1. Marla K. Ruhana, LMSW Wayne State University School of Social Work
Monitoring & Measuring Progress SW8350 Course Retrospective & Professional Development
Marla K. Ruhana, LMSW
Wayne State University
School of Social Work

2. Monitoring & Measuring Progress
Biopsychosocial Assessment.
Identification of the problem(s).
Is the problem described in concrete, behavior-specific terms?
Is the strength of the behavior defined?
Frequency? Duration? Intensity?
Is the problem identified by the client?
Who owns this problem? Is it client-centered?
Identification of strengths and resources.
Formulation of treatment goal(s).
Is the goal defined in positive, behavior specific terms
Formulation of action steps (i.e., cognitive & behavioral)
Are the action steps defined in a time-limited, specific manner?
Monitoring system.

3. Theoretical Model ↓ Case Conceptualization Strategies & Interventions

4. Evaluating Treatment – Client Progress
Main rule: Have a system of evaluation.
If you do not, how would you know if what you are doing works?
How do you evaluate your practice?
Pre- and post-test design: O1 X O2
Direct observations (in the office, at home, in the classroom, etc.)
Collateral information (e.g. parents, teachers, significant others, etc.).
Standardized instruments (e.g. Beck Depression Inventory, etc.).
Self-report: Verbal, behavioral logs, thought records, journals
How often do you measure progress?
Daily? Weekly? Monthly? Quarterly?
Benefits of measuring progress
Increased treatment effectiveness.
Advocacy with funding sources (e.g. Insurance companies, HMO, foundations, grants).

5. Steps of Evidence-Based Practice
Formulate a question
What specifically do you want to know about this case? (ex. What treatments are effective with adolescents who are self-cutting?).
Search for evidence - search for answers
Access research databases (e.g. PsycINFO, Social Work Abstracts, Cochrane Reviews, etc.).
Evaluate the evidence
What is the quality of the research? Is it relevant to the population?
Choose and implement your strategy
Evaluate the results.
Think of these as competencies
Appraise – both quality of the evidence and relevance to the pt at hand
The question must have 4 parts – pt or problem being addressed, the intervention being considered, the comparison intervention, the clinical outcomes of interest
Remember that clinical experience, pt preference, social context also play a role!
Individual clinical expertise: the proficiency and judgment of the clinician gained from clinical experience and practice. Best available external clinical evidence - clinically relevant research. Accuracy/precision of diagnostic tests Power of prognostic markers Efficacy/safety of therapeutic, rehabilitative, and preventative regimens Basic medical sciences – genetics, immunology

6. EBP Evidence-based practice integrates: Gaps in EBP
Best available research.
Best clinical judgment and expertise.
Culture and preferences of the client.
Gaps in EBP
Limited clinical/intervention research with racial/ethnic minorities and women??
How might this affect my choice of EBP?

7. Cognitive-Behavioral therapy
Our cognitions are the prime determinant of how we react emotionally and behaviorally to life events.
Information processing plays a central role in determining our emotional and behavioral reactions
CT models explicitly acknowledge the mediating role of cognitive factors in human adaptation.
What defines CBT is the ability to conceptualize or formulate cases from a cognitive-behavioral perspective.
Three key hypotheses in CBT theory
Access hypothesis
Mediating hypothesis
Change hypothesis

8. CBT Retrospective Assessment Cognitive & Behavioral Conceptualization
General: Biopsychosocial assessment
CBT specific: cognitions & behaviors
Cognitive & Behavioral Conceptualization
Core beliefs, rules, conditional beliefs, compensatory strategies automatic thoughts (meaning of automatic thoughts).
A logical link between all levels of the cognitive set.
Antecedents, Behavior (strength of behavior), Consequences (A-BS-C).
CBT principles (i.e. structured (agenda setting), present-oriented, problem-focused, active participation, collaborative-empiricism, Socratic questioning, etc…).

9. CBT Retrospective CBT treatment Psychopathology
Cognitive restructuring
Identify maladaptive thoughts – evaluate – reframe.
Thought records
Monitoring behavior (i.e. behavioral logs)
Behavioral rehearsals (e.g. role play); behavioral experiments…
Behavior modification/contingency management (rewards, reinforcement).
Exposure.
Imagery, relaxation, mindfulness.
Psychopathology
Children, adolescents, adults.
CBT and social work values and ethics.

10. So, where do you go from here?
Build on the foundation of this course
Practice, practice, practice and then, practice some more.
Keep up with the literature.
Decide where you want to go from here…
A social worker/CBT practitioner.
A practitioner who at times or often may use CBT strategies.
Independent practitioner? What does it mean?
Commit yourself to continued growth and development as a professional: licensing, certifications, continued education…
Seek supervision.
Further education?? PhD? Clinical Social Work? DSW?
Seek further development in CBT
Journals
Associations
Workshops/Training/Conferences

11. CBT Associations & Resources
Association for Behavioral and Cognitive Therapies (ABCT) (
International Association for Cognitive Psychotherapy (
Academy of Cognitive Therapy (
The American Institute for Cognitive Therapy (
The Albert Ellis Institute (
Beck Institute for Cognitive Therapy (
National Association of Cognitive-Behavioral Therapists (

12. CBT-Specific Scholarly Journals
Behaviour Research & Therapy
Behaviour Change (Australian Association for Cognitive & Behavior Therapy)
Behavior Therapy (ABCT)
Behavioural & Cognitive Psychotherapy (BABCT)
Cognitive Therapy & Research
Journal of Cognitive Psychotherapy: An International Quarterly (IACP)
Cognitive & Behavioral Practice (ABCT)
Journal of Rational Emotive & Cognitive-Behavior Therapy (Albert Ellis Institute)
Journal of Behavior Therapy & Experimental Psychiatry
Journal of Psychopathology and Behavioral Assessment
**Journals in bold letters are simply my preferences

13. Other important organizations
Substance Abuse & Mental Health Serivces Administration (SAMHSA).
National Institute of Mental Health (NIMH).
National Institute of Drug Abuse (NIDA).

14. Other interesting publications
Psychotherapy Networker (psychotherapynetworker.org)
Counselor: The magazine for Addictions Professionals (counselormagazine.com)
Addiction Professional (NAADAC, The Association for Addiction Professionals, naadac.org)

15. Licensure Apply for “limited license”.
4,000 hours of experience (2 years)
Seek supervision
100 hours (1 hr/week x 2 years) either individual or group.
Study and prepare for licensure exam
Multiple choice questions.
Critical thinking.
Application of knowledge that requires the use of critical thinking.
Continuing education (45 hrs/ 3years – post licensure).
WSU School of Social Work.
State of Michigan social work license information.
Association of Social Work Boards – practice exams.

16. Student Evaluations of Teaching
Date: April 18, 2012
Course number: SW8350
Call number:
Term: Winter 2012
Instructor: A. Gonzalez-Prendes