If during January a clinic administered urine drug screens and 88 tested negative, the abstinence rate would be 88 divided by or 44 percent. In monitoring abstinence rates, it is best to apply a specific timeframe to the client group being assessed. For example, a clinic may wish to calculate abstinence rates only for clients who have been in treatment at least 2 weeks. It may take that long for clients to begin achieving abstinence and for most drugs to clear from their systems. Marijuana is eliminated from the body slowly, so clients who have been abstinent and in treatment for less than 1 month could still test positive.
Together clinic staff and management need to develop abstinence rate timeframes appropriate for their facility. One approach is to compare the abstinence rates of clients who have been in treatment for 2 weeks with those who have been in treatment for 6 weeks or longer. Abstinence rates should increase with more time in treatment. Drug screens should be administered consistently to all eligible clients.
For example, if a clinic gives drug screens only to clients who are doing poorly, the clinic will have abstinence rates that reflect the performance of its most challenged and challenging clients. If drug screens are given to all clients equally, the abstinence rate obtained will reflect more accurately the clinicwide abstinence rate.
For some clinics, the costs of administering drug screens may be prohibitive. Although drug screens objectively measure abstinence, self-reported abstinence can be useful under certain conditions. The accuracy of self-reported data varies depending on the consequences associated with reporting current substance use Harrison For example, a client will underreport drug use if use can result in being returned to jail, losing custody of a child, or being terminated from employment. Although self-reported abstinence alone is a less than ideal measure of abstinence, for many treatment programs it may be the only basis available for an abstinence outcome measure.
For long-term rates, self-reported abstinence may be determined during a followup telephone interview, perhaps 6 months after discharge. If the followup call is made by the client's former counselor, the client may be more reluctant to admit use than if the call is made by a staff member or researcher with whom the client has no history. Clients often do not wish to disappoint their former counselor by acknowledging that they are having difficulty and have relapsed. Problem-specific monitoring. It is important to know whether treatment has not just influenced clients' substance use problems but also positively influenced other areas of their lives.
Problem-specific monitoring may be particularly important if the mission or funding of the clinic is associated with behavioral domains. For example, a treatment facility connected with Treatment Accountability for Safer Communities or a drug court might be interested in the extent to which its program is reducing clients' criminal activities. A treatment program also might be concerned with whether its interventions are reducing behaviors that put clients at high risk for contracting infectious diseases.
In either case, assessments might be administered at different points during the treatment process and after discharge to see how well clients are functioning and to track changes in behavior or status. A program might track information needed by its funding or referral sources e.
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Improvements in clients' employment, education, and family relationships can be important to funders and the public. The more a program is able to document the positive effect of its efforts, the better it will be able to justify its funding and argue for additional funding.
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It is most impressive if a program is able to establish that treatment still is having an effect several months after a client's discharge. But the followup monitoring required to obtain these data is more expensive and difficult to do than monitoring while the client is in treatment. Support group participation. Involvement in support groups, such as Step programs and other mutual-help groups, is another way of measuring continued sobriety and a client's determination to remain abstinent.
Followup calls may include questions about the number of support group meetings a client has attended in the previous week or month, whether the client has spoken with his or her sponsor in the previous month, and whether the client has a home group. Programs can monitor whether their efforts lead to improvements in these important performance indicators by quarterly or biannually assessing the rate of self-reported meeting attendance.
Other quality-of-life indicators. The following quality-of-life indicators often are included on existing statewide databases and can be monitored with varying degrees of difficulty:. These indicators usually are not generated on an individual clinic level but are of interest to many stakeholders. For decades, businesses and industry have focused on measuring customer satisfaction, and this information can be valuable for OT programs.
Client satisfaction provides information about the performance of both individual staff members and the clinic as a whole. For example, increasing client satisfaction may be a way to increase treatment engagement, attendance, and retention. In addition, health service providers, including treatment providers, increasingly are called on to monitor client satisfaction.
Client satisfaction data point to possible causes and solutions for substandard performance. Surveys showing that clients are dissatisfied may help staff members and managers understand why retention or even abstinence rates have decreased. No nationally recognized client satisfaction survey currently exists for substance abuse treatment providers. Appendix 6-A presents a client satisfaction form that has been designed specifically for use with IOT clients. Client satisfaction forms usually are divided into three sections:.
Conducting a structured telephone interview with the program's key referral and funding sources at 3-month intervals can elicit considerable information about how the program and staff are viewed. Such calls can be a check on whether the program is providing each referral source with the information the agency needs in a timely, helpful fashion. The interviews can identify areas of complaint or potential friction before difficulties or misunderstandings escalate into problems. These telephone calls also can be used to explore new opportunities for expanding or refining services.
See appendix 6-B for a sample form. An important measure of a program's effectiveness is the percentage of clients who have transferred successfully to and been retained in long-term, low-intensity outpatient services following completion of an IOT program. Another valuable approach to performance improvement is to conduct studies of clients who have dropped out of treatment. Because early treatment sessions are the most expensive, clients who drop out of treatment represent, in many ways, the greatest loss to a program. A study designed to understand better who drops out of treatment and why can help guide changes in the program that ultimately yield great benefit.
To conduct such a study, the program can conduct telephone interviews of the last 50 or clients who dropped out of treatment. The interviews should be done by an independent noncounseling staff member, such as a student intern or an assistant. The caller states that the purpose of the call is to. One result of open-ended interviews is that patterns of comments often emerge.
A preponderance of similar responses can indicate that changes are needed. For example, a program whose client population was overwhelmingly male conducted a study of women who had dropped out. The study confirmed that the women had dropped out because group sessions were dominated by male viewpoints, and the women felt their concerns were not being addressed. When conducting a dropout study, the caller should include an invitation to each client to return to treatment.
The invitation may be all that is needed to reengage a client in the recovery process. Programs might examine any performance measures that will provide meaningful and helpful information about how the clinic, individual clinicians, and clients are doing.
Outcomes can be calculated based on drug of choice, referral source, funding source, housing status, gender, co-occurring conditions, or other factors. Exhibit describes two evaluation resources. It is also important to consider the timeframe over which the program will measure outcomes. Attendance and engagement measures might be obtained monthly because they have a major effect on a clinic's revenues. No matter which performance criteria the program chooses to track, it is not wise to begin by focusing on all measures simultaneously. Performance measures should be phased in, starting with monitoring engagement, followed by other measures selected by the clinical team.
Different measurement instruments are needed for special populations, general treatment populations, and treatment services. Program and client outcome indicators will be different for different treatment groups. Clients with co-occurring disorders may have a different threshold for attendance than clients without these disorders. Other meaningful outcomes for this group include medication compliance, decrease or increase in psychiatric symptoms, and rehospitalization.
Similarly, special outcomes indicators may be appropriate for pregnant women e. Free copies of the ASI and guidelines for using it can be downloaded from www. The ASI is a standardized instrument that has good reliability and validity and can be used to collect information for comparison across sites and at different points in time. A frequently used measure for risk of infectious disease is the Risk Assessment Battery RAB , which is self-administered. Monitoring of risk reduction for infectious diseases might involve administering the RAB at intake, after 2 months of treatment, at discharge, and then 1 to 3 months after discharge.
Visit the Treatment Research Institute Web site at www. This instrument is a 5- to minute structured interview designed to provide information on the number and frequency of services received in each area. It yields a rating of the services delivered. Other important measures of client-level service delivery include the number of individual counseling sessions, number of group counseling sessions, number of urine tests and Breathalyzer checks, and length of stay. Program management and staff may be particularly interested in monitoring performance before and shortly after implementing new components, approaches, or initiatives.
For example, if a program is developing a hour oncall service, the administrators may want to know whether the service increases the number of new clients. The study might track intakes for 3 months before implementation of the new service and at 3 to 6 months after implementation of the service and compare results. The rates for attendance, engagement, and abstinence are appropriate measures to apply to new services.
Similarly, feedback from referral sources and clients who dropped out can be valuable for assessing a new service.
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When managers notice a problem e. Similarly, programs might monitor engagement and attendance rates after a clinic has moved or there has been high staff turnover. These changes are likely to disrupt operations, so monitoring might be particularly helpful at these times. Once staff members and managers have collected data, they can analyze them objectively, develop solutions to problems, and refine policies and practices.
Some States have adopted performance outcomes monitoring programs, and treatment programs in those States presumably already are aware of State requirements. However, because both accrediting organizations are emphasizing quality assurance or performance improvement activities, staff and management may wish to visit the Web sites of these organizations to learn about their specific requirements www. Before initiating performance outcomes and improvement processes, program administrators should meet with staff members to discuss the importance of monitoring.
The rationale for performance monitoring should be clear. Collecting and analyzing performance data have a practical benefit for the program and will improve service to clients. All staff members should know that performance monitoring can identify needs for additional training, resources, policy changes, and staff support—improvements the organization needs to make as a system. It is important for staff members to understand that the objective measures are being implemented to improve treatment outcomes and, wherever possible, to make it easier for staff members to work efficiently and effectively.
Management should make clear that the results of the monitoring will not be used to punish employees: The program is initiating monitoring to receive feedback that will enable staff members and managers to improve. Performance outcomes may vary from clinic to clinic and from counselor to counselor—and for the same clinic and counselor over time. For example, one clinic may work primarily with employed clients who have stable families and a low incidence of co-occurring mental disorders.
Another clinic may serve clients who are homeless, are dependent on crack, and have co-occurring mental disorder diagnoses. These two clinics likely will have different outcome rates on most dimensions. It should not be assumed that the clinic working with employed clients is better even though its objective outcomes are superior. The differences may be due exclusively to the clinic's case mix.
Likewise, case mix differences between counselors can result in very different outcomes even for clinicians with comparable skills and experience. Performance outcomes data should be used to improve the performance of all staff members—including managers and administrative support personnel.
Staff members need to be confident that the administration understands the effects of different case mixes and other influences on performance. It is essential that an atmosphere of trust and partnership be created. A critical step in creating such an atmosphere is to ensure that staff members know why data will be collected and what will be done with them. This communication should take place before data collection begins; staff should be informed orally and in writing during an orientation session.
When data collection is complete, it is extremely important that data be handled with sensitivity, particularly considering differences in the case mix from therapist to therapist. When administrators acknowledge the effects of case mix, it is possible to present data about performance to therapists. Because the data are objective, they are often superior to the subjective performance monitoring measures that supervisors traditionally have used.
An administrator conducting performance improvement studies may be tempted to act prematurely based on initial results. Depending on the indicator e. If initial data are to be shared with staff, the administrator needs to emphasize that these data are preliminary and advise staff that the data themselves are not important but the process of collecting, discussing, and working to improve them is.
The act of collecting and sharing outcome data with staff members improves performance without other interventions by management. When introducing a performance improvement system, managers should create a team consisting of clinical, administrative, and support staff. In small organizations, all staff members are on the team.
Large organizations can form a performance improvement team or quality council with staff, management, board, and payers. Program alumni representatives can be a valuable part of a performance improvement team. This team will identify the performance indicators that will be studied and will review and interpret the results. This group may recommend systemwide actions to improve outcomes. It is important to show sensitivity toward staff by handling data confidentially. This usually is done by presenting only clinicwide data—not data on individual performance—to the staff and the public at staff meetings or in reports to funders.
For example, an administrator might discuss changes in risk-reduction measures at the level of the clinic, not for individual therapists. It is natural and, under some conditions, beneficial for staff members to compare their performance with that of other staff members. However, counselors achieving the highest performance rates may be scoring well because of experience, training, case mix, random fluctuation, or unique talent. The goal is to help every counselor in the clinic improve over time. In other words, a counselor whose engagement rate has been 30 percent should be acknowledged for increasing the rate to 50 percent even though the average rate in the clinic is 60 percent.
Comparing a counselor who has a low engagement rate to the clinic average can lead to discouragement and even poorer performance Kluger and DeNisi Such comparisons should be avoided. Administrators should focus on clinicwide data and improvement initiatives. Counselor-specific data should be released confidentially to individual counselors.
Kluger and DeNisi reviewed more than 2, papers and technical reports on feedback intervention conducted in a variety of settings. They noted that performance feedback interventions are most effective if the feedback is provided in an objective manner and focuses on the tasks to be improved. Feedback should address only things that are under counselors' control.
Interventions that make the feedback recipients compare themselves with others can result in worse performance. Data on the individual performance of counselors should be confidential and secured; these data can be presented as counselor A, B, C, etc. Feedback data can be used to encourage staff members who have shown exceptional improvement. Identifying a staff member of the month can be an incentive for achievement. The key is to recognize improvement publicly, based on objective data. This kind of recognition encourages new staff members to learn from their high-performing colleagues.
Those who are performing consistently at the highest levels known as positive outliers can be acknowledged formally.
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These high achievers can be invited to give presentations, provide training, or recommend ways to improve the organization's performance. Encourage an atmosphere of mutual supportiveness in your classroom. It is helpful to explain to your learners why peer feedback is being used and how they are going to benefit from it. It is a good idea to start a peer feedback session with an in-depth discussion of success criteria.
You could show your learners examples of successful work from previous years. You know your learners, so you can judge whether to put them into small groups or pairs, and whether to put learners in a group with their friends. How much do I use self-assessment in my practice? Students initially learn self-assessment from their teacher: they follow your lead when you give them feedback about their work. Self-assessment will be most successful if you encourage your learners to practise regularly, e. It is also helpful to give your learners open questions to get them started, e.
Am I helping my students learn effectively from summative assessments? If possible, always return marked tests or exams to your learners so they can learn from their mistakes. It is also helpful to select questions that gave most learners problems and go through them in class.
It can be successful to adapt your future schemes of work based on what learners found difficult to allow more time to teach challenging concepts. What is the best way to get started with AFL? Here are four straightforward ways to introduce AFL into your teaching. Try out as many of these activities as you can.
Afterwards, reflect on your experiences and consider how you can develop the technique to fit into your regular teaching schedule. Questioning and discussion: Think Pair Share What is it? Then each learner discusses their ideas with a partner before the conversation is opened to the whole class. This strategy encourages all learners to get involved in classroom participation. It gives them time to formulate their own ideas as well as an opportunity for all learners to share their thinking with at least one other learner.
What happens? You can use this routine after asking the class any open question. For example, after reading a chapter of a book, the teacher asks all learners to reflect quietly on a question about it for one or two minutes. During this time learners record their own ideas on paper. Next, the teacher instructs them to turn to their neighbour, or a small group of neighbours, and discuss the question for several minutes. Then, the teacher calls on several pairs to tell the class what their ideas were. Feedback from the teacher: Comment-only marking What is it?
Choose one piece of work per month on which to give detailed written feedback to your learners. The feedback should be focused on success criteria that the learners are made aware of. Include specific praise about aspects of the work that the learner has done well and give learners specific targets for improving their work. Feedback can be given orally if you prefer. At the start of the next lesson, give back the work with the comments. Then allow time for the learners to improve the assignment, responding to your comments.
After the learners have improved their work, you could give out grades so that the learners know what level they were working at. Feedback from the learner: Traffic lights What is it? This technique is a quick way to find out how confident learners feel about a new concept or skill that has been covered in a lesson.
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You could give each learner a set of small coloured circles to hold up. Another way of doing this with several topics or concepts would be to give your learners a handout with a grid on which they can identify their understanding level with a smiley, sad or neutral face. Peer feedback on an assignment What is it? This activity introduces learners to the peer feedback process. Learners give each other feedback about an assignment that they have just completed. These are the qualities that make a good piece of work such as the effective use of language or using evidence to support an argument in an essay.
The first time you try peer assessment with your class, it is useful to scaffold the activity so that your learners know what to do. While your learners are giving each other feedback, walk around the class to monitor the feedback that each pair is giving. You can join in discussions to add your opinion if learners need some help giving feedback.
At the end of the session, ask your learners how they found the experience. Encourage them by praising how they have done the task and emphasise how this process takes time and practice to be effective. Here is a printable list of interesting articles and websites on the topics that we have looked at. Active learning Learning which engages students and challenges their thinking, using a variety of activities. Assessment for learning Essential teaching strategies during learning to help teachers and students evaluate progress in terms of understanding and skills acquisition, providing guidance and feedback for subsequent teaching and learning.
Cold calling Questioning technique in which the teacher selects a learner at random to answer a question, instead of learners putting up their hands to answer a question. Critical thinking The ability, underlying all rational discourse and enquiry, to assess and evaluate analytically particular assertions or concepts in the light of either evidence or wider contexts.
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Ego-specific feedback Feedback to the learner that focuses on their personal qualities. Feedback Information about how the learner is doing in their efforts to reach a goal. Feedback could also come from the learner to the teacher about how they feel the teacher could help them learn better. Formative assessment Activity that provides students with developmental feedback on their progress during the learning programme and informs the design of their next steps in learning.
Mixed ability A class that includes learners at several different levels of ability. Objectively Based on facts, and not influenced by personal feelings, interpretations or prejudice. Open question A question that cannot be answered with a one-word answer, e. By reflecting and evaluating what they have experienced and how, students and teachers can find ways of improving their learning. Reflective practice The process through which the teacher continuously learns from the experience of planning, practice, assessment and evaluation and can improve the quality of teaching and learning over time.
Scaffold learning The teacher provides appropriate guidance and support to enable students to build on their current level of understanding progressively, to acquire confidence and independence in using new knowledge or skills. Subject curriculum The content and skills contained within a syllabus applied across sequential stages of student learning. These stages normally refer to school year levels, and therefore a particular age of learner.
Success criteria Success criteria summarise the key steps or elements the student needs in order to meet a learning intention. Summative assessment Typically end-of-learning assessment tasks such as examinations and tests, to measure and record the level of learning achieved, for progression to the next level or for certification.
Syllabus A complete description of the content, assessment arrangements and performance requirements for a qualification. A course leading to an award or certificate is based on a subject syllabus. Task-specific feedback Feedback to the learner that focuses on various aspects of their work. Tutorial A short class 15—30 minutes conducted by a teacher for one learner or a small number of learners. Wait time The amount of time a teacher waits after asking a question and before selecting a learner to answer it. Getting started with Assessment for Learning.
What is the theory behind AFL? What are the challenges of AFL? There are two main types of question: closed and open. AFL checklist. If you are new to AFL, it will help if you ask yourself the following questions: How effectively am I using questioning? If possible, set your learners tasks to do to improve their work during the next lesson. Next steps: Four ideas to put into practice. Application problems can occur for a lot of reasons. However, it still does happen and is something you need to monitor for.
It is also critical to monitor things like server CPU and memory. A lot of modern web applications are not usually CPU bound but they can still use a lot of CPU and it is a useful indicator for auto-scaling your application in the cloud. Server metrics like CPU and memory are interesting, but for developers, application metrics can be a lot more valuable for true application performance monitoring. Developers need to monitor metrics around things like garbage collection , request queuing, transaction volumes, page load times, and much more.
It can also be critical to monitor things like Redis, Elasticsearch , SQL, and other services for key metrics. Standard server and application metrics can be very helpful for monitoring your applications. However, you may get way more value by creating and monitoring your own custom metrics. At Stackify we use them to do things like monitor how many log messages per minute are being uploaded to us or how long it takes to process a message off of a queue. These types of custom metrics are easy to create and can be very useful for application performance monitoring. Log data is usually the eyes and the ears of developers once their applications are deployed.
Developers need access to their logs via a centralized logging solution like a log management product. Fortunately, log management is an included APM feature in Retrace. The last thing we ever want is for a user to contact us and tell us that our application is giving them an error or just blowing up. As developers, we need to be aware of any time this occurs and constantly watching for them. Errors are the first line of defense for finding application problems.
They will just go somewhere else. Excellent error tracking , reporting, and alerting are absolutely critical to developers in an application performance management system. I would highly recommend setting up alerts for new exceptions as well as for monitoring overall error rates.
Anytime you do a new deployment to production you should be watching your error dashboards to see if any new problems have arisen.