Client Directed Outcome Informed
Recovery Practice One Client At A Time
The client-directed, outcome-informed (CDOI) approach to clinical services utilized by the Adult, Child and Family Services department of Community Health and Counseling Services is a recovery model that is based on research on the factors that make mental health treatment successful. This approach privileges the client’s voice in treatment to the maximum extent possible, while adhering to professional and ethical standards of practice, and celebrates clients’ strengths and heroic qualities. Uniquely, the approach incorporates regular measurement of client progress as well as attention to the client’s perception of the treatment process, using simple tools that can be administered in under a minute. CDOI practice has received approval by SAMHSA/NREPP as an evidence based practice.
Measuring progress based on self-report of clients at regular intervals allows us to partner with them to note early, small signs of progress or deterioration. Thus, we are in a position to discuss these small changes with clients, and to make adjustments in our approach so as to maximize the likelihood of a successful outcome. The use of measurement tools, in combination with our clinical judgment and the continuing input of the client and of others who are concerned about the client’s well-being, provide a vehicle for us to determine when maximum benefit has been attained from services. In addition, support teams that include the clients and their formal and informal helpers can make decisions about the viability and efficacy of continuation of services. Thus, we are able to closely tailor services to the specific level of need of the client, and we are able to make services accountable both to clients and to payor sources.
CHCS is the first agency in the world to apply this approach systematically to community support services and residential programs, in addition to its traditional application to psychotherapy services.
Our data from the implementation of this recovery approach is exciting. Since implementation in 2003, we have reduced our length of stay by an average of 60% across programs (72% in community integration, 60 % in therapy and 47% in adult residential), we have reduced the percentage of long term clients in our community integration program by 49%, and our client no-show and cancellation rates by 30%. Our successes have demonstrated that this approach can be utilized successfully with the clients we and other publicly-funded agencies in Maine serve. Our implementation of this approach enables us to confidently assure our clients that recovery is not just a possibility, but a probability, and it ensures that we are accountable in our use of public funding for mental health services.
More information on the Client Directed Outcome Informed approach can be found on the Heart and Soul of Change website
SAMSHA Recognizes CDOI
The Measurement Tools Used in CDOI Practice are Granted Evidence Based Practice Recognition by SAMSHA
After a two year evaluation of the tools used in Client Directed Outcome Informed work, SAMSHA has put them on the list of Evidence Based Practices. The tools are the Outocme Rating Scale (ORS) and the...
CDOI Practice at CHCS
A More Detailed Description with Data
Recovery is an individual client’s responsibility, but can be assisted by others in both formal and informal supporting roles who believe in the client, focus on strengths and resiliencies, and point...
CDOI Client Example
CDOI Work with the Severely and Persistently Mentally Ill
Joanne is a 47 year-old woman diagnosed with bipolar disorder. When Community Health and Counseling Services (CHCS) began case management with her, she had been in mental health services most of her...
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