A History of Routine Outcome Measurement in Clinical Practice: A Review of Evidence and Issues
Abstract
Over the last several decades, psychologists have come under increasing pressure to empirically demonstrate the efficacy of the clinical interventions they implement. Towards this end, Routine Outcome Monitoring (ROM) has been repeatedly shown to utilize feedback to enhance treatment outcomes by way of capturing negative changes that may otherwise lead to treatment failures. Despite the documented benefits of incorporating ROM into clinical practice, research suggests that the majority of clinicians in the United States have not done so and instead continue to base treatment planning decisions and assessments of client progress through the more subjective clinical interpretation. The reasons that practicing clinicians choose not to utilize ROM appear to be both practical and philosophical in nature. In order to better understand factors that affect ROM use among clinicians, this paper summarizes the origins of ROM and the contexts in which it currently exists, as well as research documenting the potential benefits of ROM and the ways in which it enhances treatment outcomes. Frequently endorsed reasons that practicing clinicians do not collect outcome data include the cost and time needed for regularly administering and interpreting measures, and concerns about the usefulness of this information in treatment. These challenges are discussed and considered alongside findings from the ROM literature. The limitations of ROM are also discussed, such as disorders and populations in which publicly available ROMs are needed, the lack of investigation into how clinicians’ therapeutic orientations affect implementing ROM in practice, and the immutable need to interpret data using clinical judgement. Future directions for research and practice using ROM are reviewed as well.
Keywords: Routine outcomes measurement (ROM), feedback-informed treatment, assessment, patient reported outcomes
References
Ackerman, S. J., Benjamin, L. S., Beutler, L. E., Gelso, C. J., Goldfried, M. R., Hill, C., … Rainer, J. (2001). Empirically supported therapy relationships: Conclusions and recommendations fo the Division 29 Task Force. Psychotherapy: Theory, Research, Practice, Training, 38(4), 495–497. https://doi.org/10.1037/0033-3204.38.4.495
American Psychological Association. (n.d.). Different approaches to psychotherapy. Retrieved August 27, 2017, from http://www.apa.org/topics/therapy/psychotherapy-approaches.aspx
Beidas, R. S., Stewart, R. E., Walsh, L., Lucas, S., Downey, M. M., Jackson, K., … Mandell, D. S. (2015). Free, Brief, and Validated: Standardized Instruments for Low-Resource Mental Health Settings. Cognitive and Behavioral Practice, 22(1), 5–19. https://doi.org/10.1016/j.cbpra.2014.02.002
Boswell, J. F., Kraus, D. R., Miller, S. D., & Lambert, M. J. (2013). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Retrieved July 5, 2016, from http://www.scottdmiller.com/wp-content/uploads/2014/06/Implementing-routine-outcome-monitoring-in-clinical-practice-Benefits-challenges-and-solutions-Psychotherapy-Research_Boswell-Kraus-Mi.pdf
Burgess, P., Coombs, T., Clarke, A., Dickson, R., & Pirkis, J. (2012). Achievements in mental health outcome measurement in Australia: Reflections on progress made by the Australian Mental Health Outcomes and Classification Network (AMHOCN). International Journal of Mental Health Systems, 6, 4. https://doi.org/10.1186/1752-4458-6-4
Edbrooke-Childs, J., Barry, D., Mateos Rodriguez, I., Papageorgiou, D., Wolpert, M., & Schulz, J. (2017). Patient reported outcome measures in child and adolescent mental health services: Associations between clinician demographic characteristics, attitudes, and efficacy. https://doi.org/http://dx.doi.org/10.1111/camh.12189
Eells, T. D. (2013). In Support of Evidence-Based Case Formulation in Psychotherapy (From the Perspective of a Clinician). Pragmatic Case Studies in Psychotherapy, 9(4). https://doi.org/10.14713/pcsp.v9i4.1836
Final rules under the Paul Wellstone and Pete Domenici Mental Health Parity and Addiction Equity Act of 2008; technical amendment to external review for multi-state plan program. Final rules. (2013). Federal Register, 78(219), 68239–68296.
Garland, A. F., Kruse, M., & Aarons, G. A. (2003). Clinicians and outcome measurement: what’s the use? The Journal of Behavioral Health Services & Research, 30(4), 393–405.
Hatfield, D. R., & Ogles, B. M. (2004). The Use of Outcome Measures by Psychologists in Clinical Practice. Professional Psychology: Research and Practice, 35(5), 485–491. https://doi.org/10.1037/0735-7028.35.5.485
Hatfield, D. R., & Ogles, B. M. (2007). Why Some Clinicians Use Outcome Measures and Others Do Not. Administration and Policy in Mental Health and Mental Health Services Research, 34(3), 283–291. https://doi.org/10.1007/s10488-006-0110-y
Holt, H., Beutler, L. E., Kimpara, S., Macias, S., Haug, N. A., Shiloff, N., … Stein, M. (2015). Evidence-based supervision: Tracking outcome and teaching principles of change in clinical supervision to bring science to integrative practice. Psychotherapy, 52(2), 185–189. https://doi.org/10.1037/a0038732
Howard, K. I., Moras, K., Brill, P. L., Martinovich, Z., & Lutz, W. (1996). Evaluation of psychotherapy: Efficacy, effectiveness, and patient progress. American Psychologist, 51(10), 1059–1064. https://doi.org/10.1037/0003-066X.51.10.1059
Hunsley, J., & Mash, E. J. (2007). Evidence-Based Assessment. Annual Review of Clinical Psychology, 3(1), 29–51. https://doi.org/10.1146/annurev.clinpsy.3.022806.091419
Jensen-Doss, A. (2015). Practical, Evidence-Based Clinical Decision Making: Introduction to the Special Series. Cognitive and Behavioral Practice, 22(1), 1–4. https://doi.org/10.1016/j.cbpra.2014.08.001
Kazdin, A. E. (2000). Encyclopedia of Psychology. American Psychological Association.
Lambert, M. J. (2001). Psychotherapy outcome and quality improvement: Introduction to the special section on patient-focused research. Journal of Consulting and Clinical Psychology, 69(2), 147–149. https://doi.org/10.1037/0022-006X.69.2.147
Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing feedback to psychotherapists on their patients’ progress: clinical results and practice suggestions. Journal of Clinical Psychology, 61(2), 165–174. https://doi.org/10.1002/jclp.20113
Levine, J., Cruz, R., Cooper, L., Murphy, H., Peterson, P., Hurd, L., & Feldner, M. (2017). Integrating routine outcome monitoring into graduate training clinics to advance evidence-based practice. The Behavior Therapist, 40, 17–22.
Lyon, A. R., Dorsey, S., Pullmann, M., Silbaugh-Cowdin, J., & Berliner, L. (2015). Clinician use of standardized assessments following a common elements psychotherapy training and consultation program. Administration and Policy in Mental Health and Mental Health Services Research, 42(1), 47–60. https://doi.org/10.1007/s10488-014-0543-7
Mours, J. M., Campbell, C. D., Gathercoal, K. A., & Peterson, M. (2009). Training in the use of psychotherapy outcome assessment measures at psychology internship sites. Training and Education in Professional Psychology, 3(3), 169–176. https://doi.org/10.1037/a0016135
OQ Measures. (2017, October 5). OQ-Analyst. Retrieved October 5, 2017, from https://www.oqmeasures.com/
SAMHSA’s National Registry of Evidence-based Programs and Practices. (2014, January). OQ-Analyst Intervention Summary. SAMHSA. Retrieved from http://legacy.nreppadmin.net/ViewIntervention.aspx?id=370
Scott, K., & Lewis, C. C. (2015). Using Measurement-Based Care to Enhance Any Treatment. Cognitive and Behavioral Practice, 22(1), 49–59. https://doi.org/10.1016/j.cbpra.2014.01.010
The Kennedy Forum. (2015a). A Core Set of Outcome Measures for Behavioral Health Across Service Settings: Supplement to Fixing Behavioral Health Care in America: A National Call for Measurement-Based Care in the Delivery of Behavioral Health Services. Retrieved June 23, 2016, from http://thekennedyforum-dot-org.s3.amazonaws.com/documents/MBC_supplement.pdf
The Kennedy Forum. (2015b). Fixing Behavioral Health Care in America:A National Call for Measurement-Based Care in the Delivery of Behavioral Health Services. Retrieved June 23, 2016, from https://thekennedyforum-dot-org.s3.amazonaws.com/documents/KennedyForum-MeasurementBasedCare_2.pdf
Whipple, J. L., Lambert, M. J., Vermeersch, D. A., Smart, D. W., Nielsen, S. L., & Hawkins, E. J. (2003). Improving the effects of psychotherapy: The use of early identification of treatment and problem-solving strategies in routine practice. Journal of Counseling Psychology, 50(1), 59–68. https://doi.org/10.1037/0022-0167.50.1.59
Copyright (c) 2020 The New School Psychology Bulletin
This work is licensed under a Creative Commons Attribution 4.0 International License.
This work is licensed under a Creative Commons Attribution 4.0 International License.
