How patients and clinicians experience the utility of a personalized clinical feedback system in routine practice.

Objective: The objective was to explore how a person-adaptive clinical feedback system (CFS) effects its users, and how meaning and relevance are negotiated.

Methods: We conducted a 10-month case-study of the implementation and practice of Norse Feedback, a personalized CFS. The data material consisted of 12 patient interviews, 22 clinician interviews, 23 field notes, and 16 archival documents.

Assessing Patient Progress in Psychological Therapy Through Feedback in Supervision: the MeMOS* Randomized Controlled Trial (*Measuring and Monitoring clinical Outcomes in Supervision: MeMOS).

Background: Psychological therapy services are often required to demonstrate their effectiveness and are implementing systematic monitoring of patient progress. A system for measuring patient progress might usefully 'inform supervision' and help patients who are not progressing in therapy.

Aims: To examine if continuous monitoring of patient progress through the supervision process was more effective in improving patient outcomes compared with giving feedback to therapists alone in routine NHS psychological therapy.

Acceptability, reliability, referential distributions and sensitivity to change in the Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE) outcome measure: replication and refinement.

Background: Many outcome measures for young people exist, but the choices for services are limited when seeking measures that (a) are free to use in both paper and electronic format, and (b) have evidence of good psychometric properties.

Method: Data on the Young Person's Clinical Outcomes in Routine Evaluation (YP-CORE), completed by young people aged 11-16, are reported for a clinical sample (N = 1269) drawn from seven services and a nonclinical sample (N = 380). Analyses report item omission, reliability, referential distributions and sensitivity to change.

A CORE approach to progress monitoring and feedback: Enhancing evidence and improving practice.

This article describes the Clinical Outcomes in Routine Evaluation (CORE) System and reports on its scientific yield and practice impact. First, we describe the suite of CORE measures, including the centerpiece CORE-Outcome Measure (CORE-OM), its short forms, special purpose forms, translations, and psychometric properties, along with the pretreatment CORE Therapy Assessment Form and the CORE End of Therapy Form. Second, we provide an overview of the scientific yield arising from analyses of large CORE data sets collected in routine practice.

Client and therapist agreement about the client's problems-Associations with treatment alliance and outcome.

Objective: A shared understanding of the patient's symptoms and problems is seen by most theories as a crucial aspect of the collaboration in therapy, presumably influencing alliance and outcome. The empirical ground for this argument is not solid, however. Several studies have found weak associations between a common view of the patient's problems and outcome.

Exhausted but not cynical: burnout in therapists working within Improving Access to Psychological Therapy Services.

Background: Burnout is common in mental health professionals and has serious personal and professional consequences. Levels and predictors of burnout for therapists within "Improving Access to Psychological Therapies" (IAPT) services are thus far unknown.

Aims: This study investigated levels and predictors of three burnout dimensions--Emotional Exhaustion (EE), Depersonalisation (DP) and Personal Accomplishment (PA)--in IAPT therapists.

Tracking Responses to Items in Measures as a Means of Increasing Therapeutic Engagement in Clients: A Complementary Clinical Approach to Tracking Outcomes.

Unlabelled: This article presents a novel clinical application of questionnaire feedback, which focuses on change at the individual question level rather than the total mean or clinical score level. We term the approach 'Tracking Responses to Items in Measures' (TRIM) and promote the key aims to be (1) providing both client and practitioner with feedback on areas of positive change that may be masked by numerical feedback, (2) reinforcing client strengths and self-efficacy, (3) exploring potential extra-therapeutic factors that may contribute to the lack of change or deterioration on individual questions and (4) establishing a collaborative dialogue relating clients' problems to their goals and the consequent aims of treatment. This paper profiles the clinical origins and technical development of TRIM as a clear, user-friendly display of item change across sessions using colour codes and illustrates the clinical utility through two clinical vignettes.

Leading Horses to Water: Lessons from a Decade of Helping Psychological Therapy Services Use Routine Outcome Measurement to Improve Practice.

We summarise the recent reflections of five thought leaders in the field of routine outcome measurement (ROM) for psychological therapy, and then add our own experience of introducing a national ROM system in the UK. We highlight, in particular, the post-implementation challenge of securing data of sufficient reliability to help inform service quality improvements. We ground our conclusions and recommendations in the rapidly evolving discipline of implementation science, and offer a best practice model for applying research recommendations in practice settings.

Correcting Psychotherapists' Blindsidedness: Formal Feedback as a Means of Overcoming the Natural Limitations of Therapists.

Purpose: Monitoring of client progress in psychological therapy using formal outcome measures at each session has been shown to increase the effectiveness of treatment. It seems likely that this 'feedback' effect is achieved by enabling therapists to identify clients at risk of treatment failure so that therapists can pay greater attention to client difficulties, which may be hindering therapeutic work. To date, little attention has been given to understanding relevant mechanisms of formal feedback in psychological therapy.

Psychological treatment outcomes in routine NHS services: what do we mean by treatment effectiveness?

Objectives: The question of how effective therapies are in routine practice is crucial. The answer depends on how we define effectiveness. Both the definition of who was treated and the index chosen to represent outcome can affect estimates dramatically.

Effects of psychological therapies in randomized trials and practice-based studies.

Background: Randomized trials of the effects of psychological therapies seek internal validity via homogeneous samples and standardized treatment protocols. In contrast, practice-based studies aim for clinical realism and external validity via heterogeneous samples of clients treated under routine practice conditions. We compared indices of treatment effects in these two types of studies.

Responsive regulation of treatment duration in routine practice in United Kingdom primary care settings: replication in a larger sample.

Replicating a previous study (M. Barkham et al., 2006), the authors examined rates of improvement in psychotherapy in United Kingdom primary care settings as a function of the number of sessions attended.

Effectiveness of cognitive-behavioural, person-centred, and psychodynamic therapies in UK primary-care routine practice: replication in a larger sample.

Background: Psychotherapy's equivalence paradox is that treatments tend to have equivalently positive outcomes despite non-equivalent theories and techniques. We replicated an earlier comparison of treatment approaches in a sample four times larger and restricted to primary-care mental health.

Method: Patients (n=5613) who received cognitive-behavioural therapy (CBT), person-centred therapy (PCT) or psychodynamic therapy (PDT) at one of 32 NHS primary-care services during a 3-year period (2002-2005) completed the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM) at the beginning and end of treatment.

Dose-effect relations and responsive regulation of treatment duration: the good enough level.

This study examined rates of improvement in psychotherapy as a function of the number of sessions attended. The clients (N=1,868; 73.1% female; 92.

Effectiveness of cognitive-behavioural, person-centred and psychodynamic therapies as practised in UK National Health Service settings.

Background: Psychotherapy's equivalence paradox is that treatments have equivalently positive outcomes despite non-equivalent theories and techniques. We compared the outcomes of contrasting approaches practised in routine care.

Method: Patients (n = 1309) who received cognitive-behavioural therapy (CBT), person-centred therapy (PCT) and psychodynamic therapy (PDT) at one of 58 National Health Service (NHS) primary and secondary care sites in the UK during a 3-year period completed the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) at the beginning and end of their treatment.

Towards a standardised brief outcome measure: psychometric properties and utility of the CORE-OM.

Background: An acceptable, standardised outcome measure to assess efficacy and effectiveness is needed across multiple disciplines offering psychological therapies.

Aims: To present psychometric data on reliability, validity and sensitivity to change for the CORE-OM (Clinical Outcomes in Routine Evaluation--Outcome Measure).

Method: A 34-item self-report instrument was-developed, with domains of subjective well-being, symptoms, function and risk.