Implementing FIT

FIT’s Proven Results

  • Outcomes improve 70% – 350% in BH/SUD treatment when progress measurement is used to monitor progress, adjust treatment, and thereafter measure post-treatment outcome
  • Reduce dropout rates by 50%
  • Reduce deterioration rates in treatment by 30%
  • Assess outcomes through the use of standardized instruments, which is a Joint Commission requirement.
  • Financial results improve as outcomes improve.
  • FIT helps measure, adjust, and improve the therapeutic alliance.

Given the opportunity to answer a survey on an iPad or smartphone, the answers are often more truthful. The FIT survey generates immediate results and helps to improve treatment progress and outcomes.

Administering Fit: Smartphones and Tablets

Studies show that patients will tell a smartphone or tablet device more than they often tell their therapist, especially when it comes to treatment progress. Patients often seek approval and friendship from their therapist, so they will tell their therapist what he or she wants to hear. “I’m doing well,” “I have not used,” and “I do not have thoughts of suicide,” are examples of common responses.

Using smartphones and tablets instead is recommended by the U.S. Surgeon General. From his report: “Several studies have been conducted on technology-assisted screening, assessment, and brief intervention for substance use disorders. The use of kiosks to screen patients for alcohol and drug use found that patients were significantly more likely to disclose their substance use at a kiosk compared to a health care professional or interviewer. Preliminary evidence shows that Web or telephone-based assessments combined with brief interventions are superior to no treatment, in reducing substance use, and often result in improved outcomes when compared to the sole use of brief intervention options.”

A pilot study of 200 patients at a publicly funded community mental health center evaluated the feasibility and acceptability of using handheld devices to collect symptom severity. Patients reported that the handheld devices were private and as easy or easier to use compared to filling out paper forms.

Why FIT works

  • Breaking through the barrier of shame: It is well known that those living with substance use disorders feel burdened with shame and find it difficult to fully open up to another person.
  • Cut through a patient’s desire to please by using a tablet or smartphone to collect FIT data: It is a normal human reaction to want to avoid displeasing others, even if that person is your doctor or therapist.
  • Improve communication: Patients find it easier to provide greater and more honest communication electronically. It feels more anonymous and creates a sense of security that facilitates honest responses. This was confirmed by studies cited in the U.S. Surgeon General’s report on addiction as well as a recent brain scan study out of the U.K.
  • Provide better treatment and improve outcomes 70% to 350%: Using evidence-based surveys and assessments, therapists can cover more ground and effectively tweak Treatment Plans to get at the heart of the issues underlying a patient’s addiction.
  • Improve aftercare: By including FIT as part of your aftercare program, you can rapidly identify potential issues and better document “evidence-based” follow-up. Payors are taking note. They will soon fund our RecoveryBound and AfterCare options as more evidence-based studies continue to prove their effectiveness.
  • FITs hand-in-glove: Simple, secure telehealth was developed to facilitate receipt and processing of information via FIT surveys integrated with the KipuMessenger technology.
  • Required by The Joint Commission beginning January 1, 2018

Changing Structures For the Future

The Center for Alcohol and Drug Treatment (CADT) in Duluth, MN has always been progressive, pragmatic, and innovative since its founding in 1961. CADT implemented a FIT program and reports, “As primary tools for engagement, FIT aids in planning group discussions and coordination of services.” The FIT process, they report, relates back to significant life areas of the client and aids in determining treatment planning, along with intensity and length of service. For new patients, clinicians make sure the purpose of seeking feedback and instructions for answering the FIT survey is explained at each point of service delivery.

They found that not all clinical staff believed in FIT as staff members found difficulty changing their existing structures and processes. The staff did not trust that feedback tools would provide valuable or useful information. Many clinicians were initially skeptical but eventually learned to trust the data.

The facility reports, “Our initial agency data indicated that our retention rates increased and our completion rates were the highest in the state. It was clear that FIT and a data measurement tool proved invaluable.”

The power is not in the sample questions themselves, but rather what they reveal to the clinicians.

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Administering the scales isn’t the only important part of FIT. Therapists have to be “hungry to see their failures and be interested in becoming better,” Seidel said. So therapists must create a “culture of feedback” and communicate this to their clients.

Clients need to truly believe that their therapists want honest feedback and to “feel safe that they won’t be retaliated against [for] negative feedback.” Therapists aren’t “just collecting the data, [they’re] collecting accurate data.”

What the Research Shows

Earlier work by pioneer researcher Michael Lambert and colleagues at university counseling centers found that giving therapists feedback on their clients’ wellbeing had a huge impact on the clients’ improvement. Feedback was especially critical for clients who weren’t getting better since this group tends to leave therapy early.

The FIT Norway Experiment

A 2009 randomized clinical trial of 205 Norwegian couples, one of the largest randomized study of couples ever done, according to Seidel had similar findings. According to the trial, FIT gave therapists feedback on their performance and the couples’ wellbeing, which almost doubled the effectiveness of therapy. Also, interestingly, at the six-month follow-up, couples in the feedback group had a significantly lower rate of divorce and separation than the no-feedback group.

Research conducted at mental health agencies has also found that using feedback measures leads to fewer no-shows and dropouts.

One reason, Seidel said, might be that it gives the therapist the opportunity to repair the damage or small rifts that they might not know about otherwise. FIT also has been shown to shorten the course of treatment, he said.