Academic journal article Journal of Marital and Family Therapy

Teaching Accountability: Using Client Feedback to Train Effective Family Therapists

Academic journal article Journal of Marital and Family Therapy

Teaching Accountability: Using Client Feedback to Train Effective Family Therapists

Article excerpt

The AAMFT Task Force on Core Competencies (Nelson et al., 2007) proposed that marriage and family therapy (MFT) educators teach and provide evidence of trainee competence beyond coursework and accrued clinical hours. This article describes the integration of a systematic client feedback protocol into an MFT-accredited program's curricula to address the call for outcome-based learning. Outcome management (OM) provides a framework for teaching and assessing trainee effectiveness. Continuous incorporation of client feedback embodies collaborative, strengths-based, integrative, and diversity-centered program values. Students learn a system for being accountable to clients, the profession, and service communities.

Within the past decade, calls have been made for the provision of "safe, effective, patientcentered, timely, efficient, and equitable" health care for all persons (Committee on Quality of Health Care in America, 2001, pp. 7-8). This call has extended to mental health services (President's New Freedom Commission on Mental Health, 2003). Moreover, consumers have demanded evidence of treatment effectiveness. In response, mental and behavioral health organizations have taken steps to define effective, safe care (e.g., see APA Presidential Task Force on Evidence-Based Practice; Hoge et al., 2005; Nelson et al., 2007). Despite varying definitions of best practice, mental health disciplines appear united in the ethics of providing evidence of effectiveness. Indeed, a current focus on outcome, the sine qua non of effectiveness evidence, prompted Leigh et al. (2007) to call this the "era of accountability" (p. 463).

The AAMFT Task Force on Core Competencies responded to the demand for accountability by first defining six domains of knowledge and skills required for entry-level independent practice as a marriage and family therapist (Nelson et al., 2007).1 These domains encompass all aspects of care and presumably define competent practice as a couple and family therapist. The Task Force invited further discussion regarding how best to teach and assess competence and suggested that training models shift from an input-oriented to outcome-based education. This entails less reliance on coursework and accrual of clinical hours as proof that trainees can provide effective care (Nelson et al., 2007). Instead, trainees would be required to demonstrate that their educational experiences have translated into core skills.

That training of clinical practitioners should include teaching demonstrable skills seems obvious. However, some have questioned whether therapist skill development leads to better client outcomes. According to Lambert and Hawkins (2001), the degree to which skills generalize to practice is inconclusive. For example, students may succeed in learning a particular skill set, yet have difficulty transporting that into the therapy room. Moreover, there is evidence that therapist mastery of specific interventions may actually interfere with client and therapist engagement, resulting in suboptimal outcomes (Beutler et al., 2004; Lambert & Ogles, 2004). Furthermore, means of evaluating knowledge may be readily available, while methods assessing skills present greater challenges (Leigh et al., 2007). Lichtenberg et al. (2007) claimed that traditional paper and pencil testing lacks ecological validity in evaluating practice skills. These considerations present practical and conceptual challenges in evaluating competence.

One response to addressing these difficulties is the incorporation of information derived directly from the trainee's clinical practice. Psychology educators have asserted that assessment methods that do not involve direct observation of the person in actual situations, do not include feedback from clients, and do not assess clinical outcomes cannot adequately evaluate a trainee's ability to help clients (Leigh et al., 2007; Lichtenberg et al., 2007). Kaslow, Celano, and Stanton (2005) described a competencies-based approach in family psychology as one emphasizing "the ability to apply knowledge and skills in the real world and [one that] uses performance outcome as criteria for evaluating learners and training programs" (p. …

Search by... Author
Show... All Results Primary Sources Peer-reviewed

Oops!

An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.