Prompts Keep Counselors, Clients on Same Page in Therapy

Faced with the challenge of both counselors and clients being pulled in a multitude of directions, the leadership team at Community Medical Services has developed a system for helping all parties involved in treatment to occasionally recalibrate.

At the upcoming National Conference on Addiction Disorders West, Mark Schaefer, EdS, MA, vice president of the organization’s Northern Territory, will discuss how CMS has created a series of topics to serve as discussion prompts in therapy sessions and solicited feedback from patients and staff to make sure the topics are useful and relevant.

Ahead of his presentation in Denver, Schaefer gave Addiction Professional a glimpse into the development of the topics and how they have evolved.

Editor's note: This interview has been edited for length and clarity.

Tell us a bit about your process for developing these core topics, disseminating them to staff, and ensuring they’re being used in therapy sessions.

What we do right now is we have a town hall where all staff are invited on Fridays. We have about 600 employees, 200 of those are counselors. We get about 250 people in the town halls, a mixture of counselors and other staff. Each week in the town halls, we do a 5-minute session where we share feedback. … Sometimes, there are comments where people say, “I didn’t find this useful” or “clients enjoyed this.” Then, we present the next weekly topic, and we have a counselor, clinical coordinator or supervisor talk about the topic and how they would use it in a session. If it’s grief and loss, it might be, “There are a lot of different forms of loss, and this is how I might talk to somebody about it.”

On Monday, we send out the topic with a blurb about it. What we found was, at first, we were saying, “This is the one you have to use this week.” The feedback we got was, “This wasn’t really relevant this week to my client. I wanted to use another one.” We were forcing them to use ones that weren’t applicable. … Then, we made it where it’s more of a reminder—relapse prevention and triggers every quarter, but grief and loss twice a year. There is a holiday series we do toward Thanksgiving and Christmas. The repository for these is there all the time. Staff can go in any time and look up any topics and pull ones they want to use. … We do a topic each week to remind counselors about them, but it’s optional whether they use those specific ones that week.

What makes feedback from both clients and staff so important, and what is your process for obtaining quality, useful feedback?

We are trying to provide staff and clients triggers for things we know are important to discuss. Our first questions were how do we make these useful and how do we get them to actually use them? We wanted to make it clear to staff that we thought this was valuable, so it was important to get feedback from them. It has changed as we’ve gone through. The 1-page topics we provide are very short and simple. … As an example, we did a topic on voter registration. The idea came up in leadership and we said this is a great topic because it’s important for people to be registered so they can vote. The feedback we got was that nobody liked it. Nobody wanted to use it, and for those who did, it caused problems. It’s a divisive subject, even registration. We modified our approach, and when it came up again 6 months later, someone said, “Hey, I know we did the voting thing, let’s look at that,” and we said, “Here’s the feedback we got. The staff, the clients, nobody liked it.”

We reach out to staff and clients. … We will get sometimes where a number of clients will say they haven’t had a certain discussion. That tells us one thing where we’re able to say, “Hey, just want to make sure people are reaching out and having these discussions.” 

Can you share some examples of how this process has ultimately improved care?

Initially one of the biggest pain points was getting client feedback. We have 9 states we serve, and about 18,000 clients. Trying to get a sampling across all of those states and clients to really represent who is being served was difficult. We have a call center that works out of Arizona. We were able to get some dedicated staff. … We pulled a sampling of notes from our data warehouse. We were able to provide them with around 200 to 300 random clients. They will just call those clients. Then, it was capturing that data.

At first, we asked too many questions, and clients said they didn’t have time. We narrowed it down to, “Did you talk about one of these topics?” and “Did you find it useful?” and any comments they might have. We were getting about 40 responses out of 200, a decent percentage answering those questions. For staff feedback, honestly, it’s still a pain point. The survey we send out each week is similar to what we send clients. The questions are “What’s the main topic you used?” and “Did you find it useful?” and any comments you have to improve it. Our response rate would dwindle over time. We would see 25% to 30% of counselors responding. We’ve found we have to do different surveys. This sounds crazy, but one of the surveys we did was for typing speed. We had people take a 2-minute typing challenge. It was completely unrelated and provided no feedback, but it helped to re-engage staff. Other times, we’ve asked counselors about their caseloads. We’ll ask, “When you look at your caseload, what percentage of your patients would you say are at risk of dropping out of treatment or struggling with treatment? What percentage are looking at tapering out of treatment?” That has helped, but we still have to constantly monitor.

Recently, we revamped and added 4 new topics. We have several topics we use throughout the year, but we wanted to look at what we were missing. We continually get those too. That’s helped, but it’s still a work in progress.