Academic journal article The International Journal of Narrative Therapy and Community Work

Quality Assurance at the Walk-In Clinic: Process, Outcome, and Learning

Academic journal article The International Journal of Narrative Therapy and Community Work

Quality Assurance at the Walk-In Clinic: Process, Outcome, and Learning

Article excerpt

With the emergence of walk-in counselling clinics throughout Canada, there is an important call to develop outcome and quality assurance measures relevant to time- constrained single session service delivery models. Typical psychotherapy outcome measures take an extended view to measure the short and longterm goals of a program. Given the single session nature of walkin clinics often there is not the luxury of time, continued contact, or staffing to elicit data other than immediately following the session. Longer-term outcome studies, when employed at walkin clinics, are often achieved through funding grants, volunteer services, or as funded research studies. For most children's mental health clinics, similar to the one at which I work1, the use of three and six month or one year outcome evaluations of the walk-in session is not a possibility. There is a 'lack of resources available for quality assurance and evaluation to measure and monitor program effectiveness and outcomes' (Children's Mental Health Ontario, 2013, p. 6). Base funding does not cover such initiatives and it is challenging to organise the necessary teams to apply for research funding. While many clinics utilise immediate postsession questioning to focus on determining whether people found the session helpful or had experiences such as friendly staffor easy access, these measures tell us little about people's experience of the conversation itself (quality assurance) and contribute little to the skill development of the therapist.

Brief narrat ive therapy

Narrative therapy is used at many walk-in clinics throughout the province of Ontario and is cited as used more often at walk-in clinics than a cognitive behavioural therapy approach (Duvall , Young & Kays-Burden, 2012). This brief narrative therapy is not a hurried therapy but rather complete and in harmony with the practices and ethics of longer-term narrative therapeutic practice. Brief narrative conversations can involve re-authoring conversations assisting people to identify and link the initiatives of their lives into stories in the making more fitting with their preferences for life and identity. Conversations can provide a venue for people to become more acquainted with, and share, their skills for living and wisdom associated with subordinate storylines. Conversations can also quickly begin the deconstruction of the taken-for-granted ideas or limiting discourses assisting people to develop a revised position on a problem, or further develop counter-practices to the oppression of problems. All these paths, as White (2006, 2007, 2011) has noted, provide the context in which people can begin to distance from the known and familiar of their lives in order to begin to move towards their preferences. When the material of these conversations is brought into proposals for action, the therapy stretches beyond the single contact and can prove quite useful to the people consulting to us.

Informed by brief narrative intention, a walk-in clinic organisational culture is fostered at the walk-in clinic that:

* Recognises the importance of how meaning is socially and relationally shaped and affects how people respond to the world.

* Employs practices that support the development of personal agency (a person's sense that they can do something about the problem) and increased options for proceeding (a person's sense of knowing what to do about the problem).

* Privileges insider knowledge (know-how) in that what the participants bring with them to the process is more richly described and utilised in addressing the concern, or in moving life towards their preferred direction.

* Is continually shaped by participant feedback throughout the conversation. This includes the practice of critical reflection (Fook, 2002), subjecting our practices to a critical gaze as a means to add to our practice experience.

* Collaborates in developing plans and next steps. These are co-developed and co-shaped building primarily upon participants' own knowledge and experiences. …

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