Tipping an Organisation Upside down . a work in progress. Becoming a client directed and outcome...

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Transcript of Tipping an Organisation Upside down . a work in progress. Becoming a client directed and outcome...

  • Tipping an Organisation Upside down .a work in progress.Becoming a client directed and outcome informed organisation

  • Our Assumptions .We all want the best outcomes for the people we work with / for

    We all want to use the resources we have to help as many people as possible

    We all value justice / fairness

  • Why Wesley Community Action opted for a Client Directed and Outcome Informed (CDOI) approachValues

    The research evidence

    Global change driving local reality

  • What is Client Directed and Outcome Informed (CDOI) ? Describes interactions where;The clients voice is privilegedThe worker purposefully forms a relationship based on the clients Theory of ChangeThis work is informed by the clients experience of the alliance and the outcomes

  • Factors accounting for successful outcome- Michael LambertSpontaneous Remission Client/ExtratheraputicModels/TechniquesPlacebo/Hope/ExpectancyCommon Factors Relationship

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    Sponteaneous Remission Client/Extratheraputic40%

    Models/Techniques15%

    Placebo/Hope/Expectancy15%

    Common Factors Relationship30%

    To resize chart data range, drag lower right corner of range.

  • The Therapeutic AllianceGoals, Meaning or PurposeMeans or MethodsClients view of the Therapeutic Relationship

  • The Research base? 9 Randomised Clinical TrialsOver 1000 international studies and published articles

  • The largest study ever conducted on the treatment of problem drinkingThree different treatment approaches studied (CBT, 12-step, and Motivational Interviewing).Project MATCH Group (1997). Matching alcoholism treatment to client heterogeneity. Journal of Studies on Alcohol, 58, 7-29.Babor, T.F., & Del Boca, F.K. (eds.) (2003). Treatment matching in Alcoholism. Cambridge University Press: Cambridge, UK.Connors, G.J., & Carroll, K.M. (1997). The therapeutic alliance and its relationship to alcoholism treatment participation and outcome. Journal of Consulting and Clinical Psychology, 65(4), 588-98.

    The clients rating of the therapeutic alliance the best predictor of:Treatment participation;Drinking behavior during treatment;Drinking at 12-month follow-up.Project MATCH The AllianceNO difference in outcome between approaches.

  • Considered to be the most sophisticated comparative clinical trial ever conductedFour approaches (CBT, IPT, Drug, Placebo)

    Elkin, I. Et al. (1989). The NIMH TDCRP: General effectiveness of treatments. Archives of General Psychiatry, 46, 971-82.No difference in outcome between approaches. The clients rating of the alliance at the second session, the best predictor of outcome across conditions.

    TDCRP The Alliance

  • How does it work2 formsThe first Outcome Rating Scale privileges the clients voice, promotes the clients Theory of Change and ensures transparency regarding agreed outcomes and monitoring of changeThe second- Session Rating Scale measures the fit between worker and client

  • The Outcome Rating Scale (ORS)Measuring OutcomeLooking back over the last week, including today, help us understand how you have been feelingby rating how well you have been doing in the following areas of your life,where marks to the left represent low levels and marks to the right indicate high levels.

    Individually:(Personal well-being)|------------------------------------------------| Interpersonally:(Family, close relationships)|------------------------------------------------|Socially:(Work, school, friendships)|------------------------------------------------|Overall:(General sense of well-being)|------------------------------------------------|

  • The Session Rating Scale (SRS)Measuring the AlliancePlease rate todays session by placing a hash mark on the line nearest to the description thatbest fits your experience.I did not feel heard,understood andrespectedWe did not work on ortalk about what Iwanted to work on andtalk aboutThe therapistsapproach is not a goodfit for meThere was somethingmissing in the sessiontodayI felt heard,understood andrespectedWe worked on andtalked about what Iwanted to work on andtalk aboutThe therapistsapproach is a good fitfor meOverall, todays session was right forme

    Relationship:|------------------------------------------------| Goals and Topics:|------------------------------------------------| Approach or Method:|------------------------------------------------| Overall:|------------------------------------------------|

  • What are the implications for WCA in adopting a Client Directed Outcome Informed Approach ?

  • A Riddle - What is the difference between:baking a cake;sending a rocket to the moon;raising a child?

  • Develop common ground, compromise or compete.Use experts to experiment and find the answersLearn by doing with clients and keypeople.Create stability.Follow the best practicerecipe.

  • Client led Complex IssuesFeature

    Difficult to frameMultiple root causesMultiple stakeholdersEmergentUniqueParadoxes, Dilemmas

    Response

    Good enough framingCross boundary workCollaborative & FlatAdaptive LearningCustomized ResponsesTransparent coping

  • Living systems can only be disturbed never directedMaturana and VarelaAnd all organisations are living systems (changing, sometimes messy, holding many truths)

  • Preconditions for Client Directed Approach - Wesley Community Actions JourneySt Lukes training 2002Intentional strength based practice 2003Leadership confirming SB approachSB conference 2007 Palmerston North presentation Dr Barry Duncan Visits by Barry in 2008,2009 and 2010Leadership confirming CDOIData Management SystemWesley Way 2011 organisation practice framework.

  • The Wesley Way

  • How WCA implemented it ..Developing the frameworks that support this an expectation of a culture of feedbackTraining and Supervision Internal and externalWater Cooler conversations staff feeling OK with discomfort in using the toolAccepting Data as our friend collecting and collating it

  • Client Voice

  • Is it really tipping the organisation upside?

  • YES We moving from an organisation where ...Staff believe they actually change people. The organisation takes the credit for the hard work of the clientsWe blame the clients it they are not changing how we expect them toWe design our systems as if clients are invisible or passiveWe train clients how to be receivers of help

    .

  • To an Organisation where we..understand that people only change when they intrinsically want to change and ... create an environment conducive for people to do the right thing for them.Are great at spotting and celebrating positive changes made by clientsValue regular honest feedback from clients

  • *ORS is reliable, valid and feasible:Give at the beginning of each visitClient places a mark on the lineEach line is 10cm long (100mm)Scored to the nearest millimetreAdd the four scales together for the total score (out of a possible 40)

    Creating a Culture of Feedback:When scheduling a first appointment, provide a rationale for seeking client feedback regarding outcome.Work a little differently;If we are going to be helpful should see signs sooner rather than later;If our work helps, can continue as long as you like;If our work is not helpful, well seek consultation (session 3 or 4), and consider a referral (within no later than 8 to 10 visits).

    *SRS is reliable, valid and feasible:Give at the end of each sessionClient places a mark on the lineEach line is 10cm long (100mm)Scored to the nearest millimetreAdd the four scales together for the total score (out of a possible 40)Discuss with client anytime the total score falls below 36

    Creating a Culture of Feedback:When scheduling a first appointment, provide a rationale for seeking client feedback regarding the alliance.Work a little differently;Want to make sure that you are getting what you need;Take the temperature at the end of each visit;Feedback is critical to success.

    Restate the rationale at the beginning of the first session, and prior to administering the scale.

    ***