With recent technological advancements in digital patient onboarding is diagnosis treatment matching one of the innovation goals worth pursuing?
A psychometric reporting system I follow is claiming it can improve outcomes by matching the correct treatment for the correct disorder. The first time I read this claim, a quote from a book I've been reading, Personalizing Psychotherapy, by John C. Norcross, PhD and Mick Cooper popped into my head. The quote was,
“…decades long search for optimal matches between the treatment method and the patient’s disorder has largely proven unsuccessful…”
I then googled ‘effective diagnosis treatment matching’ wondering what evidence is there to support the claim that it improves mental health outcomes. All the related research I found was from the last century. The only recent study was from a 2018 RCT study, by Hell, M.E., Miller, W.R., Nielsen, B. et al., designed to find out if outcomes improved if patients match themselves to treatment options. One of the authors, I’m assuming it was Bill Miller, author of Effective Psychotherapists Clinical Skills That Improve Client Outcomes, wrote,
“Research on matching patients to treatment has shown that matching grounded in expert views is little better than allocating patients by chance.”
I doubt any algorithm will be able to demonstrate an improvement in treatment outcomes based on matching treatment to diagnosis. So what does work?
The research I read points to working feedback-informed as a way to improves both retention and effectiveness. In one recently published study titled, Enhancing the effect of psychotherapy through systematic client feedback in outpatient mental healthcare, a clustered RCT showed the routine monitoring of outcome and relationship with the Outcome and Session Rating Scales — improved effectiveness by 25% over and above usual treatment services.
Feedback-Informed Treatment (FIT) achieves these effects, in part, by improving responsiveness to the individual client — particularly those at risk of deterioration or dropout. In the Feedback-Inform Treatment (FIT) literature, we talk a lot about adjusting service in the absence of client progress. Early in training FIT practitioners learn three ways they can adjust services.
1-change the ‘what’
2-change the ‘were’
3- change the who
Evidence-based guidelines are provided for when such modifications should be introduced. Adjusting services when it’s not working is one way that has been shown to improve treatment outcome. Another way that is emerging to improve treatment efficacy is to match clients to treatment based on certain patient characteristics and preferences. I believe this is a much more promising way technology can help us ensure every person gets the help they are looking for.
And I am not alone, in fact the Interdivisional APA task force, as quoted by John Cross and Bruce Wampold, (2019, p. 330 ) concluded,
“Adapting psychological treatment (or responsiveness) to trans-diagnostic client characteristics contributes to successful outcomes at least as much as, and probably more than, adapting treatment to the client’s diagnosis”.
If you are looking for innovation, my advice is to create a system that can:
-capitalize on client preferences
-capture meaningful data for use in real time
-efficiently personalize care pathways
-provide immediate access to support and relief
I am aware of a number of innovations and new systems that are being developed and made available to accomplish these goals and will be highlighting them in upcoming posts.
Interested in learning more about how working feedback-informed can improve retention and effectiveness?
The Upcoming FIT Café
A small online consultation/discussion group led by ICCE faculty for those seeking consultation regarding Feedback Informed Treatment & DP. The ICCE is pleased to sponsor the next FIT Café.
Join ICCE faculty, Cynthia Maeschalck and Brooke Mathewes for four 1.5 hour facilitated online discussion groups, to ask questions, discuss and consult about your use of FIT and Deliberate Practice. FIT Café consultation meetings provide participants with an opportunity to ask questions and raise topics for discussion that will enhance their FIT knowledge and skills. Café meeting agendas are driven by the areas of interest and questions brought forward by group members. Therefore, active participation is an expectation.
This small group meeting is a perfect opportunity to get specific help with:
FIT Implementations challenges
Understanding and using client feedback and FIT progress graphs
Understanding individual or agency aggregate outcome and alliance data
Individual case consultations
Implementing Deliberate Practice
The FIT Practitioner Challenge
The FIT Practitioner Challenge includes a series of trainings on Feedback-informed Treatment (FIT) core competencies curated by Measurement-based Care expert and Certified FIT Trainer, Cindy Hansen. Keep doing whatever is working but know that if you increase your FIT skills, it’s going to start showing up in really gratifying ways. Weekly lessons start with a content and activities section. Spend an hour each week engaging in the program. Take the brief multiple-choice quiz to test your knowledge, before moving on to the next step.
The FIT Basics: Practitioner Development program includes lectures from Scott D. Miller and closely follows the original activities and goals we developed during the 2015 ICCE eLearning initiative. There’s not only materials to read, engaging lectures and demonstrations to watch, you're also going to be collaborating with peers from around the world as you move through these six lessons.
FIT Practitioner Challenge Giveaway
The first 20 people to complete the six Feedback Informed Treatment lesson with a cumulative score of 80% or
higher will be entered in a draw to win a hardcover, first edition of Feedback-Informed Treatment in Clinical Practice. This book brings together clinicians, supervisors, and agency managed who have successfully integrated FIT into clinical practice. Each provides helpful advice for mental health practitioners who work with different types of clients in a variety of settings, including private practice, clinics and agencies, child and family therapy, LGBTQ counseling, the criminal justice system, and pharmacies.
