By: Dr. Cheri Shapiro, Director

Welcome to the first post for 2021!  

As we enter this new year, we are faced with our continued and collective work in what I am going to call the  “Pandemic Era.”   Unfortunately, the pandemic is just one major crisis for us.  Collectively, we are reeling from clear evidence of social injustice and intolerance, as well as living in a nation divided along partisan lines. Now more than ever it is critical that we recognize collective stress that impacts us, our communities, and the clients that we serve. Mental health and behavioral health services are needed now more than ever. 

I want to share a link to an event sponsored by the Institute for Innovation & Implementation, based in Maryland, that focuses on support for implementation of evidence-based interventions.  Coming soon is an opportunity to join a conversation about delivery of intensive in-home behavioral health services and telehealth for youth and families.

See this page for more details and register for the Tues., Jan. 26, 2021 event.

By: Dr. Cheri Shapiro, Director

Greetings to all of you! I certainly hope you and yours are safe and well.

Today I wanted to expand a bit on how we can maintain connection with clients and improve retention by using client feedback.  Many of you may be familiar with the Session Rating Scale (SRS) and the Outcome Rating Scale (ORS); when used together they form the Partners for Change Outcome Management System.  This evidence-based system of client feedback involves asking clients to report on functional outcome areas at the beginning of each session, and asking the client to rate each session at the end with regard to progress and the therapeutic alliance.

Both the SRS and ORS have only four questions each, takes just minutes to complete, and evidence shows they are reliable and valid.  Most importantly, collecting systematic feedback from clients has been demonstrated to improve both outcomes and retention in services.  

While it may be daunting to ask for and receive direct feedback from clients, obtaining this information session by session and holding meaningful conversations on progress is one way to demonstrate equality in partnership and to assure that both helper and client are on the same page.  For helpful implementation details for PCOMS, see https://betteroutcomesnow.com/resources/. 

If you wish to read a journal article, see: Duncan, B. L., & Reese, R. J. (2015). The Partners for Change Outcome Management System (PCOMS) revisiting the client’s frame of reference. Psychotherapy, 52(4), 391–401.

Happy measuring!!! 

By: Dr. Cheri Shapiro

We recently completed a Behavioral Health Landscape Survey, distributed in collaboration with the South Carolina Department of Social Services, to help us better understand what evidence-based interventions were currently being used by behavioral health providers working in this state.  This survey will help us prepare for implementation of the federal Families First legislation (check our prior blog posts on this). We are grateful to everyone who completed the survey.

Of the 2,614 providers who responded, approximately half (1,298) work with our target population of interest: children, adolescents, families, and/or caregivers.  Providers work in both the public and private sectors — for-profit as well as non-profit — and represented a range of professions: medicine, counseling, social work, and psychology, just to name a few of the larger groups.  Approximately 70% have been working in this area for 5 or more years, with 36% working more than 16 years.  Most respondents have master’s-level degrees, and the majority of counties in our state were represented.

The most commonly used evidence-based approaches used by providers within the past 12 months include:

• Cognitive-Behavioral Therapy (CBT),
• Motivational Interviewing,
• Trauma-Focused CBT,
• Dialectical Behavior Therapy,
• Cognitive Processing Therapy,
• Multisystemic Therapy,
• Parent-Child Interaction Therapy, and
• Alternatives For Families: A Cognitive-Behavioral Therapy

The number of providers reporting this relatively recent use of these interventions was 60 or more (range 60-789).

A number of additional evidence-based interventions were reported as having been used in the prior 12 months; however, the number of providers reporting using them were smaller (less than 50; range 3-46).

It is exciting to know that so many providers are using approaches that have a strong research base with evidence of efficacy and effectiveness.  Providing high quality services to all clients is one way that we can do our part to minimize known inequities in care and health disparities.

Remember, whatever approach you use, pay careful attention to tracking your outcomes as you go.  Tracking outcomes and engaging clients in discussion of progress is key to a strong therapeutic alliance — without that, no progress can be made!

By: Dr. Cheri Shapiro

Since I last wrote the world has literally altered course and life as we know it has come to an abrupt halt.  We are all struggling to create new routines, new ways of work, and new personal and family routines.

The need for social distancing to stop the spread of COVID-19 has pushed many of you into the world of remote service provision, whether by telemedicine or phone, or possibly even by text or email (on secure platforms, of course!).  As you embark on this journey, how can you stay on course?

One lesson COVID-19 has taught many around the globe is the absolute importance of data for tracking purposes.  I have written in the past about how collection of information to track progress is a critical element of use of evidence-based interventions.  Now, we all, in anxious anticipation, check daily statistics regarding the number of cases and deaths in the hope that our efforts to stop the spread of this disease are working.  The power of this information is undeniable.

How can we apply this to our support of clients?

Helping clients self-monitor can be an important part of treatment.  Creating rating scales of mood or behavior that can be easily used is important.  For example, asking a parent to rate the level of difficulty they have had in the last day in managing their child’s behavior on a scale from 1-10, or having an adolescent rate their level of sadness or fear on a similar scale, can help you track progress with your client. As home tasks are given for practice, clients can track whether they did the task, and provide a rating of their mood or behavior.  In this fashion, you can link treatment to outcomes.  

Other tracking options include using surveys that can be completed electronically or apps for tracking a variety of behaviors.  Remember, the act of tracking itself can be reactive (i.e. changing the behavior we are targeting), which may be exactly the desired goal.

Keep safe and keep on tracking …

By: Dr. Cheri Shapiro

In a recent post, I wrote about The Families First Prevention Services Act and the associated Title IV-E Prevention Services Clearinghouse.  The Clearinghouse is live, is reviewing multiple programs for potential inclusion, and can be found here.

This Act has energized discussions about adoption of evidence-based programs and interventions. One important question that systems or organizations ask when considering adoption of evidence-based behavioral health interventions is, “Which program should we select?”  However, we may not be asking the right question.  The better question might be, “Which combination of evidence-based programs and practice elements from these programs is likely to help us achieve our desired results for the largest number of youth and families in need?”

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In an earlier post I have described the Managing and Adapting Practice (MAP) modular form of intervention for children’s mental health challenges. As you may recall, MAP is a flexible, individualized intervention system designed to support clinicians in identifying evidence-based interventions (EBI’s) and key components of EBI’s that address the presenting concerns of youth and families. MAP originated in a System of Care in Hawaii to improve outcomes and quality of care for children and adolescents.  For more information on MAP, please visit the PracticeWise website.

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Today’s post is called “Another day, another clearinghouse!” But before we get too cynical, let’s take a closer look.

Policy landscape changes are like the climate – we can expect shifts over time, influenced by changes in policy leaders and reflecting changes in priorities.  The Families First Prevention Services Act (worth many kudos for shifting the focus to prevention services to support children, youth and families and to prevent placement in foster care) has created the Title IV-E Prevention Services Clearinghouse.  The Clearinghouse is live and can be found here.

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By: Dr. Cheri Shapiro

The US Congress is considering a bill that would “amend amend parts B and E of title IV of the Social Security Act to invest in funding prevention and family services to help keep children safe and supported at home, to ensure that children in foster care are placed in the least restrictive, most family-like, and appropriate settings, and for other purposes.”

This legislation is very important for advancing evidence-based services for children, youth, and families, and for focusing on prevention. Specifically, one primary component of this legislation allows for states to use federal funds to provide “… mental health and substance abuse prevention and treatment services, in-home parent skill-based programs, and kinship navigator services” to prevent placement of children in foster care.

(Read the full text of the bill here.).

Services eligible for states to use will be included in a clearinghouse that is under construction as we speak. (Think really smart people with an objective, critical eye checking out lots of research on programs to help children, youth, and their families).

States may delay adoption of this legislation and associated funding for up to two years.  This makes incredible sense, as just upskilling a workforce in a single evidence-based approach can take months … or even years … to go to scale.

Stay tuned for updates later this summer on this important topic!

Today’s update is in response to the second suicide of a young Parkland survivor. Please follow this link and take the time to pass on this important information for parents and caregivers to assess risk.

Here is a version for teens to use with their friends.

Helping those we care for have these important and difficult conversations is one way that we, and they, can make a difference!

By: Dr. Cheri Shapiro, Director

Happy New Year!

As with many parts of our lives, the new year offers and opportunity for a new start, which often means new goals. As professionals interested in the delivery of evidence-based approaches to help youth and families address mental health and/or substance use challenges, now is a great time to evaluate your practice.

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