Health Workforce Innovation Fund – Pilot on Client
Directed Outcome Informed Approach
Outline
 What preconditions support a client directed approach
– the journey of Wesley Community Action
 What is CDOI and its research base
 The Health Workforce Innovation Fund Pilot research,
method and findings
Preconditions for Client Directed
Approach - Wesley Community
Action’s Journey
 St Lukes training – 2002
 Intentional strength based practice – 2003
 Leadership – confirming SB approach
 SB conference 2007 Palmerston North – presentation Dr
Barry Duncan
 Wesley Way 2011 – organisation practice framework.
What is CDOI?
Client Directed Outcome Informed is an interaction where;
 the client’s voice is privileged
 recovery is expected and
 the worker purposefully forms a relationship based on their
client’s theory of change.
It is the only consumer rated outcome tool that is empirically
validated.
The research base –
Treatment
Depression Collaborative Research Project
Considered to be the most sophisticated
comparative clinical trial ever conducted
Four approaches (CBT, IPT, Drug, Placebo)
No difference in outcome between
approaches. The client’s rating of the
alliance at the second session, the best
predictor of outcome across conditions.
Elkin, I. Et al. (1989). The NIMH TDCRP: General effectiveness of treatments. Archives of General
Psychiatry, 46, 971-82.
Evidence based practice and
Practice based evidence.
9 randomised clinical trials show the
effect of feedback
It is the single most important thing
you can do differently
Factors accounting for successful outcomeMichael Lambert
Common Factors
Relationship
Spontaneous Remission
Client/Extratheraputic
Placebo/Hope/Expectancy
Models/Techniques
International Research
 Length of stay in psychotherapy was reduced by 40 percent to 50
percent across a broad range of behavioral health services
(Bohanske &
Franczak, 2010; Duncan, Miller, Wampold, & Hubble, 2010; Miller, Duncan, Sorrell, & Brown, 2005).
 Cancellation rates declined by 40 percent and no-shows by 25 percent
(Bohankse & Franczak, 2010; Duncan, Miller, Wampold, & Hubble, 2010)
.
 Child & Family Services in South Florida. Based on 2100 cases during a
recent 2-year period CFS reported a decrease in the average number of
sessions by 40%, dropouts decreased by 40%; no-shows decreased by
50%; cost savings estimated at $494,600.00. (Dave Claud, this listserve.
Norway Study – Couple Therapy
 Key Finding - Feedback v Treatment As
Usual; Over doubled effectiveness;
Effect Size: 0.5; 4 times # of clients
reached clinically sig. change
Anker, M., Duncan, B., & Sparks, J. (2009). Using client feedback to
improve couple therapy outcomes: A randomized clinical trial in a
naturalistic setting. Journal of Consulting and Clinical Psychology,
77, 693-704.
HWIF - Methodology
• Dr Barry Duncan completed 2 day training for staff
within:
• Wesleyhaven (residential aged care)
• Counselling service
• Youth services
• Older People Community Services
• Drug and Alcohol Services
• Independent Evaluator interviewed staff before
training and after the pilot and 8 months post training
• Focus on how CDOI contributes to; staff retention,
access to additional training, and staff satisfaction.
HWIF Pilot - Findings
 “In the end of project survey, 74% of respondents
agreed that CDOI enhanced their practice. Examples
of this described in interviews centred on using all of
the time available on clients’ concerns, getting to
issues that had previously been missed, and
accountability.”
 “By the end of the project 91% of staff surveyed
thought that using the CDOI tools had benefits for
clients”
Quotes from Staff in Findings
 “[The tools] hold us really accountable, when there is a
change in the ratings, it holds us accountable for
following things up – which is important – to do what
you say you will. “
 “It has added to my satisfaction with work in a way,
made me more aware of residents’ individual needs –
just by talking and sharing you can find out [things]
that are beneficial for residents. It does make a
difference – people open up and give us a better
understanding.”
Quotes from Staff in findings
“Using CDOI does get older people to concede that
forward movement is possible.”
“It has led to better use of the time. Before we use to talk
about everything under the sun, now straight away we
are onto the client, their issues, and we get to issues I’d
missed, the conversation we have brings it out, all the
issues for clients.”
“Residents do want to please you, but when you sit one to
one and focus on things relevant to them, that's when
they start to share (their real concerns).”
Evidenced based practice – WCA has found out
 WATCH Programme:
Number of Tauira attending three or less appointments
reduced from 58% to 15%
 Counselling Service
Number of no Shows reduced from an average of 14 per
month to 5 per month
WCA Tauira Speak
Further information
 On CDOI – www.heartandsoulofchange.com
 On CDOI - New Zealand focus www.wesleyca.org.nz
 HWIF pilot report – www.healthworkforce.govt.nz and
www.wesleyca.org.nz