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Before the Evidence Arrives- Helping More Clients, More Often
September’s issue begins with a question from the FIT in Action: Patterns, Cues, and Clinical Role-Play workshop: what has to happen before feedback, measures, and evidence can change practice? It also features an editorial published by the Canadian Science Policy Centre and reflections from UN Digital Cooperation Day in New York City.
FIT in Action: Patterns, Cues, and Clinical Role-Play
Before the Evidence Arrives
After facilitating FIT in Action: Patterns, Cues, and Clinical Role-Play last week, I kept returning to one question: what had participants taken away? The Feedback-Informed Treatment training was delivered with the Vancouver Coastal Health Research Institute (VCHRI) as a collaborating site in applied clinical capacity-building.
Did they leave with a vision of how something they learned might help them help more clients, more often?
That question stayed with me while reading a Substack by Key Peterson, called Before the Evidence Arrives. Its argument helped me understand what I was really asking: before evidence, measures, or methods can change practice, people first have to see a possibility worth pursuing. Had the workshop helped participants see that noticing something sooner might change the course of care for a client who was not benefiting?
In Feedback-Informed Treatment, the first step is not measurement.
It is learning to see.
Before the evidence arrives, there is a moment of noticing. A moment when a therapist becomes curious about whether a client is experiencing therapy in the way the therapist assumes. A moment when a subtle cue, hesitation, shift in engagement, or change in direction raises a question:
What am I missing?
Without that orientation, measurement risks becoming administration. Data risks becoming paperwork. Feedback becomes something collected rather than something learned from.
The workshop was designed around those earlier moments. Participants practised recognizing patterns, explored cues that often go unnoticed, and used role-play to test what they might do differently when something in the therapeutic process began to shift.
The goal was not to secure commitment to a particular model, method, or set of tools. It was to help participants recognize a possibility: that noticing sooner could change what happens next for a client who is not benefiting.
The hope was that they might leave with a different possibility in mind.
Imagine ten new clients seek your help.
Chances are good that most will experience meaningful improvement.
But chances are also good that one or two may not return after the first session. One or two more may attend several sessions without experiencing meaningful benefit. Others may remain in therapy for much longer than expected without achieving the changes they hoped for when they first sought support.
Now imagine you could prevent one of those early dropouts.
Imagine you could identify the client who wasn't benefiting and make adjustments early enough to help them find relief.
Imagine you could recognize that something wasn't working before that person quietly disengaged or accepted that this was simply as good as things were going to get.
That's the vision.
Helping more clients, more often is not an abstract aspiration. It is the possibility of changing the trajectory of even one person's experience of care.
When therapists see that possibility, they usually find their way toward the next steps. They become curious about feedback. They seek training. They develop new skills. They experiment, learn, and adapt.
But when we rush past that first step, all of the later conversations about measures, implementation, and outcomes can feel disconnected from the reason most of us entered this profession in the first place.
That was the connection between the article and the workshop: before therapists can use feedback to change a client’s trajectory, they first have to see that another trajectory is possible.
Before the evidence arrives, before the measures, before the implementation plans, and before the outcome reports, there has to be a reason to care.
There has to be a moment when a therapist realizes that better outcomes are possible for the clients who are least likely to benefit from treatment as usual.
Everything else is built on that foundation.
Question for reflection: What first convinced you that small changes in your practice could help more clients benefit from therapy?
Also published in September
Before Canada Scales Health AI Infrastructure, It Must Govern What Health Data Becomes
Canadian Science Policy Centre · September 9, 2026
In an editorial I wrote for the Canadian Science Policy Centre, I argue that Canada’s move toward greater use of AI and health data infrastructure requires a broader governance question. Infrastructure is not neutral, and access is only part of the issue. What matters is also what health data becomes when it is combined, transformed, interpreted, inferred from, or used to represent a person—because those representations can shape consequential decisions about their care and their lives.
UN Digital Cooperation Day and the Next Governance Question
LinkedIn · September 22, 2026
Last week I attended UN Digital Cooperation Day in New York City. The conversation there was necessarily broad: digital cooperation, AI, evidence, infrastructure and governance. But I came away thinking about something more specific. We have increasingly sophisticated ways to move, link and process information about people. Yet our governance frameworks can still focus on the data without adequately accounting for the representation of the person that emerges from that data. A digital subject representation isn't simply a dataset, and once it begins to influence decisions about the person, questions of agency, consent and accountability change.
Pictures and video clips from New York Trip
Listen to the scientists 
