The following is a sampling of questions regarding Home for Good and its services and methodology.
To make a referral, complete an intake screening by phone, or to inquire about our services, contact Home for Good.
What is Client-Directed, Outcome-Informed (CDOI) treatment?
Client-Directed, Outcome-Informed (CDOI) treatment is a practice that dramatially improves treatment outcomes, and reduces costs.[1] Developed by Scott Miller and Barry Duncan, CDOI is based on decades of mental health research proving three things:
1. Progress in therapy is highly predictable, with the majority of change happening early in treatment. Clients who make no progress, or who deteriorate early in treatment are at high risk for poor outcomes.[2]
2. The client’s rating of the therapeutic relationship predicts treatment success far better than the treatment method, severity of diagnosis, or the therapist’s training or experience.[3]
3. When clients are directly engaged in measuring their own progress, and the therapeutic alliance, outcomes improve dramatically. Results have ranged from 65%, to more than 100% increase (or doubling) of therapeutic effect scores.[4]
CDOI tools have been proven valid and reliable in peer-reviewed studies.[5] Their speed and ease of use make them readily acceptable to clients.[6] At Home for Good, we use a web-based application called “My Outcomes” (www.myoutcomes.com). "My Outcomes" measures individual progress, overall program outcomes, and the effectiveness of each therapist and supervisor.
Is CDOI an “evidence-based treatment”?
CDOI is not a treatment method. CDOI is a practice that promotes better client engagement, better therapeutic relationships, and better results. It is compatible with all treatments methods and clinical settings. CDOI means matching the treatment approach to the client’s own “theory of change,”[7] monitoring the results session to session, and making adjustments in response to direct feedback.
The current focus on “evidence-based practices” assumes that matching the treatment to the diagnosis or presenting issue will result in better outcomes. Yet, in head-to-head studies comparing bona-fide treatments, one method has rarely been found superior to any other.[8] In the few studies that have suggested the superiority of one approach, the differences are small -- around 2-3% differences in therapeutic effect scores[9] -- and the number of studies that show differences is no higher than would be expected by chance.
Agencies adopting CDOI practices have experienced 65% and greater improvements in therapy outcomes. Instead of adding to the cost of treatment by requiring expensive certifications, CDOI practices have been proven to reduce the cost of metal health care, while improving results and client satisfaction.[11]
At Home For Good , we view evidence-based treatments as avenues of approach to explore with each client and family. Our therapists are trained to privilege the client's voice, to monitor and adjust the approach in response to systematic client feedback, and to discuss discharge or stepping-down services when maximum progress has been made.
If CDOI is not a treatment method, what is your treatment method?
At Home for Good, we focus on the common factors that span all types of therapy—the very factors that have proven to be the main components of success.[12] We view the various clinical perspectives as informing rather than competing with each other. We focus on helping the client and family to identify and engage their own strengths and resources. Our clinical team allows clients who are not making progress to receive direct input from other therapists with different specialties. The family and therapist then discuss the suggestions, and incorporate those that resonate into the treatment plan.
Our therapists have a variety of clinical backgrounds. Our consultants are recognized experts in family therapy, applied behavioral analysis, and the treatment of traumatized children. Consultants provide training and consultation for our staff, and therapeutic consultation services for our clients. They also participate in clinical staffings, so that all clients and family members have access to their expertise.
All of our therapists are familiar with motivational interviewing and solution-focused approaches. They are trained in the basics of family systems, trauma-focused, and behavioral treatment. Most critically, they understand the impact of developmental trauma and disrupted attachment, and they know how to help families reduce stress to create a safe environment for their children.
Who else practices CDOI treatment?
In the Richmond area, several agencies have been working to integrate CDOI philosophy and practice, including Chesterfield Community Services Board’s Adult Services Team, and the Department of Rehabilitation Services. Customers of “My Outcomes,” the web-based application for CDOI practice (www.myoutcomes.com), include huge organizations such as Magellan Health Services and the U.S. Navy, as well as agencies of every size offering virtually every type of service. CDOI is also attracting practitioners in over a dozen countries, including Canada, Australia, England, Norway, and Singapore.
We are committed to accountability in outcome reporting. All of our outcome data is client-generated, with no possibility of therapist bias. We record outcomes for all clients for whom we have at least 2 measurements, meaning any client who has completed at least 2 weeks of service. This leads to greater accuracy and transparency, as we will not filter out our unsuccessful cases by excluding those who “did not complete treatment,” which is a recognized flaw in many outcome studies.
What happens when clients are not making progress?
When this happens later in treatment, it usually means that it is time to discuss discharge or step-down. When it happens early in treatment, the client is at risk for a poor outcome. So we raise the issue promptly -- if there is little or no progress from week 1 to week 2, this is already a red flag.
The first place to look is the therapeutic relationship. A poor alliance that does not improve is highly correlated with treatment drop out and poor results. If this cannot be resolved, we will discuss the possibility of trying a different therapist. If clients do not make progress despite a positive alliance, a different treatment strategy may work. At Home for Good, we have the benefit of a clinical team, allowing clients to get suggestions from therapists with different specialties. Sometimes a change in the type or schedule of services is in order. If clients are not making progress after several adjustments, we will raise the possibility of referral to a different program.
It is important to stress that the scores do not determine what to do -- they provoke the discussion. The meaning of the scores ultimately rests with the client. Decisions are made collaboratively by everyone involved, with the client and family’s preferences front and center.
How does Home for Good offer an alternative to Therapeutic Foster Care (TFC)?
Children enter Therapeutic Foster Care (TFC) because they require a high level of care. Yet, ongoing TFC services include, at most, weekly visits by a social worker, who also covers custodial and case management issues. Foster parents and TFC caseworkers must therefore arrange mental health services in the community. This can lead to difficulty locating services, transportation and attendance problems, and little coordination of care with therapists who do not participate in treatment team meetings. Service fragmentation is a common result -- a known contributor to placement breakdown.
When a child’s needs become more intense, intensive in-home services may be added. This causes duplication of case management, and higher costs. It also increases demands on the foster parents, requiring them to accommodate multiple home visitors.
At Home for Good, we work with families and agencies to develop a seamless plan of care. This may incorporate intensive in-home services, ongoing, customized training for foster families, and step-down support. The plan may include therapeutic consultation by a licensed family systems specialist, trauma specialist, or behavioral analyst, and may even include hypnotherapy for drug, alcohol, or smoking cessation. We monitor outcomes at every phase of service, and report outcome data to all agencies involved in the child’s care.
Can families who are not receiving home-based services participate in the parent training program?
Yes, the parent training program is open to families who are not participating in other Home for Good services. However, we cannot generate outcome data for families participating in this service alone. Training sessions focus on building skills for parents and caretakers, and the child may or may not attend. Therefore, we do not have predictable opportunities for the “identified client” to complete the rating scales.
Do you work with youth in independent living?
Yes, we offer home-based services, as well as therapeutic consultation, for youth living independently. In-Home Residential Support (IHRS) services do not require parent participation. However, at Home for Good, we believe that it is never too late to achieve permanency. Young people continue to need supportive, permanent families as they move into adulthood. This need does not change simply because a youth reaches the age of 18 or 21, or is determined to live on his own.
At Home for Good we work with the youth, his case-worker, relatives as appropriate, and other supportive people, to help establish and cement permanent and unconditional relationships. In particular, we work to make sure that the youth will have a place to live if he or she falls upon hard times. We are committed to doing everything we can to help prevent young people from aging out of foster care without a permanent family, as this is a major risk factor for homelessness and many other negative outcomes.
Do you offer mentoring services?
Home for Good does not offer mentoring services. We see mentoring as a durable relationship based on mutual interests. Instead of paid mentoring, we help the youth and family create mentoring relationships within the community. By encouraging natural rather than paid supports, the family and child are better prepared for discharge, and the mentoring relationship is more likely to continue long-term.
Families may be hesitant to reach out for help, and our therapists are trained to honor this natural reluctance. We help families to explore the pros and cons of involving others, and to determine in advance what information to share.
How does Home for Good help clients identify and develop their strengths?
Successful businesses know that the way they treat their employees is the way their employees will treat their customers. At Home for Good, we know that if we motivate our therapists to reach their potential, they will do the same for the kids and families they serve. Therapists cannot be effective at helping clients identify and develop their strengths unless they can identify and develop their own.
Our staff development program is based on research proving that focusing on strengths rather than weaknesses leads to better outcomes. It begins with staff completing the Clifton Strengths-Finder assessment,[13] a research-based tool used to improve organizational results. The focus continues throughout our training, evaluation, and employee feedback processes, as staff complete a process of recorded self-observation, sharing their results with the team. The focus is to help the employee do more of what she does best. Therapists gain an experiential understanding of strengths-based practice, with direct insight into the variety and extent of untapped human potential.
By privileging the client’s rather than the therapist’s voice, CDOI is inherently compatible with strengths-based practice. At Home for good, our assessment and treatment planning process shines a spotlight on client strengths, instead of reducing them to a generically-written afterthought.
How are services funded?
Medicaid
Medicaid can fund Intensive In-Home services. The assigned therapist will perform the in-home assessment to determine eligibility (we do not use an “assessment team”).
Children’s Mental Health Program services (Family/Caregiver Training, Therapeutic Consultation, and In-Home Residential Support) may be eligible for Medicaid funding. Please call us for more information.
Other Funding Sources
We accept FAPT funding, and self-pay arrangements for all services.
Some insurance companies may provide limited coverage for home-based therapy or hypnotherapy services. We will be happy to complete insurance forms, but at this time, we cannot bill private insurance. Please contact us if you have questions about funding for services. We will do our best to make our services available to those who can benefit.
What is Client-Directed, Outcome-Informed (CDOI) treatment?