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ACE, Achieving Clinical Excellence, Conference
May 2-4, 2018, Östersund, Sweden

This program might be subject to change (until the very last minute) due to circumstances outside our control.
PLEASE NOTE:  All conference presentations will be offered in English.

4th May, Conference: Day Two, 09.00-16.00

Morning Registration, Opening Ceremony, and Keynotes
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14.00 – 14:45 Workshop Session 2.1

1. Using FIT with survivors of torture and collaborating with an interpreter
Tina Ammundsen & Laila Jacobsen, Denmark
The challenges and the joys of using FIT with refugees survivors of torture are many and the effect of the visualisation of the ORS and SRS is surprising to us. We use FIT with individuals, whole families and collateral raters. We can present the following:

Client group present starting score below 12, which is more than average population.  In this context, adults and especially children score lower than average on SRS. They can be very verbal about what they expect and what the clinician does. Challenges arise when clients are influenced by an interpreter’s reactions, which initially affected SRS due to alliance with clinician until training for interpreters was introduced. Very little resistance from clients to use FIT. Parents can be motivated by seeing and experiencing their children’s score.

David Prescott David Prescott

2. Criminal Justice FIT in Criminal Justice: Long Overdue 
David Prescott, USA
Background: In a 1974 essay, criminologist Robert Martinson famously asked “Does nothing work?” His preliminary analyses of data had found that rehabilitation efforts in prisons weren’t working and prompted widespread de-funding and elimination of services in the criminal justice world. His essay, which became the basis of the “nothing works” philosophy, was premature. Indeed, the following year, Martinson was part of a group of researchers whose findings were more encouraging (Lipton, Martinson, & Wilks, 1975). Martinson would subsequently reconsider his earlier statements (Martinson, 1979), but by then the damage was done, followed by decades of belief that criminals don’t change and that treatment doesn’t work. It would be roughly 15 years before improved statistical procedures revived rehabilitative efforts in the criminal justice field (e.g., Gendreau & Ross, 1987). Martinson’s story offers a vital reminder: political agendas and charismatic personalities are not the same thing as facts or findings.

Fast forward 30 years to 2014, and psychologists Therese Gannon and Tony Ward wrote an article provocatively titled “Where has all the psychology gone?” In it, they observe that treatment in the criminal justice system in the past several years has often had an overly narrow focus is specific areas, and does not consider the therapeutic alliance adequately enough (Gannon & Ward, 2014).

Some of the clearest examples of how treatment in the criminal-justice system can go wrong are found in the treatment of substance abuse and sexual offending. White and Miller (2007) wrote about inherent problems in adopting harsh and confrontational approaches. Many, but not nearly all, efforts to treat people who had sexually abused were overtly confrontational in nature (e.g., Salter, 1988).  In many ways, this presented professionals with dilemmas. Confrontational professionals often maintained seemingly straightforward relationships with their clients, even as Jenkins (1990) noted that many clients who have been violent can interact in subtly provocative ways that appear to “invite” their therapists to interact with them in a violent way. On the other hand, while many professionals working in the 1980s and early 1990s received explicit instruction on harsh confrontation that would have been considered completely unacceptable in more traditional mental health settings, they did not learn how to develop a relationship, much less agreement on the goals and tasks of the treatment experience itself.
This chapter illustrates how, contrary to historical wisdom, actively engaging criminal-justice clients in treatment is critical to successful outcomes.  Psychoeducation, such as that provided to domestic violence perpetrators or drunk drivers, may be necessary but is far from sufficient to making interventions meaningful. Ultimately, decades of research has shown that imposing a crime-free lifestyle onto a person does not make him or her safer. Indeed, a large meta-analysis (Parhar, Wormith, Derzken, & Beauregard, 2008) found coercive, mandated treatment methods to be generally ineffective. A central problem in current methods of treatment provision is that professionals can make highly inaccurate assumptions about their clients’ experience of treatment (Beech & Fordham, 1997).

A rich body of research has found that programs adhering to effective correctional principles (i.e. those of risk, need, and responsivity) have the greatest effect on criminal re-offense. These principles, championed by Andrews & Bonta (2010), have explained the success and failure of numerous criminological interventions. Simply put, the risk principle holds that the majority of treatment resources should be allocated towards those who pose the highest risk. The need principle holds that interventions should focus on treatment goals demonstrated to be related to criminal re-offense. The responsivity principle holds that interventions should be tailored to the individual characteristics of each client. This last principle – responsivity – can be the most confusing and challenging for professionals to accomplish. At its most basic level, the responsivity principle includes matching treatment to specific client features such as intelligence and learning style. At a more challenging level, responsivity involves a deep understanding of, and respect for, each client’s motivation to change and the barriers the might hinder meaningful engagement in treatment (Melton, this volume).

Presentation: This workshop with review how FIT can work in treatment programs within the criminal justice system, including both within institutions and in community-corrections settings. It will review practical implications of implementing FIT in practice and across programs in the criminal just world, as well as the importance of autonomy support on which FIT rests.

Learning objectives:

  • Review what works in criminal justice treatment programs
  • Review principles and concepts that make FIT work in criminal justice
  • Review practices that don’t work when implementing FIT
Workshop handouts:.

3. Use of FIT with People with Disabilities
Patrik Ulander, Sweden
Summary: Beginning in the summer of 2017, Misa AB has implemented FIT as a way to track client progress delivering supported employment to people with various disabilities. The presentation will cover experiences from the implementation process and aspects from both clients and job coaches of using FIT in a welfare environment, as opposed to a therapeutic one. I will also talk about introducing FIT in an agency operating in a social care system with low external demand for outcome based measures.

Kerstin Öqvist Kerstin Öqvist

4. Implementation
Kerstin Öqvist, Sweden
This workshop will cover important considerations and building blocks during an implementation of Feedback Informed Treatment. The workshop builds mainly on the presenter's experiences from Framtid Stockholm during 2010-2016. Framtid Stockholm is an agency that works with teenagers with risky behavior, substance abuse, and criminality and also offers victim support. Discussion will include success and risk factors along with a broad approach to implementation from the smallest practical details to the larger feedback culture. While implementation can be a mix of fun, complexity, and hard work, participants will leave inspired.

Kerstin is a social worker, consultant and FIT-trainer. She has primarily worked with teenagers with risk behavior and their families at Maria Ungdom in Stockholm where she has been involved in implementing Feedback Informed Treatment (FIT). She is currently a consultant at local social services, assigned to different municipalities. Kerstin came in contact with ORS & SRS back in 2002 and is now working with FIT as a practitioner, trainer and supervisor.

5. Meta -analysis of data from ORS/SRS
Ole Karkov Østergård, Denmark
What is the effect of using the Partner for Change Outcome Management System (PCOMS) in psychotherapy? Preliminary results from a systematic review and meta-analysis.

PCOMS is a promising candidate for enhancing the overall effect of psychotherapy, maybe especially for patients’ not-on-track (NOT) of a good outcome or in risk of dropping out. PCOMS has been supported by several randomized clinical trials (RCT) and is included in the Substance Abuse and Mental Health Administration’s (SAMSA) National Registry of Evidence-based Programs and Practices. However, more recent effect studies have shown inconsistent results, seriously questioning the evidence base for PCOMS. This workshop will present the results of the first meta-analysis focusing solely on PCOMS including about 15 controlled or randomized controlled trials. What is the overall effect of using PCOMS? What is the dispersion of the effect from study to study? Is it possible to explain this dispersion in effect by study design, outcome measure,patient population, the way PCOMS was used and implemented, or by allegiance effects? What are the changes, that you will improve your effectiveness, if you implement PCOMS at your clinic? And finally, does PCOMS especially improve the outcome for NOT cases?  For further information about the study methodology, please see protocol CRD42017069867 published at PROSPERO. 

Ole Karkov Østergård, licensed psychologist and PhD fellow at the Department of Psychology and Behavioural Sciences, Aarhus University.

6. The impact of working with feedback together with clients and substance abuse.​​​​​​
Gun-Eva  Andersson Långdahl, Sweden
Working with addiction and substance abuse? This workshop is for you.
  • How can we develop our skills by working with clients feedback.
  • What impact does clients feedback have on you?
  • How do we continue to develop our skills?
  • What are the most common questions working with ORS/SRS in the meeting with clients with addiction?
 This is an interactive workshop lead by:
 Gun-Eva Andersson Långdahl, Licensed Psychologist Specialized in Clinical and Pedagogic Psychology

ORS/SRS Handbook (in Swedish) :

15.00-15.45 Workshop session 2.2

 1. FIT in a physiotherapeutical/medical setting
Charlotte Krog, Denmark
The physiotherapist's primary biomedical education seems to limit the study and treatment focus solely to biomedical factors. This may adversely affect the patient's confidence with the "training / activity" intervention administered by the physiotherapist. The use of Feedback Informed Treatment allows for a more reflective BioPsychoSocial approach. This gains increased insight into and understanding of the patient's psychosocial factors influence and contribution to the patient's overall presentation. This, together with the patient-therapist alliance, has a decisive effect on the treatment and access to a person who is bothered by “chronic” musculoskeletal problems.

Charlotte Krog, Pt. Dip. MDT, Specialist in Musculoskeletal Physiotherapy, Master in Positive Psychology (MoPP)

Jason Seidel Jason Seidel

2. FIT in Private Practice, Process-oriented Group Therapy, and Long-term Therapy
Jason Seidel, USA
Many therapists in private practice have the advantage of being the front-line clinician and practice administrator. Having this much control over how FIT is integrated into one’s practice creates a playground for adaptation and substantially better service than other therapists provide. Vignettes about client reactions to different instruments, different modes of administration, and its use in long-term therapy, group therapy, couples therapy, child therapy, and process-oriented group therapy, will demonstrate the wide range of options and the therapeutic impact of integrating FIT into psychotherapy.

Bill Andrews Bill Andrews

3. Wendy, 10 years on 
Bill Andrews, United Kingdom
Many who have seen Scott Miller present over the years since 2008 may be familiar with Wendy, a therapist who provided an excellent example of FIT in practice. Bill Andrews, from the Pragmatic Research Network, is a colleague of Wendy's and provided that original material back then. Since the exciting exuberance of 2008 there have been many new studies that have considerably toned down the early claims that were made about the incredible gains in treatment effectiveness through working with feedback on outcome and alliance. In this presentation Bill discusses, amongst other things, some of these findings in a recent interview with Wendy, 10 years on. 
How does she think about her work these days? Where is she now professionally? What's changed in her perspective; on FIT, on practice in general, on her assumptions she used to have? How does she react to the latest research findings?
Bill will use clips from his interview with Wendy to provoke discussion amongst the attendees. Come prepared to be surprised.

Liz Pluut Liz Pluut

4. Eliciting Feedback with young people
Liz Pluut, Nederland
Allthough collateral ratings are a sine-qua-non when using FIT with children, it may help to focus more on the age-related or developmentally-related differences in communicating with children about the scales and the notion of how to handle the "mandatory" issues involved. This workshop will focus on special issues involved when using FIT with children and adolescents, including examples of how the developmental age of children can influence the conversation about the scales. It is very important to pick up the signs from children of how they experience the treatment relationship. The feeling of being sent into therapy must also be understood.

Examples of how the therapist can handle these issues will be presented in a practical way.

Learning objectives:

  • Theoretical knowledge
  • Do’s and don’ts in the therapy room

5. Therapists' reactions to negative feedback 
Heidi Brattland, Norway
This presentation focuses on the situation that sometimes occurs in therapy – with and without the help of client feedback systems – when a client voices dissatisfaction with the therapist.

Diverse theoretical orientations acknowledge these situations to be highly potent and proscribe ways in which therapists should respond to move therapy forward. Feedback from clients could also benefit the therapists’ own professional development. In real life however, interacting with people who are critical of one’s performance can be quite challenging. Research on how therapists experience, react and respond to negative feedback is reviewed. In particular, when do we learn from our clients?

6. Feedback Informed treatment in psychosocial  and job rehabilitation programs in Denmark
Irene Bendtsen & Helle Obbekær, Denmark
In this workshop we will present how we use Feedback Informed Treatment with adults, who suffer from severe mental health problems – and how the use of FIT contribute to change in intervention and development for the client.

We will talk about the use of FIT in two different contexts:

  • In residential homes, where people stay temporarily
  • In short term focused job rehabilitation

In residential homes the professional intervention will focus on the activities of daily living and  supporting the residents in living as healthy and independently as possible.

In short term jobrehabilitation we prepare clients for returning to work and how to cope with severe mental health challenges both privately and at work. In this program we use network-meetings as part of the intervention. 
Helle Obbekær, consultant in Psykosocial rehabilitation programs in the city of Copenhagen. Irene Bendtsen, director at Center for Psykosocial Interventions in the municipality.

Von Borg Von Borg

7. The Working Alliance in Treatment of Adolescents
Von Borg, USA - Japan
The Working Alliance in Treatment of Adolescents.
The presenter's recently published study in the Journal of Consulting and Clinical Psychology examined the role of the working alliance in a sample of 2,990 military youth who were treated by 98 therapists. The study strongly suggests that growth in the working alliance in the initial sessions of treatment with adolescents is a positive indicator of therapy outcomes. The study also found significant therapist effects in the alliance, suggesting therapists’ ability to form sound working alliances over time is a key element to successful outcomes with adolescents. 

This session will review the research and highlight deliberate practices aimed towards benefitting therapists in the monitoring and continual promotion of the working alliance with adolescents, thereby allowing them to challenge the therapist in a manner consistent with their developmental stage in life and improve treatment outcomes. 

8. FIT in Out-patient Settings
Pauline D Janse, Nederland
This workshop reviews results of a study into the use of FIT in the context of out-patient care.

Aim:  Client feedback can have a positive effect on treatment outcome (e.g. Lambert & Shimokawa, 2011). The study investigates whether using the Outcome Rating Scale and Session Rating Scale (Miller & Duncan, 2004) as instruments for measuring feedback from clients improve results of cognitive behavioural therapy. Also, differences between therapists are investigated; the influence of big five personality traits, internal or external feedback propensity and the influence these factors have on treatment outcome will be investigated. Method. Results of two studies performed at a Dutch nationwide mental health organisation will be presented. 1006 patients outpatients participated in the first, quasi experimental, study and 353 patients in the second study, a rct. They were treated by over 50 therapists.

Results: In the first study results of multi level analysis show that treatment in both conditions was effective, but feedback did not improve outcome as measured on the SCL-90 except for patients with mood disorders. However, in the first study the amount of treatment sessions is significantly less in the feedback condition, indicating that treatment efficiency might be improved with using this feedback system. Results of the rct will be presented at the conference. Further data analyses in the coming months will also focus on differences in effectiveness of therapists. Implications of these results will be discussed.

Lambert, M.J. & Shimokawa, K. (2011). Collecting client feedback. Psychotherapy, 48, 72-79.
Miller, S.D. & Duncan, B.L. (2004). The Outcome and Session Rating Scale. Administration and scoring manual. Chicago, IL: Institute for the Study of Therapeutic Change.

Pauline D. Janse (MSc), Clinical Psychologist, Radboud University

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This program might be subject to change (until the very last minute) due to circumstances outside our control.