In this historical series of blog posts, the previous post shared the road to scientific credibility via the first 3 randomized clinical trials and the designation of the Partners for Change Outcome Management System (PCOMS) as an evidence based practice. This blog addresses the RCTs since then and how they broadened the applicability of PCOMS across client populations and problems.
While we were very excited about the results of our initial studies, we knew we needed to continue investigation. We believed there to be no reason why PCOMS wouldn’t be useful for any client population or any therapeutic modality, but we also knew we would have to prove it if the ideas were to be widely disseminated. Critics and naysayers could always present the now classic question: “That’s all fine and dandy, but what about (fill in the blank with this or that population or this or that modality of service)?"
But What About Mandated Clients and Substance Abuse?
This is a legitimate question and given my love of working with mandated clients, I was anxious to confirm my own experience. But the question itself belies a misunderstanding of mandated clients, being that they want the same things as voluntary clients: to have a voice and benefit from therapy. And the alliance functions exactly the same way with both mandated and voluntary clients; i.e., it predicts outcome. Thanks to Don Schuman (Schuman, Slone, Reese, & Duncan, 2015), we addressed this question directly.
- Two hundred sixty-three returning Iraq and Afghanistan soldiers, or those about to be deployed, were mandated to group substance abuse treatment, either PCOMS or treatment as usual (TAU).
- PCOMS clients achieved significantly more improvement, higher rates of clinically significant change, higher ratings of success by blinded commanders, and attended more sessions.
- Bonus: Forty two percent of the sample were from minority populations and ORS results were corroborated by blinded commander ratings. This study also addressed the next question.
But What About Group Therapy?
- Thanks to Norah Chapman (Slone, Reese, Matthews-Duval, & Kodet, 2015), this study confirmed the applicability of PCOMS in group therapy.
- Eighty-four group therapy participants were assigned to PCOMS or TAU in a university counseling center.
- Feedback participants had significantly larger pre–post group therapy gains (d = 0.41) and higher rates of reliable and clinically significant change when compared to TAU.
- Bonus: Clients in the PCOMS condition also attended more group sessions compared to TAU participants.
What About Eastern Cultures?
- Thanks to Zhuang She (She, Duncan, Reese, Sun, Shi, Jiang, Wu, & Clements, 2018), this study examined the impact of PCOMS in a college counseling center in Wuhan, China (N = 186).
- Clients in the feedback condition demonstrated significantly greater improvement than those in the TAU condition at posttreatment: Six times the rate of reliable change.
- 67% of the clients in the feedback condition achieved reliable and clinically significant change after a median of 4 sessions whereas 57% of the clients in the TAU condition achieved reliable and clinically significant change after a median of 6 sessions.
- PCOMS not only a Western phenomenon.
- Bonus: Alliance scores improved significantly more across treatment and were higher at posttreatment in the feedback condition.
What About Children?
- Thanks to Mick Cooper (Cooper, Duncan, Golden, & Toth, 2019), this pilot study looked at children aged 7-11 years old and compared play-based counseling with and without PCOMS (N = 38).
- Using the Strengths and Difficulties Questionnaire (SDQ), PCOMS kids showed significantly greater reductions in parent completed total difficulties with advantages in all outcomes in favor of PCOMS.
- This study confirmed the results of an earlier cohort study of 288 children that found significantly improved outcomes for PCOMS over TAU, also on the SDQ (Cooper, Stewart, Sparks, & Bunting, 2013)
- This was a pilot study and we are in the beginning stages of a large study in the schools in the UK.
- Bonus: Some say that the PCOMS is only suited to brief, solution, or problem-oriented approaches. This study addressed play therapy and still realized a significant advantage of PCOMS.
Do you see a pattern here?
But What About Integrated Care?
More on this groundbreaking, hot off the presses RCT in the next blog. But why wait? Set up a free trial now of Better Outcomes Now and check in with your clients to improve both your effectiveness and efficiency.
And don’t forget about the upcoming Training of Trainers Conference (TOT). Made for night owls (from 6-9PM Eastern) and colleagues from the other side of the planet. Also, check out the new TOT scholarship, the Dr. Bob Bohanske Memorial Scholarship for Inclusion and Equity.