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Using PCOMS with Alcohol and Other Drug Users: Mandated and Group Challenges

2014 Spectrum Health Systems, Inc. Counselor Inservice Training

Brauchtworks Consultingbrauchtworks.com

Applying Science to Practice1

9:00am Welcome and introductions - Taschovia Smith

9:15am PCOMS: Skill I - George Braucht and

Schedule

9 5a CO S S Geo ge auc a dSherri Bloodworth

10:30am Break10:45am PCOMS Skill II12:00pm Working lunch: Practicing a Recovery

Group12:45pm PCOMS Skill III2:00pm Break2:15pm Google Drive rosters and other

administrative issues- Taschovia Smith3:30pm End: Arrive home safely!

1. Use the Partners for Change Outcome Management System (PCOMS) in every

Learning Objectives

g y ( ) yMotivation, Assessment and Planning (MAP) and the Recovery Group.

2. Follow the MAP and Recovery Group handouts while modeling relationship enhancement skills and using contingency management techniquesand using contingency management techniques.

3. Engage in self assessing MAP and Recovery groups and quality improvement professional development activities to achieve expert competence and confidence in using the PCOMS.





Three Skills of Recovery-Oriented, Client-Directed, and Outcome-Informed Services

1 Build a Culture of Feedback1. Build a Culture of Feedback

2. Integrate Client Feedback into Practice

3. Inform and Tailor Services Based on Client Feedback

ThreeSkillsforUsingPCOMS www.brauchtworks.com Page1

Three Skills of PCOMS-Informed Services

1. Introducing the scales and the client’s voice in all services and all decisions Two key points to emphasize: 1) collaboratively monitor outcomes and do something

different if this is not work and 2) the client’s voice and perspective is what is needed to

direct what we do

Put into your own words:

a. I may do things a little differently than you have experienced before because your

ideas, goals and resources are most important for your long-term recovery.

b. I am committed to advocating for your self-directed care and the services that I

provide focus on getting what you need for recovery.

c. To do that, it would be helpful to find out how you are doing and how well I am

providing what you need.

d. Many others I have worked with have found the two scales that I use to be very

helpful in tracking how thing are going for you and whether we are on track.

e. It will really help me learn about you and it takes only a few minutes.

f. Are you willing to do that now?

2. Integrating client feedback into practice Provide feedback about the client’s ORS score in reference to the clinical cutoff then

allow the client to make sense of it.

Connect the client’s described experience with her/his marks on the ORS subscales –

allow revisions

Relate the client’s reasons for seeking services to marks on the ORS and SRS

At the end of the interaction, review the SRS scores and solicit feedback on how the next

interaction could be better or more useful to her/him.

3. Informing and tailoring services based on client feedback Compare the current and last ORS score and look at the change over time.

When positive change occurs on the ORS, listen for and empower the client’s self-

efficacy.

If no change or lowered ORS, discuss what needs to happen next. If persists over two

sessions, check SRS scores and discuss alliance issues then engage in an urgent

discussion to brainstorm options and entertain the possibility of a referral or transfer to

another helper.

If ORS change still does not occur, even if the SRS score(s) is high, fail successfully via

a warm handoff to another service provider or program.

Duncan, B. L. (2014). On becoming a better therapist: Evidence based practice one client at a

time (2nd ed.). Washington, DC: American Psychological Association.





Supervision Outcomes & Roles

SuccessfulDischarge

LawEnforcement

CounselingInteractions &Interventions

Re-Arrest/Revocation

Every interaction is an opportunity tomodel prosocial behavior -

Blended RNR-Enhanced Supervision

Five Key Supervision Principles in a Blended Risk-Need-

Responsivity EnhancedResponsivity Enhanced Supervision Model





Evidence-Based Core Correctional PracticesNational Institute of Corrections and Crime and Justice Institute

1. Assess actuarial risk/needs2. Enhance intrinsic motivation3 Target interventions3. Target interventions

A. Risk Principle: Prioritize supervision and treatment resources for higher risk offenders

B. Need Principle: Target interventions to criminogenic needsC. Responsivity Principle: Be responsive temperament, learning style,

motivation, culture, and gender when assigning programsD. Dosage : Structure 40-70% of high-risk offender’s time for 3-9 monthsE. Treatment: Integrate treatment into the full sentence/sanction

requirementsrequirements4. Skill train with dedicated practice (use cognitive behavioral treatment

methods)5. Deliver reinforcement 4:1 over punishment6. Engage ongoing support in natural communities7. Measure relevant processes/practices8. Provide measurement feedback

“What Works” Principles

WHO & How Much Risk PrincipleRisk Principle

WHAT

HOW

WHY

WHEN

Need PrincipleNeed Principle

Responsivity PrincipleResponsivity Principle

Collaboration PrincipleCollaboration Principle

Frontload PrincipleFrontload PrincipleWHEN Frontload PrincipleFrontload Principle

A Blended Risk-Need-Responsivity Enhanced Interaction Model





Supervision Conditions and Recidivism

Compliance with conditions is a fact of community supervision

Time Recidivism

10 minutes 18.9%

But too much emphasis can backfire

15 minutes or more 42.3%

Rates adjusted for risk level

From: Bonta, J. (2009). Translating “what works” into sustainable everyday practice.

Criminogenic Needsand Recidivism

Discussing criminogenic needs was related to reduced recidivism

Length of Discussion Recidivism (n)

Low (0-15 minutes) 59 8% (49)

reduced recidivism

More focus on criminogenic needs is correlated with lower recidivism rates

Low (0 15 minutes) 59.8% (49)

Medium (20-30 minutes) 47.6% (26)

High (40+ minutes) 33.3% (3)

From: Bonta, J. (2009). Translating “what works” into sustainable everyday practice.





Research-Based Principles of EffectiveCriminal Justice Interventions

III.III. Responsivity principle = HOW: deliverResponsivity principle = HOW: deliver

Motivation

Race/culture

Sexual orientation

Age

III.III. Responsivity principle HOW: deliver Responsivity principle HOW: deliver interventions that are congruent with interventions that are congruent with individual individual characteristics & situationscharacteristics & situations

Gender

Affiliative orientation

g

Cognitive skill

Faith





Risk of Arrest Highest the FirstMonths After Release from Prison

The likelihood of arrest drops 40 2.5%

percent between post-prison months 1 and 15

ILIT

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2.0%

1.5%

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Drug

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1.9%

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1-6 7-12

13-18

19-24

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SOURCE: Analysis by Richard Rosenfeld and Robert Fornango, originally presented in Parole, Desistance from Crime, and Community Integration, National Research Council, 2007

PR

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“What Works” Principles

WHO & How Much Risk PrincipleRisk Principle

WHAT

HOW

WHY

WHEN

Need PrincipleNeed Principle

Responsivity PrincipleResponsivity Principle

Collaboration PrincipleCollaboration Principle

Frontload PrincipleFrontload PrincipleWHEN Frontload PrincipleFrontload Principle

A Blended Risk-Need-Responsivity Enhanced Interaction Model









Partners for Change Outcome Management System (PCOMS)

PCOMS is

www.heartandsoulofchange.com

Dr. Barry Duncan





A compelling

Humbugs, Witches and Wizards!

A compelling metaphor for helpers

The best of us are humbugsare humbugs, witches or wizards!

The Wonderful Wizard of Oz

Story about life and the resolution ofthe resolution of human problems

Tale of four characters who perceive something missing in their lives

Each believes that a wizard is necessary to help them find completeness





The Wizard

The Wizard, the expert faced with overwhelmingfaced with overwhelming problems, did what manyhelpers are trained to do…

He prescribed a protracted j ( t h i

He prescribed a protracted j ( t h ijourney (a technique or process) to acquire something he thought theyneeded

journey (a technique or process) to acquire something he thought theyneeded

Upon returning: The Humbug

After his embarrassing ““Oz never did Oz never did give nothinggive nothing

exposure, the Humbug cleverly addresses the requests by granting the Scarecrow, Tin Man, and Lion something tangible.

give nothing give nothing to the Tin to the Tin Man,Man,

They are pleased to receive validation of their desires for completeness, but…

that he didn’t,that he didn’t,didn’t already didn’t already have.”have.”





Effective Helpers are Good Witches/Humbugs/Wizards: ROPDOI

Glinda, and all of the other characters, helped Dorothy find her , p yown meaning about her perilous quest to Oz, her journey of change, and relied on her own resources to return home, to reach her goal =

Recovery-Oriented, Person-Directed&

Outcome-InformedOutcome Informed.

Although PCOMS doesn’t provide a magic wand (or enable travel in a bubble), it helps you know that people always carry into tough circumstances what’s needed to prevail.

MetaMeta--Analytic ResearchAnalytic Research

Treatment factors:Treatment factors:

13%

oo 7% due to Alliance factors (or 7% due to Alliance factors (or 54% of effects due to 54% of effects due to treatment)treatment)

oo 1% due to Model and technique 1% due to Model and technique (or 8% of effects due to (or 8% of effects due to treatment)treatment)

31

87%

))

Extratherapeutic/Client factorsExtratherapeutic/Client factors

Wampold, B. (2001). Wampold, B. (2001). The Great Psychotherapy DebateThe Great Psychotherapy Debate. New York: Lawrence Erlbaum.. New York: Lawrence Erlbaum.





The Wheel of Change:The Wheel of Change:Factors That Account Factors That Account forfor

Successful Successful OutcomeOutcome

40.0%40.0%

30.0%30.0%1 0%1 0%

Client/ExtraClient/Extra--TherapeuticTherapeutic

RelationshipRelationshipModels/TechniquesModels/Techniques

15.0%15.0%

15.0%15.0%

Hubble, M., Duncan, B., & Miller, S. (1999). The Heart and Soul of Change. Washington, D.C.: APA

Placebo/Hope/ExpectancyPlacebo/Hope/Expectancy

Over 1000 Studies of the Over 1000 Studies of the Helping AllianceHelping Alliance

Client’s Theory ofClient’s Theory of

MeansMeans

oror

MethodsMethods

GoalsGoals

or or

PurposePurpose

Client s Theory of Client s Theory of ChangeChange

MethodsMethodsPurposePurpose

Client/Peer’sClient/Peer’s View of the View of the Helping RelationshipHelping Relationship





First contact: Add who you are.

I may do things a little differently than you have experienced before because your ideas, goals and

resources are most important for your long-term recovery.

I am committed to advocating for your self-directed care and focusing the services that I provide on getting

what you need for recovery.To do that, it would be helpful to find out how you are

doing and how well I am providing what you need.Many others I have worked with have found the two yscales that I use to be very helpful in tracking how

things are going and whether we are on track.Also, it will really helps me learn about you and it takes

only a few minutes. Are you willing to do that now?





Brauchtworks Consulting Applying Science to Practice Page 1 of 1

Materials Needed for Conducting

PCOMS-Informed Recovery Action and Progress Groups

1. Outcome Rating Scale*

2. Group Session Rating Scale*

3. Self-Completed Overview of Recovery Experience Board (SCORE Board)**

4. Recovery Action and Progress Group handout**

5. Ruler: centimeter side!

6. Name tags or tents

7. File folder

8. Optional: Recovery Capital Scale and Plan (WHAM)**

9. Optional: File folder for each participant

10. Optional: Contingency management rewards: Stickers, coupons, treats, etc.

11. Optional: Clock

* = PCOMS scales available at www.heartandsoulofchange.com

** = available at www.brauchtworks.com





II. Integrate Client Feedbackinto Practice

Provide feedback about the client’s ORS score in reference to the clinical cutoff then allow thein reference to the clinical cutoff then allow the client to make sense of it.

Connect the client’s described experience with her/his marks on the ORS subscales – allow revisions

Relate the client’s reasons for seeking servicesRelate the client s reasons for seeking services to marks on the ORS and SRS

At the end of the interaction, review the SRS scores and solicit feedback on how the next interaction could be better or more useful to her/him.

Looking back over the last week, including today, help us understand how you have been doing in the following

areas of your life where marks to the left represent low

Outcome Rating Scale

Individually

(Personal well-being)

Not so good Doing OK Doing well

areas of your life, where marks to the left represent low levels and marks to the right indicate high levels.

Not so good Doing OK Doing well

I----------------------------------------------------I

Recovery Action and Progress Group

Instructions: (1) Complete an Outcome Rating Scale (ORS) and update your SCORE Board. 2) Review the Group Guidelines (A). 3) One participant does a Recovery Check-In (B) with another participant using the Relationship Enhancement OARS (D) until everyone has checked in. 5) End group by completing then discussing today’s Group Session Rating Scale (C) scores. Be sure to add the GSRS score to your SCORE Board.

A. Group Guidelines

1. No pizzling! Turn off cell phones, pagers, etc., and do not leave the room without telling someone first.

2. Vegas Rules: Say “Vegas Rules” before you say something that you do not want repeated

outside of this group. 3. No fixing! Instead, share what recovery activities have worked for you by using “I…”

statements. 4. What other guidelines will help make this a safe and respectful place for you to talk?

B. Recovery Check-In. Use the Relationship Enhancement OARS (below) to ask…

1. What’s right with you today? 2. What is your Outcome Rating Scale (ORS) score? What progress did you make since your

last group on your recovery goals? May show your Self-Completed Overview of Recovery Experience Board (SCOREboard).

3. From 0-10, what is your highest craving level since the last group, with 0 = Never thought

of using alcohol or other drugs; 10 = Used 4. Do you have a safe and sober place to stay? 5. Would you like more group time today after everyone has checked in?

C. Complete and discuss the Group Session Rating Scale - add it to your SCORE Board D. Relationship Enhancement OARS

Open-Ended Questions: Express concern, interest, puzzlement, etc.; Who, What, How Affirmation/Validation: Affirm appreciation for the other person and identify his or her

strengths; “You stayed sober last weekend!” instead of, “How did you manage to avoid drinking?” “You are concerned about…”

Begin with “You…” not “I” Describe behaviors Attend to solutions instead of problems Attribute interesting qualities to the person Focus on a strength or attribute, not the lack of something or what was not done

Reflective Listening: Make statements about what you heard the other person say instead of asking questions

Begin with: “You think (feel)…,” “You’re wondering if…,” “So you feel (think)…,” Summaries: Short, clear statements that organize what’s been said; Use “and” instead of “but”





7

ORS: An ExampleORS: An Example

Clinically, what can Clinically, what can we glean from this we glean from this

8

5

8

ggclient’s scores?client’s scores?

How could we use How could we use this information to this information to begin or focus the begin or focus the

i ?i ?Total = 28 session?session? Explore why the client decided to enter therapy.Explore why the client decided to enter therapy. Use the referral source’s Use the referral source’s view to rate view to rate the the ORS.ORS.Avoid Avoid “depth“depth--oriented” techniques.oriented” techniques. Use strengthUse strength--based based methods to focus methods to focus on on clientclient--specific specific

issues in issues in a a concernconcern--exploration mannerexploration manner









III. Informing and tailoring services based on client feedback

Compare current and last ORS score and look at change over time – SCORE Board.g

When positive change occurs on the ORS, listen for and empower the client’s self-efficacy.

If no change or lowered ORS, discuss what needs to happen next. If persists over two sessions, check SRS scores and discuss alliance issues then engage in an urgent discussion to brainstormengage in an urgent discussion to brainstorm options and entertain the possibility of a referral or transfer to another helper.

If ORS change still does not occur, even if the SRS score(s) is high, fail successfully via a warm handoff to another service provider or program.

23

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Brauchtworks Consulting Applying Science to Practicewww.brauchtworks.com Certified PCOMS and Recovery Coach Trainer

Outpatient Program Report March 2009

Referral Sources

Services Jail Probation Parole DCourt Other

Initial Calls Received Total ORS SRS

Initial Recovery Check-In & Appointment Reminders (before 1st appointment)

Total ORS SRS

Initial Appointments Total ORS SRS

Individual Sessions Total ORS SRS

Groups Total ORS SRS

Recovery Support Check-Ins Total ORS SRS

Last Month’s Ending Census Intakes + Planed Transfers -

Average Length of Stay Unplanned Transfers -

Average Length of Stay This Month’s Ending Census

Quality Improvement Targets I. Initial Recovery Check-Ins = 100% O/SRSs: Actual _________% ...... DNM Met II. Planned Transfer = 95% of all transfers: Actual _________% ..... DNM Met III. Recovery Support Check-Ins = 100% 1X week 1st 2 months

Actual _________% ..... DNM Met

Brauchtworks Consulting Applying Science to Practicewww.brauchtworks.com Certified PCOMS and Recovery Coach Trainer

Program Dashboard: March 2009

81%

86%

94%

87%

70%

75%

80%

85%

90%

95%

Jan Feb Mar Average

Initial Recovery O/SRSs: Goal 100%

85%

86%

88%

86%

83%

84%

85%

86%

87%

88%

Jan Feb Mar Average

Recovery Support Check‐Ins: Goal 100%

57%

62%61%

60%

54%

56%

58%

60%

62%

Jan Feb Mar Average

Planned Transfers: Goal 95%





www.heartandsoulofchange.com

Start

To Motivate Change, Do What Works!

Start

by doing what’s necessary,

then do what’s possible,

and suddenly you are doingy y g

the impossible.

St. Francis of Assisi

Documents

Ui PCOMS ith Al h l wbrauchtworks.com/yahoo_site_admin/assets/docs/Sepctrum_Counse… · Relate the client’s reasons for seeking services to marks on the ORS and SRS At the end