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What are Treatment Outcomes?

In this episode, Dr. Alexander Danvers and Psychometrist Adrian Dinkins lead a discussion on how data is being collected and interpreted, to develop and refine treatment plans for clients at Sierra Tuscon.
Alexander Danvers, PhD | Adrian Dinkins, BS
Dr. Danvers is a psychologist with expertise in research and statistical methodology. He is the author of over 25 scientific publications, which have been cited over 750 times. He has worked in collaboration with clinical psychologists, medical doctors, personality psychologists, law professors, anthropologists, and philosophers. He also writes for a public audience at the blog “How Do You Know?” on Psychology Today. His articles there have over half a million views. At Sierra Tucson, Dr. Danvers leads efforts to collect and analyze data on patient mental health during and after treatment. 

Adrian Dinkins has a Bachelor of Science degree in Psychology with a minor in Substance Abuse Education and Prevention from Central Michigan University. At Sierra Tucson, Adrian acts as a psychometrist for the psychology department and manages the day to day operations of the Measurement Based Care program. He has conducted assessments and interpretations with over 1800 different residents in the Measurement Based Care program.

Scott Webb (Host): On today's podcast, we're gonna learn how data is being collected and interpreted at Sierra Tucson to develop and refine treatment plans for clients. And joining me today for this conversation are Dr. Alex Danvers. He's the Director of Treatment outcomes at Sierra Tucson and Adrian Dinkins. He's a psychometrist at Sierra Tucson. This is Let's Talk Mind, Body, Spirit by Sierra Tucson. Sierra Tucson, a leader in the field of behavioral healthcare since 1983. I'm Scott Webb, so I wanna thank you both for joining me today. This is gonna be an interesting conversation. We're basically gonna talk about treatment outcomes and what that means exactly. So I'll give you both a chance at this first question. Adrian, I'll start with you, tell us about your role at here at Tucson and how it marries to that of Alexanders.

Dr. Adrian Dinkins: Yeah, so my role here is here at Tucson is a psychometrist. And so a traditional psychometrist actually administers and proctors different psychological assessments and things like that. And I do do that here at Sierra Tucson. But also what I do is I kind of manage the day-to-day of our measurement-based care program. And so it marries really well with what Alex does because Alex then takes all that information that I'm collecting from our day to day with our residents, and then he can kind of turn that into different outcomes and things like that, that I'm sure he'll talk a lot more about as well.

Dr. Alex Danvers: Just to piggyback on top of that, my role here is really looking at the data once it comes in, right? So Adrian does a great job of helping residents understand what the test is for. He helps them understand what their results look like, so he goes over this in small groups with every single person who comes through here. But my background is really in sort of data science, analytics, machine learning. And so I create reports that are individualized, and I think that's really helpful for therapists who are planning treatment.

It's helpful for residents who want to understand themselves better, who want to say, Hey, look, this turned out to be my attachment style. This turned out to be my level of coping. But then there's kind of bigger picture things that we can do for Sierra Tucson, build a report, what program seems to be working best, what features of that program are working, what features of that program aren't? Some of the kind of machine learning angles for me have been things like, can we predict who is gonna be suicidal part of the way through treatment from the survey that they take within their first couple of days in residential care.

So it's a really valuable tool on a lot of different levels for us. It's for residents, it's for therapist. And it's for, um, guiding the, the institution to make better decisions and to identify points of risk and sort of strengths and weaknesses.

Scott Webb: Yeah, I really get a sense of the benefits for everybody involved in and how the two of you work together, how your work is sort of married, to each other. Alex, what's the purpose and mission of data outcomes? And then maybe Adrian after that you can jump on and talk about the treatment evaluation.

Dr. Alex Danvers: In mental healthcare, you typically have somebody come in and they've got a presenting concern. They're going to talk about their depression, they're gonna talk about some kind of trauma maybe that they faced. And a talented therapist will often have several different modalities that they're trained in or several different approaches they can take. And they're gonna sort of jump in and start doing therapy. But what we're trying to do in the measurement-based care program, Is put data to the treatment experience and put data to the patient's experience where they complete, well-validated sort of research grade scales. We take a lot from the World Health Organization.

We take a lot from the National Institutes of Health promise toolbox, and we measure, okay. What is your level of depression? What is your level of anxiety? How disturbed is your sleep? And so we get this comprehensive picture and that allows us to really understand sort of the full 360. Our particular suite of tools that we use is, I think one of the most comprehensive I've seen in the field. It captures 13 different categories from psychological symptoms to physical symptoms like chronic pain. It captures positive indicators.

So things like how resilient do you feel? How good are you at coping? What's your quality of life? And that gives us this full picture of the patient that you wouldn't otherwise have, right? So if you're, they're coming in, I'm depressed. Well you're depressed. But also now we found out you have a difficulty feeling close to people. You don't feel very good at coping with your emotions, and you also seem to have trouble sleeping. So now we have this kind of like full picture.

Dr. Adrian Dinkins: Yeah. And so a lot of two what, like the real purpose of, you know, the treatment evaluation is, and it's a form of measurement based care, which is measuring our symptom, our resident symptomology through psychometrics, right? All of those different measures, those 13 that Alex was just mentioning. And so the reason that we're doing this is cause we want to provide informed care. And what that really means is we not only want our residents to be able to understand where they are, given a bunch of different areas within their own personalities and their own symptomologies, but we also want our therapists and our clinicians to be able to look at this and view this when the resident originally comes in.

And so that's kind of where that really molds very well with the type of assessment that we're giving. Because as Alex was mentioning, we're covering a. Bunch of different areas, and so this allows people to walk in. A lot of times when people come into treatment there tends to be something that kind of brought them in. And so what this allows us to do is not only look at how that factor might be affecting all of these different areas, but maybe how all those other different areas are also having an impact on how they're viewing that specific situation. And so that's really the purpose of why we're doing this, is we want to be able to provide that informed care.

And we also want to be able to open them up to the other possibilities of the different reasons that they might be here and how we can help treat that better.

Dr. Alex Danvers: I'm excited about this stuff. I think it's really useful. But one of the things that is nice to hear on our end, when we share this with a therapist, the therapist will come in and say, Hey, I really appreciate having that attachment style that helps me figure out how to talk to my client. And then some therapists will come in and say, Hey, I'm a trauma informed therapist. I really want to know what was my client's history, you know?

And so we'd give this adverse childhood events questionnaire and that allows them to say, oh, okay, this person has a history of viewing violence in their community. And that's gonna change the. That they approach their client.

Dr. Adrian Dinkins: Yeah, it just opens it up to a very much holistic point of view for not only the resident, but also the clinician.

Scott Webb: Yeah, it also seems like it might just save some time, right? Whereas the therapist trying to dig through all of this and pull this out of a resident or a client where they can just have that handed to them. Say, here, here's what we found. You can sort of skip over some steps and get right to it.

Host_1: Am I hearing that right? Does it actually really just save everybody some time?

Dr. Adrian Dinkins: That's exactly a big reason that we do it right, because we're not, that's a lot of interview questions. That's long, long interview process. And so you're a hundred percent right. We're able to kind of see the problem areas and we're able to be able to address 'em off this little sheet of paper. And one of the things that you know, I'll let Dr. Danvers talk about a little bit more is, we're creating a little sheet that makes it even easier to be able to catch those things. And so we'll be able to answer all of these questions and then we'll actually have just a small list of the problem areas that we really feel are gonna be topics of discussion and we really feel that may benefit the resident talking about more.

Dr. Alex Danvers: Yeah, I mean, so we do a, a few different things with the data just to sort of like exactly what Adrian was talking about. One thing we do is we give it to residents and we try and make that more of a kind of graphical report so it'll. This is where you are and we have a little chart. This is maybe where you are at the beginning of treatment. This is where you are now at the middle. And so you can see, you know, hopefully the bad stuff has gone down and the good stuff has gone up. But sometimes treatment is a mix. So some stuff's gotten better, some stuff's gotten worse.

You've peeled back the Band-Aid, you started getting into that trauma, and maybe you are a little more stressed than you were when you came in. We also have this provider report, which is really geared towards more like medical providers. And so it's got details of this is what the test is, this is what it's been validated for, this is why we give it, and then it gives the results. And now we're also introducing what we call kind of a one pager or a brief report. And this is just like the at a glance, Hey, anybody who's here and who's gonna interact with a resident, here's this quick one page summary that you can get where you can get all the information really quickly.

So we have at Sierra Tucson, these residential therapists and they're kinda like the free safeties, right? They're like going out, they're dealing with things that come up. So they might be called out, oh, this person's feeling really activated and they're may be kind of needing some calming down. Well, some of them now will just go, Hey, let me pop on and check a little bit about this resident. Oh, their depression scores high. Their anxiety scores high. Their trauma scores low. That's all right. This is all good to know. I'm gonna go do my job.

Scott Webb: Yeah. I get the reference, the free safety reference for sure. And Adriana, it sounds like you work with the clients, the residents. However it needs to be phrased, but in general you are there giving them the test, you're administering the test, or you're explaining the test to them at the very least. So what does it look like? if I were about to take one of them, maybe you could explain to me what I could expect.

Dr. Adrian Dinkins: Yeah, so what it looks like when you originally come and you admit into our residential facility here at Sierra Tucson, I'm one of the first people that you're gonna meet. And so what testing really looks like with me is you're scheduled for about an hour and. This is the downside a lot of times is it's a very long assessment. It's about 218 questions long, because again, we're covering 13 different measures and sadly you can't do that in five questions if we could that would be amazing. I think we would be great.

Host_1: It sure would. Yeah.

Dr. Adrian Dinkins: But what it looks like is I bring in, and we usually do it in group settings, because you're just taking an assessment. You're kind of taking it alone. So being in a group setting, it's not too intimidating for anyone in that sense. And so you come in and I give a whole spiel on what you're participating in, how you're participating in our measurement-based care program. And then my job is to really guide you through the assessment and the sense of making you feel comfortable taking it.

A lot of the questions that are being asked within this assessment can get very personal. We're talking about things like post-traumatic stress, we're talking about things like depression and anxiety. And those can be triggering topics at times, right? And so what we're doing, what I'm here to do is I'm here to make you comfortable throughout that entire session. So you come in, I explain it, and then I really let you do your thing. So a lot of it is me watching them take an assessment. But when they do need me to answer questions for them, they do need me to clarify certain things, then that's when I become their guide.

I'm able to help them understand like, oh, we're looking for your perception for this question. We're trying to understand where you're coming in. Because a lot of times when people are taking they come into a treatment facility and they start to take an assessment. They think I need to take this perfect. The assessment needs to underst, they need to understand every single thing about me. Cause this needs to be absolutely perfect. I can't be wrong. I have to really think these questions through. And the way that our assessment is set up is so we don't have to do that, right?

We want to make it a very easy process for them to be able to come in, answer these questions and get their feedback. And so part of them getting their feedback and everything is them going. , these are perception based questions. Nothing in here is diagnosing you anything, and they're really just there for conversation pieces, and so that's kind of the role that I play within that environment is just really helping them through understanding the assessment and guiding them through answering those questions.

Scott Webb (Host): Yeah, and it makes me wonder if we can keep it as anonymous as possible. When you actually go over the results with them, like how do they react? Is it usually pretty eye-opening? When they see the results, does it make them wanna roll up their sleeves and dig in and do more?

Dr. Adrian Dinkins: So this is actually, this is really one of my favorite parts about the entire process of doing it is because we give the interpret or we give the actual assessment and then we get to do the interpretation portion where we give them all of their graphs and their tables and different things like that. And it's about what if 13, about what a 12 page, 13 page report that they get back. And then you have all of these different assessments and things.

So they can, we look at things like quality of life functioning, you know, how are they perceiving themselves, functioning through domains like environmental, through their physical, through their social, and we go through their anxiety, depression, stress, and people love it. People absolutely love it because they're able to take all of that clutter that's inside their head and put it down on a piece of paper. And so what this helps them do is this helps them to be able to take all of that information and split it up. We're no longer thinking about it as this big jumbled mess.

Now we can look at quality of life functioning. We can look at how my anxiety is, we can look at how my depression is. We can even see things like Alex had mentioned earlier attachment style. And it just allows them to be able to take that opportunity. And split it up and think things one by one. And so seeing their reactions to this is actually the coolest thing ever. Because some people will have that reaction of, wow, this is the coolest thing I've ever seen. I've never done. It's like getting a big personality test back in a way. Even though it's not necessarily that.

It's like getting a big personality test and they're like, oh, this is really cool. Like this makes sense. Well, yeah, it makes sense because we asked you to. Your perception when you're answering the questions.

Dr. Alex Danvers: I love that. Like, how did you know it's, well, you told us .

Dr. Adrian Dinkins: Yeah. told us how to do it. You know that's kind point of it. You know, we wanted to really capture how you were feeling and so it does also, because we do this two times. So we do this at admission and then we also do this at Midt treatment. So around, we have about our average day of about 28 days. And so around that 14th day, they actually get rescheduled to come back in and retake that same assessment. And so what we're then looking at in that second time is we're gonna be looking at the progress that's being made over the time that they've been here.

So we can see how their depression's changed over two weeks. We can see how their anxiety's changed over two weeks, and that's the really nice part for them. Not only them, also our clinicians, but really we are looking at an individual level as well. They're able to come in. And see even that little amount of progress they may be making and that does want them to dive deeper into it, right? They're like, oh, well this is actually working. Well, I wonder what is working. And those are the types of conversations that we want to elicit between them and the clinicians that they're working with are what is working, how we can continue moving in that direction.

But not only how we can continue moving in that direction, but if things aren't working as well as we want them to, how can we then change treatment planning to. Cater to the exact type of change that they're really looking for. And so that's really what it looks like is they just get excited to be able to see these results, but then they're also able to look at the spots they might find, be finding deficits in, and then be able to kind of correct those as we move through.

Dr. Alex Danvers: Yeah. Another word that I feel like comes up a lot with this is validation. It's very validating for people to say, oh, hey, I felt like I was depressed. Then I took this standard depression scale, and it says I'm in the 80th percentile for depression, and that puts a number and it puts a reality to it where you can just say to your friend, I'm feeling pretty depressed. They're like, yeah, okay. But then you're like, no, hey, this is like a real thing. This is what it looks like compared to other people, and sort of in a quantitative.

Yeah, just it makes you feel good being able to know that you're not just imagining where your symptoms are. You're not just imagining that you're feeling bad. No one else can ever resonate with the way that you're feeling it. It allows them to understand that we do have some sense of how they may be feeling coming into treatment, and that can also just help us provide that informed care that we're really looking to provide.

Scott Webb: Yeah, I see what you mean, Alex. Like that validation of not only, okay, I'm not imagining this, this isn't just anecdotal. Uh, you know, I took the test, I took it twice. It's real. I really am suffering from this. I really have this thing. And also probably validation that they've, even though they've only been there two weeks, they may have already, the second test may sort of validate that they made the right choice going to Sierra Tucson because they're already making progress, right?

Dr. Alex Danvers: Exactly. I mean, and that's one of the nice things. So, the first time I kind of broke into a data set here, there's a little moment of trepidation where you do your first big statistical test. Is there gonna be a decrease and there was no need to worry. With Sierra Tucson, everybody gets a lot better across all of the indices that we measured, right? So we have a bunch of reports on outcomes on the Sierra Tucson eBooks section. But the easy headline is, All the bad stuff goes down, all the good stuff goes up.

Dr. Adrian Dinkins: And that's not to say too, we have the data to show that majority of our people are getting better within this time. But that's not to say that we don't have people who may be showing worse symptomologies at time. And that's really a key point of measurement-based care is we want to be able to, we want to be able to catch that. We want to be able to catch that your depression's gone up, so that way we can then come back in and ask you, what do you feel might be causing this issue?

This is what the problems, these are the conversations that we want to have with our therapist and our psychiatrist while we're here, right? Is your depression or your anxiety is well, why do we feel like it's going up? What part of treatment? You know, this is a scary place. Let's be real. Yeah. You, we tell you to come here and then stay here for 28 days and talk about your problems every single day. That's terrifying. That is to say the absolute least. I have so much respect for the people who come here and do that. And so, this allows us to be able to catch those people who may be falling through the cracks. Right. And that's why we do it at Mid treatment is so we're able to make those corrections.

Scott Webb (Host): Yeah, I see what you mean. Like for some folks, hey, it's only been 14 days and things are looking up. Whereas others, especially from your perspective, you might look at it and say, Hmm you know, things seem to be getting a little bit worse in some areas for this person, and it's been 14 days. Maybe we need a little bit of a course correction in terms of how we're treating them. Right?

Dr. Alex Danvers: Yeah, I mean that's exactly it, right? And that's where the clinician's part comes into play. And that's why measurement-based care is super important for them is because they're able to look at that and they're able to catch that. And so, yeah, I mean, and, and that's exactly it. We just want to be able to. Talk to them about why they may be feeling this way and make the changes that we need to make. We're trying to get better. We're not perfect, so we have things that we also need to work on. And so that allows us to be able to check how we may be doing something, change it, and now we can actually provide the type of care that we strive to provide. And so that's where it runs.

Scott Webb: Yeah. Well, and it sounds Adrian like you develop pretty close relationships with folks while they're there, and maybe just have you talk about that a little bit, the relationship between you and the residents while you're working with them. From the first day that you administer that test, and along the way, maybe you can just talk about that a little bit.

Dr. Adrian Dinkins: Yeah. And so what's actually like interesting is I actually only see our residents maybe about five times over the times that they're here. And the fifth time is just if they want to talk more. And you wouldn't guess that because I get so much information about them, like I spend this hour with them taking an assessment. Yeah. I don't talk to them too much about that, but then I very much am that person. Presents all of these problems they already know they have to them.

And what's really cool about the relationship that I can have with them is, no, I'm not their therapist. No I'm not their psychiatrist or anything like that. But I am someone who can talk them through the process of being able, or the process of seeing these different things split out on paper. And so they do open up to me very much. There are certain questions that they don't even say to their therapist or anything like that, that for the first time, I'm the person that they actually admitted to because we asked a question about it.

Right. You don't really think about it unless you ask a question about it sometimes, and because I answered that quite hard because we asked that question, they then come and they're like, oh, you know, this is what I'm thinking about. Or just different areas like attachment style, for example. A lot of people think that attachment style may be, it's a stagnant thing. It's something that just doesn't change. That's not true. And that's not true because you can have different attachment styles with many different people in your life, right?

And so your attachment style is actually constantly, constantly changing. And so seeing people come in on their midt treatment evaluations and they're like, oh, hold on. How did I change from a fearful attachment style to a secure attachment style? And you're like, well, these things mold. You're a moldable person, you know, just because you're an adult doesn't mean you just stay the way you are. And so the relationship that I really have with them is just being able to walk them through those different things. And I like to think that they do trust me in a lot of ways, just in the sense of being able to express how they actually feel. Not only about their results, but also their just experience that they're having at Sierra Tucson as a whole.

Dr. Alex Danvers: Yeah, and just to follow up on that, I like, love to brag on Adrian because he was hired for a research role here doing all this, you know, complex psychological testing, but his clinical touch is great and a lot of these people really appreciate having somebody who can talk their language, who can kind of take what's really complicated information and explain it in a way where it's like, oh, okay, I get it. Oh, okay, this makes sense for me, you know?

Dr. Adrian Dinkins: Thank you, thank you.

Scott Webb (Host): Yeah. Just kind of distill it down into something that that makes more sense to them, right?

Dr. Alex Danvers: And that's the whole goal. We want to be able to make it, what's digestible really. We want to just be able to make it digestible for them, make it so they under, they're understanding the results that they're coming back with. for That's the goal.

Scott Webb: This has been so interesting. And Alex, you said earlier that you're really excited about this and I totally understand why you're so excited about this and wish we could stay on longer, but I've got one last one for you. I want to talk a little bit more just about what do you do with the results? Like, where do those results go? Who can access them and use them, and how ultimately do they really help residents?

Dr. Alex Danvers: Some of that I've already touched on. Right? So one thing is that it helps us evaluate programs overall and how we're doing it. It Goes into, you know, my babies, which are like the, you know, machine learning and predictive modeling things where you can say, oh this is gonna help find somebody who might be more at risk. That also, those types of models help us identify factors. So for example, I mentioned we have this model on suicidal ideation and self-harm. What predicts that? What pops out is not other clinical symptoms, but our meaning and life scale. So there's a scale that asks, do you feel like you've got purpose?

Do you feel like you've got what it takes? Do you feel like you're lost? And your answers to those questions are a very good predictor, above and beyond, whether you're already depressed, of whether you're gonna have this feeling of, I want to keep going. So to me that's really powerful. And then there's the hands-on clinical piece, right? It goes to the. And we also have folks who are reference, they'll come in to Sierra Tucson. They'll say to me, Hey, can I get a copy of this? This would be really great, because the healing journey for any resident in here starts at Sierra Tucson, or maybe it doesn't always start.

Maybe they've been to previous places, but, we're working with them for a month, but it's the rest of their life when they have to continue to feel good about their lives and not slide back into depression, not slide back into addiction. And so as they go on to continuing care options at other places we have these reports available to other practitioners who can use them and try and use them for creating better, more personalized treatment.

Scott Webb: Yeah, it's so fascinating. I mentioned to you guys before we got rolling and I've done some recently on adventure therapy and equine therapy, and always fun to talk about miniature horses, you know, little horses. Are just, you just, you see like your reaction. You think of miniature horses. They're just so cool. And I thought this one was gonna be more sort of clinical in nature and maybe not quite as fun, but it's really fascinating, really interesting. Just wanna give last word to you, Adrian. Final thoughts, takeaways. Never wanna sound like a shill for Sierra Tucson, but a lot of good reasons for folks if they need this kind of treatment and they're up for taking that test a couple of times, probably a lot of benefits. Right?

Dr. Alex Danvers: Oh, I mean tons. And the really, the big takeaway away is that it gives them something that they really may not already know about themselves. Right. Like I had mentioned before, we take a lot of stuff that's put in your head and we put it down on a piece of paper and tell you to, hey, Come look at this. But the thing that's really great about it is Sierra Tucson does offer tons of different therapy for tons of different things from pain to our pain, addiction, mood, trauma. And so the cool thing about the assessment is it covers all of those areas. And so even people who may be coming in for depression, they may not realize that some of that depression may be due to trauma.

Right. I mean, you come to learn a lot of Sierra Tucson. We learn a lot about trauma. Trauma is a very, very important thing when it comes to any type of healing, when it comes to mental health. And so our assessment allows us to look at all of those different areas that Sierra Tucson already covers, and it really allows us to be able to highlight the types of treatments that we're able to give, and so we can see the changes throughout each one of those areas.

And I think that's just really the important part about it, is just being able to provide the holistic type of care that we say we provide, and that we're able to give, because we not only have the data to show that we can do that, but we also have the data to show that. Usually when people come in with one thing, there may be some things backing it that maybe the problem as well.

Scott Webb: And I think if nothing else, guys, we've proved today that data doesn't have to be boring. We could have some fun when we talk about data, we can get excited, right, Alex, about data.

Dr. Alex Danvers: I love it, man.

Scott Webb: We can laugh and have fun, and it doesn't have to be a drag. So this is really awesome. Thank you both. And you both stay well.

Dr. Adrian Dinkins: All right. Thank you for having us. Appreciate it.

Dr. Alex Danvers: Thank you very much.

Scott Webb: And if you find this podcast to be helpful, please share it on your social channels. And be sure to check out the full podcast library for additional topics of interest. This is Let's Talk: Mind, Body, Spirit from Sierra Tucson. I'm Scott Webb. Stay well.