Measuring Up

In his wonderfully titled chapter Suggestions for Becoming a Positive Deviant, Atul Gawande instructs young physicians to

Count something”. Regardless of what one does in medicine – or outside medicine, for that matter – one should be a scientist in this world. In the simplest terms, this means one should count something.

This should, without question, apply to ACT teams. We should measure something, something of what we do, something of how our clients are doing. We should not leave all the counting to researchers; we should be doing it ourselves.

Over 10 years as the psychiatrist on a PACT team I never once directly helped someone find, get or keep housing. I was however part of a team of skilled clinicians who worked tirelessly to help clients deal with the, at times, gargantuan challenge of finding housing. I got to take their work and, with the help of an able researcher, who did most of the heavy lifting, got to measure whether ACT makes a difference in terms of housing outcomes. Analyze 65 clients’ 407 addresses from over 8 years and out comes a paper.

The result? That “the observed changes [in stability] imply that ACT was effective in helping clients to achieve stable housing and live independently.” Not earth-shattering but worth measuring. (Click Housing Outcomes to view pdf)

Front line ACT clinicians are always juggling too many balls. Even knowing this, it’s still worth counting something. It doesn’t have to be a randomized double blind control study; think small, think real world. Maybe you can present at a local conference or even just to your team during an educational session.

As a certain shoe company might say “Just do it”.

Shalom Coodin

Gawande, A, (2007) better: A Surgeon’s Notes on Performance


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