Resources to Monitor Your Clinical Outcomes

 

Several instruments have been developed and studied to monitor the results of psychological interventions. The different monitoring (or feedback) systems vary in size, addressed issues and criteria used to measure clinical effectiveness. The psychotherapist should choose the instrument that best meets his or her clinical and / or research needs, also considering the degree of empirical validation of each instrument. [1]

 

Three systems that stand out for their high quality and degree of empirical evidence to support them are the Outcome Questionnaire-45 (OQ-45) [2], the CORE-OM [3] and the PCOMS [4].

 

 

  

The OQ-45 is one of the most widely used and investigated clinical outcome instruments [25]and it is recommended by the Substance Abuse and Mental Heath Services Administration (SAMHSA). Developed by Dr. Michael Lambert and co-workers, it is a self-report measure created to assess the progress of the client during and after the psychological intervention. The OQ-45 consists of three subscales:

  1. Symptoms of subjective discomfort (depression and anxiety)
  2. Interpersonal relationships (loneliness, conflict with others and family difficulties)
  3. Social context (difficulties in the workplace, school or household duties)

The OQ-45 takes about 3-5 minutes to fill. Session-to-session administration is recommended in order to continuously assess the client's psychological state throughout the therapeutic process. The instrument may also be administered at predefined time intervals, for instance, every 5 sessions. 

Administration of the OQ-45 can be done manually, with paper copies, or digitally, through the OQ-AnalystThe software processes the client's results and automatically creates a chart of therapeutic progress, thus reporting the effectiveness of psychological intervention. The results obtained in each subscale also help to identify particularly problematic areas, signaled by the OQ-Analyst as a suggestion of focus for treatment. The software provides final feedback on the client's trajectory of change, comparing it to the expected path statistically, based on data collected from thousands of completed therapeutic processes.

 

 Imagem 1. Tratamento de dados e apresentação gráfica da

monitorização de resultados através do OQ-Analyst.

 

 

The rights of the instrument and software are held by the company OQ-Measures.  

 


 

 

The Clinical Outcomes in Routine Evaluation - Outcome Measure, or CORE-OM, is a 34-item client self-report tool, widely studied and used, mainly in the UK. [3]

 

Figura 2. Linhas de corte a definirem gravidade do caso clínica conforme pontuação total do CORE-OM.

The instrument is composed of four subscales:

  • Subjective well-being (W)
  • Problems and symptoms (P)
  • Social and personal functioning (F)
  • Risk Behaviors (R)

As with the OQ-45, the CORE-OM can be applied session-by-session or at longer time intervals, with the ultimate goal of assessing the progress and outcome of psychological intervention. 
 

The total score obtained through the CORE-OM can be compared with the empirically established cut lines, providing an assessment of the severity of the client's psychological state.

 

 

 

In addition to the paper version, the CORE-OM can also be managed digitally through the CORE NET, which processes and presents client data graphically. The image below shows session-to-session outcome monitoring in an 8-session therapeutic process.

 

Figura 3. Representação gráfica dos resultados CORE-OM através do software CORE NET.

A linha superior (azul) traça a pontuação total obtida; a linha inferior (vermelho) traça a pontuação

total da subscala "comportamentos de risco (R)"; a linha pontilhada representa a linha de corte clínica.

 

The rights of the instrument and associated software are reserved to CORE IMS (Information Management Systems).

 


 

 

The Partners for Change Outcome Management System, or PCOMS, is an empirically validated feedback system recommended by the Substance Abuse and Mental Heath Services Administration (SAMHSA). Along with the OQ-45, it is possibly the most scientifically supported outcome monitoring system. [45, 6]

 

The PCOMS consists of the application of two short measures: the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS). Created in 2003 by Scott D. Miller and Barry Duncan, these instruments aim to monitor clients' progress in psychotherapy. With only 4 items each, the scales enable a particularly quick implementation in all sessions of the therapeutic process, taking less than 1 minute to complete. The ORS is completed by the client at the beginning of each session, and the SRS is completed at the end of each session.

 

The ORS originally emerged as a brief alternative to the OQ-45. It assesses the client's clinical progress through self-report in four areas:

  • Individual subjective well-being (from oneself to oneself)
  • Interpersonal well-being (with family and close relationships)
  • Social well-being (at work, school, friendships)
  • Overall assessment of well-being
The results of the ORS scale report the effectiveness of the ongoing or completed psychological intervention and identify areas of work that may be more relevant to the therapeutic process (e.g. difficulties in close relationships).

The second measure, SRS, is applied at the end of each session, focusing on variables related to the therapeutic alliance, one of the strongest predictors of success in psychotherapy. [7] The results of this measure signal potentially problematic areas of work that the therapist will have to address within the session, such as setting therapeutic goals and the therapist's approach to these goals. This measure helps the therapist to responsibly adapt the psychological intervention to the needs and characteristics of the client.

 

 

Figura 4. Representação gráfica dos resultados PCOMS através do website FIT Outcomes.

A linha inferior (negrito) traça o progresso clínico do cliente, avaliado com o ORS;

a linha superior (cinzento) traça a qualidade da aliança terapêutica, avaliada com o SRS.

 

You can download the paper version of the PCOMS for free here.

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