather not say

Provider Variation: Feedback Improves Effectiveness!

Counselor's Outcomes(n=30 or more cases)

0

0.20.4

0.60.8

11.2

1.41.6

1.8

1 (n

=94)

2 (n

=74)

3 (n

=67)

4 (n

=65)

5 (n

=59)

6 (n

=58)

7 (n

=55)

8 (n

=50)

9 (n

=48)

10 (n

=48)

11 (n

=47)

12 (n

=47)

13 (n

=41)

14 (n

=41)

15 (n

=40)

16 (n

=39)

17 (n

=37)

18 (n

=35)

19 (n

=34)

20 (n

=31)

21 (n

=31)

22 (n

=30)

Counselor

Eff

ec

t s

ize

Mean Effect Size for all Cases

Miller, Duncan, Sorrell,& Brown. (2005). The partners for change outcome management system. Journal of Clinical Psychology,

61(12), 199-208.

1. Valid initial Outcome Rating Scale (ORS); Duncan, 2014

35+: Invalid initial score – why come to see you?

ORS average, 500,000+ administrations: 18-20

Goal: Less than 1/3rd over the Clinical Cutoff (25, 28, 32)

2. Reliable change index (RCI*)

6+ point increase from the initial ORS

3. Clinically significant change index (CSCI*)

6+ and cross the Clinical Cutoff

*Jacobson & Truax, (1991) & Jacobson et al, (1999)

Immediately Experienced and Cumulative Career Growth:

Three Research-based Progress Indicators

1. Administering ORS, But Don’t Get Its Purpose.

Clients/peers must understand PCOMS’ purpose

(monitoring outcomes & privileging client perspective);

Helpers must understand & convey it; no data integrity

2. Administering ORS, Using Parts. But not the clinical cutoff or

numbers…Use but no continuity; no data integrity

3. Administering ORS, Using Some. But not connecting to the

client’s experience or reasons for service; no data integrity

4. Administering the SRS. But seeing it as reflecting competence

rather than an alliance building tool; no value added

Clinical Nuances of the ORS & SRS = Not Perfunctory

1. Start by looking at all client/peer graphs or lists of ORS scores.

Job One: ensure valid use of the measures & data integrity

2. Spend the most time on at-risk clients/peers: shape discussion

and brainstorms options; look for over-utilization

3. Review stats & Appreciative Inquiry:

a. What’s working

b. Opportunities to improve

c. Ways to improve; Encourage reflection, journaling & action

4. Mentor for skill building, client/peer teaching, & ongoing reflection

Appreciative Performance Support/Clinical Supervision: Four steps for currently experienced and cumulative career growth

A Closer Look: The PCOMS Performance Reportbrauchtworks.com/toolkit

Date Type

Name: Johnny B. Good Start: 3-Jun-14 Peer Recovery Service

Number: 691903 Transfer: A

Server: Greta Listner Reliable Change Index: 6.6 Clinically Significant Change: Y

* = Reason ORS SRS

Date for Service *Ind Int Soc Overall Total Rel G&T AorM Overall Total

Session 1 4.2 7.8 8.0 8.2 28.2 9.3 10.0 10.0 10.0 39.3

Session 2 3.1 8.1 6.2 7.4 24.8 9.6 9.8 8.1 7.9 35.4

Session 3 3.6 7.9 8.1 8.6 28.2 10.0 9.8 9.9 9.8 39.5

Session 4 4.3 8.2 8.1 8.4 29.0 10.0 9.9 9.6 9.9 39.4

Session 5 5.2 8.4 7.9 8.4 29.9 0.0

Session 6 7.8 8.1 8.1 8.6 32.6 0.0

Session 7 8.8 8.4 8.2 8.4 33.8 0.0

Session 8 8.8 8.4 8.8 8.8 34.8 0.0

Session 9

Session 10

Session 11

Session 12

Partners for Change Outcome Management System

0

5

10

15

20

25

30

35

40

Session 1 Session 2 Session 3 Session 4 Session 5 Session 6 Session 7 Session 8

ORS Total

7

8

9

10

Individual

10

A Closer Look: The PCOMS Performance Report (cont.)brauchtworks.com/toolkit

Helper: Greta Listner Program: Peer Recovery Service Start Date: Organization:

Number Name

Entry

Program ID #

(A)ctive

(P)lanned Transfer

(U)nplanned Transfer

Start

Date

End

Date

ORS

Initial

ORS

Last

# of

Sessions

Raw

Change

Reliable Change

Index (6+ points)

Clinically Significant

Change (RCI & 25+)

SRS

Last

1 Johnny B. Good PRS 691903 A 7-Jul-14 15.1 23.0 3 7.9 Y N 39.0

2 Noe Nohow CRU 328945 P 2-Sep-14 11-Mar-14 18.6 23.0 5 4.4 N N 40.0

3 Willit Help WAC 563247 P 10-Mar-14 19-May-14 32.5 36.3 9 3.8 N N 40.0

4 Scooby Doo PRS 123456 P 11-Jul-14 13-Sep-14 14.2 19.9 12 5.7 N N 38.7

5 Swift Taylor WAC 654321 P 14-Jan-14 28-Jan-14 36.4 32.7 2 -3.7 N N 36.4

6 Mr. T CRU 234567 P 11-Aug-14 22-Sep-14 20.3 31.9 6 11.6 Y Y 40.0

7 Elvis PRS 918273 U 8-Jan-14 13-Jan-14 11.7 34.2 2 22.5 Y Y 38.8

8 Canu Elpme CRU 453627 A 17-Jan-14 20.5 19.4 2 -1.1 N N 39.4

9 Truly Yavis PRS 564738 P 14-Feb-14 28-Mar-14 23.6 31.3 6 7.7 Y Y 39.8

10

11

12

13

14

15

16

17

18

19

20

My Effect Size Participants Average Average Average Average Planned - Met RCI Planned - Met CSC Average

0.99 Active 2 21.4 28.0 5.2 6.5 2 2 39.1

Planned 6 StandDev StandDev StandDev StandDev % Planned - Met RCI % Planned - Met CSC StandDev

Unplanned 1 8.28 6.57 3.49 7.58 33.3% 33.3% 1.15

Total 9 Highest Highest Highest Highest Unplanned - Met RCI Unplanned - Met CSC Highest

36.4 36.3 12.0 22.5 1 1 40.0

Peer Recovery Support 4 Lowest Lowest Lowest Lowest % Unplanned - Met RCI % Unplanned - Met CSC Lowest

Change R Us 3 11.7 19.4 2.0 -3.7 100.0% 100.0% 36.4

We All Change 2 Total Transfers - Met RCI Total Transfers - Met CSC

3 3

% Total Transfers -Met RCI % Total Transfers -Met CSC

42.9% 42.9%

Weeks in Service

Data Integrity: Look for…

1. 30% or more of Intake ORSs over the CutoffClient/peer or therapist does not understand the ORS - Role play introducing the ORS during performance support, watch a peer who has better results

2. ORSs between 35-40Client/peer or therapist does not understand the measures; Rarely a good score; even mandated clients/peers don’t score this high - Role play introducing the ORS during PS, discussing overall and sub-scale scores when they don’t match the client/peer’s description of her/his recent experience;watch a peer who has better results

3. ORS Graph Looks Like a SawBeing used as an emotional thermometer; Client/peer or helper does not understand the ORS - Role play connecting the client/peer’s reason for service to the marks on one or more ORS subscales during performance support; watch a peer who has better results

Participating in Appreciative PCOMS Performance

Support

#1 Self-assessment, reflection and journaling that informs your

professional development plan : PCOMS Report,

Appreciative Inquiry (AI) questions:

1) What’s right with you today,

2) What could be better (improvement opportunities) &

3) What keeps you hopeful (celebrate successes)

#2 Peer support and e-Meetings: PCOMS Report & AI questions

#3 Quality improvement visits: PCOMS Report, observations,

proficiency feedback, AI questions

Typical Appreciative PCOMS Performance Support

Conversation: The longer without change, the quicker to #7

1. What does the client/peer say about goals/reason(s) for

seeking service?

2. What do the ORSs reflect about progress?

3. Is the client/peer engaged? SRSs?

4. What have you done differently?

5. What can be done differently now?

6. What other resources can be rallied?

7. Time to plan for transfer (successfully)?

Non-blaming Transfers:Warm handoff to adjunct services or planned transfers

Not dumping clients/peers

Says nothing about the helper’s

competence

Says nothing about client/peer’s

ability to change

Says everything about doing

something positive and proactive

with clients/peers who are not

benefiting

heartandsoulofchange.com

Questions?

Webinar Learning Objectives. Upon completion of this

session participants will be able to:

Explain four research-

based factors

responsible for client

change that cut across

professional disciplines

and preferred treatment

models

Assess the 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 tools to

gather practice-based

evidence of service process

and outcome effectiveness.

1 32

Start

by doing what’s necessary,

then do what’s possible,

and suddenly you are doing

the impossible.

St. Francis of Assisi

George S. Braucht, LPC & CPCS

Email: george@brauchtworks.com

Website: brauchtworks.com

Brauchtworks ConsultingApplying Science to Practice

Thanks for your attention and

participation!

www.naadac.org/PCOMS-retention-

outcomes-supervision-webinar

Cost to Watch:

Free

CE Hours

Available:

2 CEs

CE Certificate for

NAADAC

Members:

Free

CE Certificate for

Non-members:

$25

To obtain a CE Certificate for the time you spent watching this

webinar:

1. Watch and listen to this entire webinar.

2. Pass the online CE quiz, which is posted at

www.naadac.org/PCOMS-retention-outcomes-

supervision-webinar

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.

CE Certificate

March 22, 2017 April 26, 2017

April 12, 2017

Effective Screening for

Gambling Disorder

by Loreen Rugle, PhD, ICGC II

May 10, 2017

Upcoming Webinars

www.naadac.org/webinars

Motivating the Troops: Creating an

Advocacy Mechanism

by Sherri Layton, MBA, LCDC, CCS

Developmental Trauma Disorderby F Malcolm Horn, LCSW, MAC

Six Types of Sex Use Disorder

by Douglass Weiss, PhD

www.naadac.org/webinars

Free CEs for

Members

Levels:

Professional

Associate

Student

www.naadac.org/

join

Over 75 CEs of free educational

webinars are available. Education

credits are FREE for NAADAC

members.

WEBINAR SERIES

In each issue of Advances in

Addiction & Recovery, NAADAC's

magazine, one article is eligible for

CEs.

MAGAZINE ARTICLES

NAADAC offers face-to-face

seminars of varying lengths in the

U.S. and abroad.

FACE-TO-FACE SEMINARS

Earn CEs at home and at your own

pace (includes study guide and

online examination).

INDEPENDENT STUDY

COURSES

NAADAC Annual Conference,

September 22-26, 2017, Denver, CO

CONFERENCES

Demonstrate advanced education

in diverse topics with the NAADAC

Certificate Programs.

CERTIFICATE PROGRAMS

Contact Us!

NAADAC

44 Canal Center Plaza, Suite 301

Alexandria, VA 22314

phone: 703.741.7686 / 800.548.0497

fax: 703.741.7698 / 800.377.1136

naadac@naadac.org

www.naadac.org

NAADACorg

Naadac

NAADAC