1 March 2019 • Nurse Profiles

Joanna Price

Clinical Nurse Specialist for the Lakes District Health Board Primary Mental Health Service (PRIMHIS), Joanna Price, has just earned her credentials to be a trainer in Feedback Informed Treatment (FIT) methodology with the International Centre of Clinical Excellence.

Clinical Nurse Director for Mental Health and Addiction Services, Michael O’Connell, says Joanna is the first nurse in the world to have completed the very challenging training programme.

FIT is a tool that monitors a client’s progress by using their feedback and active participation to inform their treatment. The approach involves routinely and formally soliciting feedback from clients about: the process of therapy; the working relationship with the clinician; and the client’s overall wellbeing.

Joanna says FIT is a patient centred approach to care focusing on the client’s goals and needs as the client sees it. Once the clinician or therapist knows precisely the clients’ needs, they’re better equipped to adjust treatment accordingly. The approach makes sure the clinician is working alongside a person rather than focusing on what the clinician may see as the focus.

“It’s very exciting because it’s so patient centred and as clinicians we can constantly improve ourselves to get better outcomes for the people we work alongside. We can identify gaps in our own knowledge from feedback within the relationship, through the computerised programmes and individual data it produces which then informs deliberate practice. Deliberate practice will identify the coaching we need to fill our knowledge gaps. It is a move away from a medical approach to treatment,” she says.

Joanna says the research confirms that utilising a FIT approach decreases DNAs and hospital admissions and also increases adherence to attending appointments and medication.

“It’s checking in with the person; are we on the right path for you? Also, how do we know people are progressing unless we measure it? FIT is a measure of a person’s outcomes and therapeutic alliance rather than a treatment modality.”

Joanna says FIT requires a huge culture change in the way clinicians work alongside a person, even the language used is different. When people become a FIT clinician, there are several competencies that need to be adhered to, like other health care professionals’ work competencies.

“It’s just brilliant. It’s a culture shift but it improves outcomes and you can’t get better than that. Once people are exposed to FIT, they are excited about the opportunities and see it as extremely valuable in terms of helping set up care plans and clinicians adjusting themselves to work better for people. It has the potential to acquire information we would not have otherwise had.”

Joanna says it’s important to create a relationship with a person because having a strong alliance, encourages a culture of feedback, including being able to share negative aspects of the interaction.

“Creating a culture of feedback, especially negative feedback, takes work and time and a strong alliance. Research states the more you can engage and have a strong relationship or alliance with a person, the better the person’s outcomes.”

The Mental Health and Addiction service senior leadership team at Lakes has supported the implementation of FIT. FIT is currently being implemented in the Whare Whakaue Inpatient Unit with a plan to eventually roll it out across the whole service.

Michael O’Connell says this is a crucial development for Mental Health and Addiction services if we are to advance an outcomes culture. Further – this is a highly effective tool that Mental Health nurses can use that tangibly supports their commitment to growing the partnership of all service users, maximising their participation and enhancing the protective requirements of Te Tiriti o Waitangi – in the context of health care delivery.

“We have made a commitment to growing this structured, evidence-based approach to maximising clients’ feedback into their care. This process is specifically about growing consumers direct input into their care and the evaluation of clinician effectiveness. This is also an excellent fit with Te Ara Tauwhirotanga, the new model of care.”

“It keeps us on our toes as clinicians. There’s so much potential with the tools and the philosophical re-focussing on the client as the expert of their experiences. It’s the therapeutic version of the 360-degree review, we are constantly improving ourselves,” Michael says.

Having completed the course including four workshops, an exam and a video providing evidence of her competence, Joanna is a certified trainer and can now facilitate training sessions with groups of health professionals interested in advancing their practice.

The first structured training and implementation is occurring in the Inpatient Unit – which in itself is a first in Australasia.

Michael O’Connell
March 2019