What are the implications of client-driven, outcome-informed intervention for training programs?
The dogmas of the quiet past are inadequate to the stormy present. —Abraham Lincoln (quoted in Shenkman, 1988).
This information is adapted from Chapter 8 of the book:
Murphy, J. J., & Duncan, B. L. (2007). Brief intervention for school problems (2nd ed.): Outcome-informed strategies. New York: Guilford Press. (www.guilford.com)
Consider how practitioners have traditionally been trained: In graduate school we are taught the content deemed necessary for competence, tested on that content, and ultimately retested on licensing exams. After graduation, the emphasis on the areas of content thought to promote competent practice persists as we are required to get continuing education to maintain state licensure.
Training programs also require students to be supervised in practicum settings—the field places great value on experience which is usually specified as hours of client contact. All states require participation in supervised internships and practice. Competent practitioners, therefore, are expected to emerge from training programs teaching specific content areas combined with supervised experience over time. Unfortunately, these methods have not been shown to matter much in terms of effectiveness (Sapyta, Riemer, & Bickman, 2005). Not training; not supervision; not experience—they have no impact on outcome! Why? Practitioners are trained in intervention models, are supervised, and practice in the absence of information about the response to the delivered services, especially from the client’s perspective. Making matters worse, practitioners are notoriously bad at determining their own effectiveness, predicting clients who are risk for negative outcome, and identifying a troubled alliance.
Given current training and licensing standards, it is theoretically possible for practitioners to graduate, obtain a license, and work their entire careers without ever helping a single person! Outcome-informed training programs would go a long way toward correcting this problem while offering protection to consumers. Training, licensure, and standards of care could involve ongoing and systematic evaluation of outcome—the primary concern of those seeking our services. Rather than evidence-based practice, practitioners can be trained to tailor their work to the individual client via practice-based evidence. Available evidence suggests that such feedback improves the practitioner’s effectiveness over time—people do learn and change when given the opportunity.
Several training programs across the country are requiring students to track outcome with every client they serve in practicum and internship. Building a culture of feedback with students—eliciting client perspectives about outcome and alliance to best tailor services—positions students to succeed in an evolving consumer-driven and accountability-focused world. Students find outcome-informed work a huge relief of the burden to be experts, knowing they can rely on clients to provide direction and keep them on track. Emphasizing effectiveness rather than competence in graduate training involves students in a paradigm shift—a shift that not only improves outcome one client at a time but also assigns those we serve key roles in the delivery of services.