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You say you want a revolution: How can you tell a change is needed?

Posted on November 3, 2017

You say you want a revolution: How can you tell a change is needed?

Connecting Paradigm: A trauma-informed & neurobiological framework for Motivational Interviewing implementation is a book about change. On a practical level, the focus on Motivational Interviewing (MI) implementation focuses on helping clients make difficult life changes. On a theoretical level, the trauma-informed and neurobiology framework speaks to a shift in how we conceptualize our clients, their behaviors, and what they need to achieve their goals. The very first paragraph of the book speaks to both the practical and theoretical goals of the book:

“Connecting Paradigms is written to fill a void in the social-work, psychology, educational, and public-health literature. It is a void that I felt all too powerfully when I left the halls of academia and entered the helping professions. This void, stated simply, is that I had no idea why my clients struggled the way they did or what my clients needed from me as a counselor, educator, case manager, or therapist to help them change behaviors that kept them trapped in cycles of violence, addiction, and extreme poverty. Connecting Paradigms ambitiously seeks a comprehensive answer to the who, what, and how of helping others live the best life possible.”

In the hundreds of pages that follow, Connecting Paradigms, brings together knowledge on trauma and neurobiology with the practical application of Motivational Interviewing (MI) and other complementary approaches. With the questions of “who, what, and how of helping others” answered, how can we pull back from the focus on direct care presented in the book and explore how the concepts presented in the book realize their full potential when implemented across programs, organizations, and entire systems.

To start this discussion, we begin with two significant challenges. First, how does a program, organization, or system integrate knowledge and principles of trauma and neurobiology into their conceptualization of the people they serve. Second, based on this understanding, how do we help staff build competency in the skills and practices required to effectively assist clients to make difficult life changes and heal from trauma.

As demonstrated throughout the book, change is hard and requires a restructuring of the brain to support new behaviors and thinking. This difficulty with change applies to our clients but also to those providing services, working support roles, and leading and supervising staff. Since change is difficult and disruptive, how can you judge if your systems should take on a change process such as integrating the concepts in Connecting Paradigms?

Ideally, data and not just observations from the top inform change decisions. There is a great deal of research demonstrating that the perceptions of those in leadership regularly are much more favorable than is shown by quantitative data. Data offers crucial feedback on how we are doing at meeting our mission and the goals of our services without personal basis getting in the way.

So what measures help show a need for change?

The obvious answer is client outcomes. Are your services effective? To answer this question, you need to state clear goals for what your services are designed to accomplish and collect data that demonstrates how well you are meeting these goals. Initial data provides a critical baseline. As you implement change, new data can be measured against this baseline to show the effects of your efforts.

If you are currently not generating meaningful data, don’t worry, we will help you with some direction around quality improvement in this series.

It is essential to compare your measures against something besides your own internal baseline. Knowing how you are doing this quarter compared to last quarter is nice, but without industry standards, there is no context for this quarterly data. Of course, it is good if one quarter’s outcomes are better than the previous, however; without industry data to compare it again, you risk misinterpreting poor outcomes for a positive one.

If your data is great, congratulations! Your challenge is finding small improvements to maintain your success and continue in a positive direction. Increasing knowledge on trauma and bringing in trainings for best practices will build upon this momentum.

If your outcomes are not so great, your data is providing a focus for your change and quality efforts. This series of post will help you construct a plan for identifying and implementing change to improve your services and outcomes. As I always tell people, this work is incredibly complex, and we rarely have enough resources to do it effectively. If you don’t like your outcomes, focus on how improving them will positively improve your clients’ lives.

Beside client outcomes, client satisfaction is also a critical measure. As put forth many times in this blog and the book, the quality of the relationship is a major driver of outcomes. The better the client experience, the higher the engagement and the more likely the client is to reach their service goals as well. Often, client satisfaction scores are lead indicators. If your program outcomes are good and you see a drop in client satisfaction, you will likely see a decrease in other outcomes in future months if you do not figure out why scores are dropping and make some strategic change to address these issues. Conversely, increases in client satisfaction scores often predict future improvement in programmatic outcomes.

Just as important as client measures, staff satisfaction and well-being can indicate the need for change. It is rare to find a burned out and unhappy staff achieving strong programmatic outcomes. I usually suggest two measures if systems are currently not accessing staff satisfaction or well-being. For well-being, I highly recommend the Professional Quality of Life Survey as it measures compassion satisfaction, compassion fatigue, secondary trauma, and burnout. High rates of fatigue, trauma, and burnout likely negatively affect programmatic outcomes or will in the future if not addressed.

For staff satisfaction, I suggest the Gallup 12 or Q12. Gallup has years of research supporting 12 questions that predict staff engagement which they have correlated with high performance, loyalty, financial performance, quality, efficiency, and a ton of other outcomes. Several excellent books, including two of my favorites First Break all the Rules & 12: The Elements of Great Managing, support this survey. Finally, there is a great deal of data from survey results which you can compare your results. Like client satisfaction, staff measures are lead indicators as improvement or declines will often show up before changes in programmatic outcomes.

We’ve given you quite a bit to think about this week! Our question is whether you can identify the need for change in your program, organization, or systems? If you think a change could affect outcomes what would get you the most significant improvement for your efforts?

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