using pcoms with substance abuse

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George S. B

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Brauchtw

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Georgia State B

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Georgia State B

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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





Respond to each question by pressing p q y p gthe appropriate button & look for a greenlight

Answers are recorded anonymously but we will see the results immediately

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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1.3%1.9%

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1-6 7-12

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19-24

25-30

31-36

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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0.5%

0.0%

Violent

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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)

30

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

RelationshipRelationship Models/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?





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





Progress Rating Scale

Name: ______________________________ Date: __________________ Score: ___________

Looking back over the last week, including today, mark how well you have been doing in the

following areas of your life. Marks to the left of center represent unsatisfactory levels and marks to the right of center indicate satisfactory levels.

Individual (Personal well-being)

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

Outcome Rating Scale

Interpersonal (Family, close relationships)

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

Social (Work, school, friendships)

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

0-100 1 2 3 4 5 6 7 8 9 10

0-10

0-10

Overall

(General sense of well-being)

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

©2004 Barry L. Duncan. Adapted from the Outcome Rating Scale, ©2000 by Scott D. Miller and Barry L. Duncan.

Total: ____0-10





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

2-1

428

Johnny R. Goode

20 29 31 30 36 31 29 30 31

2-8 2-15 2-22 3-14 3-21 3-28 4-6 4-13 4-20 4-27 5-5

304 4 2 10 0 0 4 6 6 7 4

O

O OO

O

A seven point increase!

OO

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Questions?





www.heartandsoulofchange.com





Pl l tPlease complete a session feedback form!

Start

To Motivate Change, Do What Works!

Startby doing what’s necessary,

then do what’s possible, and suddenly you are doingy y g

the impossible.St. Francis of Assisi

using pcoms with substance abuse

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