DateWise, Ltd

Solution for a blind therapist

Vic Fanberg, October 25, 2018

At the recent AUCCCD conference, one counseling center director approached me to ask if I could provide a solution that would allow a blind therapist to work in a Ti* environment. He had a senior staff member who had worked for him for years and was going progressively blind to the point where he had trouble using the mouse inside Ti* and soon would be unable to use other portions of the software. The user was already using screen magnification software and his vision was getting to the point where that was also failing him. My mind immediately went to traditional solutions to such a problem, which would require access to the source code that Ti* was written with. Since I do not have access to the source code, my answer was there is nothing I would be able to do to help that situation.

In the quiet of driving the 14 hours home from the conference, I considered that problem more closely. Actually, the solution is very simple and I do not need access to the source code for Ti* to solve this problem. My solution would allow a sighted user to turn off their monitor and still have enough access to the Ti* environment to be able to function as a therapist. Therefore, such a solution would also work for a blind individual since the user doesn’t have to see the monitor to use Ti*.

There is already software available that allows blind users to create/edit/read documents. I already write queries that can verify user credentials/rights and read or insert documents for the Ti* database. The only thing that is missing is a menu system that would allow a blind person to navigate to the point of reading/editing/creating information in a client's file.

My solution uses the traditional computer capabilities for blind (such as voice commands and touch typing) and adds a menu specific system specific to the software. The menu system doesn't have to (and actually shouldn’t) identically match Ti*'s mouse controlled menu system. In fact, there are more efficient menu commands than using the same design as one would use when navigating with a mouse.

Finally, similar solutions exists and can be integrated into my menu system to handle data forms, retrieving CCAPS scores, scheduling appointments, etc. What I am proposing here is general enough that it could enable a blind front desk user to successfully use the Ti* environment.

If you would like further information on how to allow a therapist to continue working when they are no longer able to see the screen, or would like software designed to enable this, please contact me using the contact link above. Even though my extensive experience is with Ti*, the actual underlying system may not matter.

How to count distinct clients seen

Vic Fanberg, December 2, 2017

I have seen as much as a 25% variance in the quantity of distinct clients seen for the same basic year depending on the exact dates chosen. It doesn’t matter whether you are using Medicat, Point and Click, Pyramid, Titanium Schedule, or any other software. One embedded report might say 4,000 distinct clients, but then change the dates about 6 or 8 weeks, and the same report might say 5,000 distinct clients. The cause of this issue is that causes this is that you are including people from partial terms (i.e., quarter, semester or year).

To visually see the problem, consider the following diagram. It shows the schedules of 3 students (A, B and C). The green boxes represent years, which are labeled along the timeline at the bottom. Student A graduated at the end of the term ending in 2017. Student B started school in 2016. Student C graduates at the end of the term ending in 2018. The blue ovals represent the date ranges when the counseling center saw the student. The red box represents a 1-year term in which we are trying to count how many distinct clients were seen. The first illustration shows just student A and student C were seen during the one year period starting in 2016 and ending in 2017.

Selecting a one year period beginning at the start of fall term

Watch what happens if we pick a date range a little after the previous one. Now the red box contains appointments for all 3 students. The count of distinct clients seen would say 3 students, even though only 2 students were really seen during the 2016-2017 academic year. So, it is now easy to see how easy it is to create a large error in the count of distinct clients seen (here it is a 33% overstatement).

Starting even a few days into the next term will pick up clients who were not seen during the period

The majority of students start their school experience in the fall and end their school experience after the spring term in some future year. Students also take more classes during fall and spring terms than over the summer. Finally, I noticed that students who start counseling (such as group sessions) in the fall have a higher tendency to continue counseling in the spring, as opposed to students who start counseling in the spring tending to continue counseling in the summer or fall. All of this means that the same effect as shown above happens if you calculate the quantity of students at the beginning of spring term rather than the quantity of students at the beginning of fall term.

In general, the closer you get to the center of a term, the worse the distortion will be. This is especially true of the center of quarters or semesters, but even, to a lesser effect, the center of years. So, if you are only looking a day or two into the start of a year, the only distortion is going to be from a few of the clients seen in the first day or two of the added year. Likely any clients with an appointment in the first day or two of the cut short year will have some other appointment that year, so will not be subtracted from the count as easily as new term specific clients will be added.

If you would like to verify this effect with your own data, run a report that gives the quantity of distinct clients seen for the following date ranges, and see if they come close to matching:

  • The first day of fall semester in 2016 for a full one-year period
  • One week after the first day of fall semester in 2016 for a full one-year period
  • Two weeks after the first day of fall semester in 2016 for a full one-year period
  • Three weeks after the first day of fall semester in 2016 for a full one-year period
  • Four weeks after the first day of fall semester in 2016 for a full one-year period
  • and so on until you convince yourself

So, how do you get the closest to an accurate count of distinct clients seen?

  • The closest to an accurate count of distinct clients seen during the school year will be the 12-month period starting after the end of summer term and before the beginning of fall term that gives the fewest clients when calculated. In other words, if your summer term ends on August 18, 2017, and fall term begins August 28, 2017, use your EMR reports to calculate the quantity of distinct clients seen for a 1-year period ending on each of the following dates (and the one that gives the lowest number is the best estimate of the quantity of distinct clients seen): 8/18, 8/21, 8/22, 8/23, 8/24, 8/25 and 8/28.
  • If you must count clients for some other period, just report the difference how much different it is from one year to the next year rather than raw numbers. For example, if you are asked for the number of distinct clients seen between 1/1/2016 and 12/31/2016, report how that compares with the clients seen between 1/2/2015 - 12/31/2015, instead of reporting raw numbers (assuming the goal is to look for growth in demand for counseling services). If the goal is to get raw counts of clients seen for the year, give the counts for the clients seen starting at beginning of fall term instead because this is more accurate.
  • Whenever I reported distinct clients seen for a year period, I also always specified the exact date range I had used right along with the raw count. That allowed me to reproduce the numbers later on, or provide further details for the matching count.