MBC Module 3.docx

**Module 3: Using MBC in Practice -- Share and Act** Module 3: Module Overview In this module, you will continue to learn about using MBC in practice through the share and act parts of the STAY model described earlier. You will continue as a service provider being introduced to MBC by Rayan, and o...

**Module 3: Using MBC in Practice -- Share and Act** Module 3: Module Overview In this module, you will continue to learn about using MBC in practice through the share and act parts of the STAY model described earlier. You will continue as a service provider being introduced to MBC by Rayan, and observe Zara, and Samira, as they work with Max. Through audio and video, you will see examples of MBC in practice. **Learning Objective** - Understand the tasks involved in the share and act components of the STAY model - Apply your knowledge of the share and act components of the STAY models to a case study. Share **What Is Share?** The share component is the third phase in the STAY model. It focuses on sharing the results from the measures with youth. This should be done in a timely way as a discussion between the service provider and client (Connors et al 2022). You and the youth will interpret the results together, discuss any changes observed, and relate these findings to the youth\'s goals. The sharing of information is done in a way that respects the youth\'s capacity for understanding and engages them as active participants in their care, reinforcing the therapeutic alliance and promoting transparency. You can review whether the surveys show any improvement, no change or a worsening of symptoms and explore the client's thoughts as to what might be impacting their trajectory (Barber & Resnick, 2022). During share, it is important to check to see if the scores match how the client is feeling and to explore that further if necessary (Barber & Resnick, 2022). Do the results match their own sense of their progress? If not, you can explore that with them to find out which results are more accurate and what is contributing to the discrepancy (Connors et al 2022). **TIP:** Motivational Interviewing skills are helpful during this phase to demonstrate curiosity and a nonjudgmental attitude. (Barber & Resnick, 2022). Why Is Sharing Results from Measures with Youth Important? MBC is not a data-only approach. It is a client-centred approach that uses measurement to help facilitate discussions. You already know the overall benefits of MBC, but when you share data with youth, there are even more benefits for youth and their care. Enhances awareness and understanding of functioning and progress Sharing feedback from measures helps youth gain greater awareness of their symptoms, functioning and goals (Fortney et al., 2017). It can also help youth recognize improvements in their progress that they may not have noticed. This may help youth feel more optimistic and can encourage them to continue to work toward achieving their goals (Fortney et al., 2017). ------------------------------------------------------------------ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- Promotes active participation and a client-centred approach Sharing feedback from measures helps to empower youth to take control of their care decisions by providing them with the data needed to make informed decisions (Fortney et al., 2017; Guo et al, 2015; Eisen et al., 2000). This puts them in a position to make collaborative decisions about their care and to reflect on their progress, rather than the service provider making decisions on their behalf. Builds the therapeutic alliance Open communication helps with improving therapeutic alliance and trust with the provider, which can lead to both an improved experience with services and overall care outcomes as well (Fortney et al., 2017; Lewis et al., 2019; Scott & Lewis, 2015). Validates experiences Sharing results from measures can help youth feel like they are being heard and understood (Fortney et al., 2017). How Do You Share Results from Measures with Youth? There are many considerations of how to share results from measures with youth. These will be influenced by decisions around how you introduced and collected data. Consider the importance of sharing as it influences how you implement the components. Here are some components for consideration in this step: +-----------------------------------+-----------------------------------+ | Review measures in advance | Service providers review measures | | | ahead of each session with youth, | | | looking at individual responses | | | and/or summary scores and | | | graphs/reports. | | | | | | Digital measures make sharing | | | between youth, service providers, | | | and the youth's circle of care | | | easier. MBC platforms are | | | software that is used to | | | implement MBC by supporting data | | | collection from measures, sharing | | | data, and presenting feedback to | | | help providers with care | | | decisions (Bickman et al., 2012). | | | MBC platforms make it easier to | | | administer MBC by reducing the | | | need to input data, easing access | | | to data, and by presenting | | | results of data to providers and | | | youth in a meaningful way. | +===================================+===================================+ | Review together with youth | Service providers share and | | | discuss the responses with the | | | youth, ensuring that the youth | | | understands the results. This | | | step is essential for engaging | | | the youth in collaborative, | | | nonjudgmental dialogue, as it | | | offers them an additional way to | | | share how they are doing, discuss | | | changes, and address any progress | | | or setbacks that they experience | | | (Barber & Resnick, 2022; | | | Jensen-Doss 2020). | | | | | | It also reinforces the purpose of | | | completing measures and is part | | | of a partnership between youth | | | and service provider. Sharing | | | results allows youth and service | | | provider to collaboratively | | | address youth needs and goals and | | | track their progress. Simple | | | visual aids such as pie graphs | | | and line graphs can be used to | | | provide an easier way to | | | communicate with youth their | | | measures data (Lambert, 2010; | | | Brooks et al., 2021). | +-----------------------------------+-----------------------------------+ | Verify that data reflects youth | Service providers and youth work | | experience | together to reflect on whether | | | scores and responses match the | | | youth's experience and progress, | | | gaining further insight into how | | | the youth is doing and what they | | | are going through, including | | | information and experiences that | | | might not be captured by the | | | measure(s) being used. Here, MBC | | | is used as a starting point for | | | deeper reflection and | | | conversation (Barber & Resnick, | | | 2022). | | | | | | This step also gives service | | | providers a chance to confirm | | | that youth understand measures | | | questions. If youth are having | | | trouble understanding important | | | concepts or terms, service | | | providers can flag this and work | | | with other staff to give youth | | | more support/education (Barber & | | | Resnick, 2022). | +-----------------------------------+-----------------------------------+ | Capture the data | Sharing ensures that data is | | | recorded in the appropriate | | | medical record. Points discussed | | | can be written in progress notes | | | for future sharing with | | | individual youth and summarized | | | centre data used for quality | | | improvement (Barber & Resnick, | | | 2022). | +-----------------------------------+-----------------------------------+ What Do You Do if the Results Do Not Match the Youth's Experience? **You:** I was thinking back, and I've used screeners a few times before, but not routinely. I also didn't communicate the results back to the youth. I'm wondering, what should I do if what the results they filled out don't match what they're saying in session? **Rayan:** While the measures we use are evidence-based, we are all still human and there might be a change from how someone feels from the moment they fill out a screener to your discussion with them. This does not make MBC any less effective and, in fact, provides a great starting point for discussion. Watch how Samira handled a similar situation with Max in the middle of their fourth session online. What Do Youth Have to Say About Sharing Results from Measures? According to Youth4MBC Council, youth may appreciate time to review results on their own before reviewing it together with the service provider. Service providers should review the results ahead of time so that they are prepared. Rather than assuming how youth interpret the results from measures or jumping to discuss service providers' own conclusions, discussions should be opened nonjudgmentally and time should be provided for youth to mention their thoughts after seeing the results. In addition, youth suggested focusing on their emotions in addition to the scores alone. They also indicated that having specific measures would help the discussion (e.g., using a feelings wheel while discussing emotions, highlighting, or marking dates when there was a change to their care). Youth also asked that service providers keep discussions with youth focused on their strengths even if their scores are showing that they had a difficult week. Asking about ways youth coped with the difficult week and acknowledging and reinforcing strengths will likely help them get through the difficult symptoms moving forward. Act **What Is Act?** **Act,** the last phase of the STAY model, uses measures informed by youth, families/support people, and clinical judgment, to make collaborative decisions about care to best support youth needs/goals. The **act** stage is comprised of three key steps: a. **Review data over time:** Over time, service providers assess any change in data collected to understand the progress of care. This involves determining whether key scores or responses have improved, worsened, or remained the same, and discussing what led to these changes. Like during share, service providers review this trajectory with youth to verify it reflects their experience (Barber & Resnick, 2022). b. **Collaboratively determine if care should be adjusted:** Service providers talk with youth, sharing ideas and discussing the best way to move forward (i.e., not making changes, adjusting intervention or changing the intervention altogether) based on MBC data and experience (Barber & Resnick, 2022). c. **Agree on a plan of care:** After reviewing the data and brainstorming next steps, service providers and youth reach a shared decision on whether adjustments to their (initial and/or continuous?) plan of care are needed. This plan is then documented in the youth\'s record, with target timelines and which measures will be used to track progress (Barber & Resnick, 2022). Why is Acting on Results from Measures with Youth Important? MBC is a dynamic process which goes beyond simply collecting data. An important part of MBC is using this data in a collaborative way with youth to help inform plans for, and adjustments to, care. Here are some benefits: Enhance the therapeutic relationship between youth and provider Discussing results from measures and youth brainstorming with providers about how their care can be adjusted can help improve the therapeutic relationship with providers which can have positive impacts on outcomes (Lewis et al., 2019; Scott & Lewis, 2015; Fortney et al., 2017; Jensen-Doss et al., 2020). ----------------------------------------------------------------- ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Care is tailored toward youth Allow youth to discuss what is working and isn't working for them within a structure which allows for personalized modifications to their care, particularly as evidence-based practice incorporates client preferences. Enhance youth buy-in into care If youth are part of deciding care adjustments and have a sense of control, they may be more likely to follow through with those changes (Fortney et al., 2017; Hayes et al., 2020; Knaup et al., 2009). Empower youth Allows youth to take an active role in their care which can help empower them to take more ownership of their care and goals. Why Should Providers Act on Measures Results? Providers check in with youth on an ongoing basis to see how data is trending and how that corresponds with how the youth feels about how they are progressing (Barber & Resnick, 2022; Lewis et al., 2019; Brooks et al., 2021). Broadly, data can be - trending in a positive direction - stable/not have much change - trending in a negative direction - show high variability/fluctuations from one session to the next In all cases, the data may not be in line with youth's experience. This can lead to discussions around reasons for the discrepancies and ways to address them. Based on your discussion, different actions may be appropriate. However, in most cases the data and youth's experience do match with their experience. When there is congruence between the data and youth experience what you do may differ based on the trend of data (Connors, Childs, Doglas, & Jensen-Doss, 2024). For example, when there is a positive trend, it may be appropriate to continue the intervention or start discussing what lower intensity services or experiences the youth might be interested in attending. When there is stable data, it may be worthwhile to collaboratively make shared decisions on making changes to intervention or services or if progress is expected to plateau before making gains depending on what's being measured. If there is a negative trend, it may be important to assess what's causing the downward trend and make changes based on your shared understanding with the youth. How to Act on Measure Results to Adjust Care The process of adjusting services based off measure data is collaborative and dynamic. In this step, input from youth is constantly integrated and the youth and provider engage in shared decision-making regarding adjustments to care. While working with youth, here are some ways you can make adjustments to care. +-----------------------------------+-----------------------------------+ | Checking in regularly to see if | Providers check in with youth on | | data trends match youth | an ongoing basis to see whether | | experience | the way the measure data is | | | trending is reflecting how the | | | youth actually feels they are | | | progressing in their care (Barber | | | & Resnick, 2022; Lewis et al., | | | 2019; Brooks et al., 2021). | | | Sometimes the data is not in line | | | with their experience, and this | | | can contribute to discussions | | | around reasons for the | | | discrepancies and ways to address | | | them. | +===================================+===================================+ | Exploring potential barriers to | Providers should ask youth what | | progress | might be getting in the way of | | | progress in their care and what | | | is their perception of the | | | factors that are impacting their | | | care goals (Hunsley & Mash, 2010; | | | Laposa, 2018; Barber & Resnick, | | | 2022). Sometimes they may not be | | | able to identify a barrier of | | | progress in their care or what is | | | leading to continued symptoms. In | | | this case a provider can use | | | Socratic questioning to help them | | | gain awareness of the barriers | | | they are facing (Hunsley & Mash, | | | 2010; Laposa, 2018; Brooks et | | | al., 2021). | | | | | | To see some examples of Socratic | | | questioning, please visit: | | | [[UCONN University of | | | Connecticut: Socratic | | | Questions]](https://c | | | etl.uconn.edu/resources/teaching- | | | your-course/leading-effective-dis | | | cussions/socratic-questions/#:~:t | | | ext=Types%20and%20Examples%20of%2 | | | 0Socratic%20questions&text=Why%20 | | | do%20you%20say%20that,this%20rela | | | te%20to%20our%20discussion%3F) | +-----------------------------------+-----------------------------------+ | Brainstorming adjustments to care | Work with youth to brainstorm how | | | to adjust their care to better | | | help them meet their goals | | | (Barber & Resnick, 2022; Lewis et | | | al., 2019; Brooks et al., 2021). | | | If you share ideas, ensure that | | | you are providing rationale as to | | | why you think it would help the | | | youth and ask the youth to do the | | | same for the ideas they share | | | (Barber & Resnick, 2022; Boswell | | | et al., 2023). | | | | | | Some examples of adjustment to | | | care can include: | | | | | | - The number of therapy | | | sessions may need to be | | | increased (Hunsley & Mash, | | | 2010; Laposa, 2018) or spaced | | | apart further to allow for | | | more time to have an impact | | | | | | - Adjusted homework (i.e. | | | Reducing worksheets and | | | instead having youth engage | | | in skills in their daily | | | routines) (Hunsley & Mash, | | | 2010; Laposa, 2018) | | | | | | - Other therapies or activities | | | may need to be added or | | | replaced (i.e. Using CBT | | | instead of DBT) (Hunsley & | | | Mash, 2010; Laposa, 2018) | | | | | | - Using a completely different | | | approach (Hunsley & Mash, | | | 2010; Laposa, 2018) | | | | | | - Addressing co-occurring | | | conditions and stressors more | | | directly (Courtney et | | | al., 2024) | | | | | | - Adding more family | | | involvement | | | | | | - Focusing more on functional | | | improvement, rather than | | | symptom improvement | | | | | | - Looking at the youth's | | | satisfaction with service | | | provider data and seeing if | | | adjustments need to be made | | | to provider approach | | | | | | - Attending to spiritual and | | | cultural practices | | | | | | - Exploring socio-economic | | | impacts | | | | | | - Connecting with other | | | services to address | +-----------------------------------+-----------------------------------+ | Planning | Once a plan of action is | | | established collaboratively, it | | | is important to also have | | | discussions around the duration | | | of the plan and when to reassess | | | it (Barber & Resnick, 2022; | | | Boswell et al., 2023). | +-----------------------------------+-----------------------------------+ What Do Youth Think About taking Action During MBC? According to the youth council, a service provider should validate youth if they are not ready to set goals based on the MBC results. All care done with MBC should be empowering and respectful of youth and their ability to make decisions about their own care. Note: Providers may decide to explore the hesitation around goal setting. For some youth, setting a goal can also feel like setting oneself up for failure -- as their experience with goals is that it has led to disappointment. Moreover, it may be perceived as another area in the youth's life where they feel they aren't meeting expectations. If the youth agrees, it may be a reasonable first goal in therapy to understand this hesitancy and/or learn how to set goals in a way that's motivating and supports emotional health. Module Summary Throughout this module, as the service provider working with Rayan, you learned about the last two phases of the STAY model: share and act. These phases are often implemented by providers who deliver interventions to youth on an ongoing basis and may require the most level of adaptation to your own practice based on your centre and own practice in delivering evidence-based care to youth. You continued to explore youth perspectives about MBC in relation to these components and were exposed to a series of considerations when sharing and making adjustments to interventions.