The use of Feedback Informed Treatment (PCOMS) within an International Student Population Setting

Steve Taylor - Head of Faculty,Applied Social Practice

NTEC, Auckland, New Zealand

Training 21st Century Therapists:

International Student Population: Auckland

• $1.5 Billion in income (2% of Auckland GDP).

• 56,253 IFPS (2/3rds of the national IFPS total).

• China 31%; India 14%; South Korea 11%; Japan 10%.

• English Studies 41%; Commerce Studies = 28%

• PTE sector (like NTEC) attract 50% of this total income.

(Wilson, 2015).

NTEC – A Brief Introduction

• Please see Post-Card Summary.

• Celebrated 10 year anniversary in 2014.

• Now NZ’s largest Private Tertiary College (Aspire 2 Group).

• NTEC exists solely as a result of the high client outcomes itproduces – if we don’t achieve high client outcomes – we willcease to exist (No Govt funding).

• “Heart-ware” ethos infuses entire business model.

• NTEC CEO office? Right in the heart of “Student Central”.

NTEC Faculty of Applied Social Practice• Delivers an NZQA-accredited Diploma in Counselling &

Family Therapy (Level 6). Application via Skype Interview =40% declined application rate.

• First graduate cohort in 2014 = 100% allied health joboutcomes (e.g. Counselling, Social Work, CommunitySupport Roles).

• No employment roles secured insisted on professionalassociation membership status, although some advertisedthis preference (relationships, networks, W.O.M. rated >).

• Key role requirements on my arrival in April 2014: BuildFaculty; Secure student placements for an applied practicequalification; Achieve successful graduate job outcomes.

International Student Counselling Centre

• Resolution: We built our own agency for our Practicumstudents to provide service to other NTEC Faculties,campuses, and the wider Auckland International StudentPopulation.

• International Student Counselling Centre (ISCC): mediaattention instant (i.e. local press, and international Chinese &Indian TV).

• Provides Counselling and support to international students,under internal and external Supervision, utilising FIT /PCOMS client outcome measures (SRS & ORS).

“Counselling?”: Ooops!

• The use of the word “Counselling” in the agency title was aBIG barrier to target population service engagement.

• International students (or any migrant population) presentvarious challenges to social service engagement (Najmi,2013).

• Changed the agency name to International StudentSupport Centre (ISSC), lessening any sense of “stigma” forclients.

If you build it, they will come? YEAH / NAH!

• Very slow uptake initially, owing to cross-cultural stigma of“asking for help”.

• Revelation: “We have to go to them!”.

• Question: How does one offer a high standard Pastoral Careservice to a population of nearly 3000 students, so as tobetter ascribe to the International Code of Pastoral Care,whilst working to identify risk within an at times veryvulnerable population, when said population is reluctant tocome and talk to you (especially in English, when it is a 2nd

or 3rd language?).

Answer: Formalised Early Intervention

“Success Navigator” Assessment introduced in 2015.

30 minute online assessment for all NTEC students, measures:

• Academic Skills — behaviours, beliefs and skills that directlyfacilitate academic success.

• Commitment — commitment to, drive toward and perceivedimportance of academic success.

• Self-Management — ability to anticipate and respond to pressureand stress related to college life.

• Social Support — availability of resources to support academicsuccess.

ISSC Success Navigator Process

• Conduct the SN assessment with each NTEC intake (6intakes per year).

• A student report in the 4 key categories is produced.

• Identification of any potential / actual risk factors.

• Appointment made with each NTEC student to discussreport results, and provide Counselling, support, andassistance as may be required.

• Each session FIT / PCOMS (ORS, SRS) measured,assessed, case noted, and outcome-tracked (ASIST).

So……..what happened?

1/ Consistent with research, we discovered that para-professionals (read “Counselling students”) could achieveclinically significant client improvement outcomes, on paror superior to seasoned practitioners in the field.

(Atkins & Christiansen, 2001; Nyman, Nafziger, & Smith, 2011;Ericsson, Charmess, Feltovich, & Hoffman, 2006; Malouff,2012; Miller & Hubble, 2011).

So………….what happened?

2/ Consistent with research, we discovered that culture,gender, age, sexual orientation, qualification, professionalmembership status, Supervision attendance, or languagematching across 30 cultures and dozens of languagesbetween Counsellors and clients were all irrelevant toachieving positive client outcomes: Counselling studentsjust got on with the business of one person helpinganother person, who ever and however someone presentedfor service.

(Miller, Hubble, & Duncan 2007; Chow, Miller, Seidel, Kane, &Thornton, 2015).

So………what happened?

3/ Consistent with research, we discovered that we didn’trequire the arbitrary, non-evidenced based practicerequirements of various voluntary-to-join professionalassociations to be successful in, or to legitimise our work,or for our graduates to secure jobs (e.g. a minimum ofpractice hours, or minimum Supervision exposure, ormandated cultural supervision, or membership of…….).Establishing a baseline, securing feedback, and utilisingdeliberate practice to improve, student by student, andclient by client, is becoming an embedded part of thestudent training process in the NTEC Diploma inCounselling.Beutler, Malik, Alimohamad, Harwood, Talebi, & Noble, 2004;Miller, Hubble, & Duncan, 2007; Miller, Hubble, Chow, andSeidel, 2013).

ISSC Client Outcome Results (30/6/14 – 10/11/14)

• ISSC Student Counsellors = 9

• Completed appts sample size = 142

• Average Change (Effect Size) = 0.7

• Aggregate Change (Effect Size) = 0.65

• Percentage of clients reaching ASIST baseline = 82%

• Drop-out rate of clients contacted: < 10%.

Remember my role goals at the beginning?

• “Build Faculty”: 500% role increase in 18 months, with anadditional student cohort now being considered for theFaculty.

• “Secure student placements for an applied practicequalification”: Students have access to their own on-siteagency under Supervision, and Feedback InformedTreatment (PCOMS) methodology.

• “Achieve successful graduate job outcomes”: 100% of 2014graduates now working in paid Counselling, Social Practice,Healthcare, or Allied Health roles.

Improvements ISSC made since 2014:

• Appointment of an ISSC Lead Student Counsellor.

• Appointment of a dedicated SN Facilitator.

• Presenting issues screen tagged to SN assessment.

• ISSC Phone screening process, post SN assessment.

• Appointment follow-up is now at 44% of student population(we need more ISSC student Counsellors – does anyoneneed an Auckland student placement?).

Why “21st Century Therapists” need to embrace formal routine

client outcome measurement

• Results Based Accountability / Payment by Results.

• Funders want more, for less, within quite strict parameters(See Relationships Aotearoa demise).

• Clients want results, and will vote with their feet if they don’tget them.

Why “21st Century Therapists”….(Cont.)

• Getting better at what we do, by measuring how we do it,and working out how we can improve, by privileging theclients voice in the process, is a great example of “bestpractice”.

• Therapists (and particularly Counsellors & Psychotherapists)risk extinction / assimilation if they don’t start providingevidence of their client outcomes.

• Because when graduates go for a job interview in the future,they will need to have valid, reliable, and consistent evidenceof their client outcomes alongside their grades and CVs inorder to be “market-competitive” for available work roles –ours already do.

Presentation References

Atkins, D.C., & Christiansen, A. (2001). Is professional training worth the bother? A review of the impact of psychotherapy training on client outcome. Australian Psychologist, 36, 122-130.

Beutler, L., Malik, M., Alimohamad, S., Harwood, T., Talebi, H., Noble., S. (2004). Therapist variables. In M.J. Lambert (Ed.), Bergin & Garfield's handbook of psychotherapy and behaviour change (5th ed., pp 227-306). New York: Wiley.

Chow, D., Miller, S., Siedel, J., Kane, R., & Thornton, J. (2015). The role of deliberate practice in the development of highly effective therapists. Psychotherapy, Vol 52(3), Sep 2015, 337-345.

Ericsson, K., Charmess, N., Feltonvich, P., Hoffman, R. (eds.). (2006). The Cambridge Handbook of Expertise & Expert Performance (pp 683-704). New York: Cambridge University Press.

Malouff, J. (2012).The need for empirically supported Psychology training standards. Psychotherapy in Australia 18 (3), 28-32.

Najmi, S. (2013). A qualitative exploration of international students experience of counselling services at University. Canada: University of Ottawa.

Miller, S., Hubble, M., & Duncan, B. (2007). Supershrinks: Learning from the fields most effective practitioners. Psychotherapy Networker, 31 (6), 26-35.

Miller, S., & Hubble, M. (2011). The road to mastery. The Psychotherapy Networker 35 (2), 22-31.

Miller, S., Hubble, M., Chow, D., & Seidel, J. (2013).The Outcome of Psychotherapy: Yesterday, Today, & Tomorrow. Psychotherapy 50 (1). 88-97.

Nyman, S., Nafziger, M., & Smith, T. (2011). Client outcomes across counsellor training levels within a multi-tiered supervisionmodel. Journal of Counselling & Development, 88, 204 – 209.

Wilson, R A (2015). Industry snapshot for Auckland: international education. Auckland Council technical report, TR2015/001

Thank You