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Why is it so important to measure patient progress?

Research has shown that consistent use of objective measures in therapy improves overall treatment outcomes. One study found that when patient progress was measured in treatment, twice as many patients improved, and at-risk patients stayed in therapy longer and were less likely to deteriorate (Lambert et al. 2001).

Studies have identified the following four items as some of the major benefits derived from measuring patient progress.

1. Increased engagement

Providing patients with a clear display of their progress and symptoms has been shown to reinforce motivation and engagement in therapy. This increased level of transparency offers patients a sense of control over their treatment process. Studies have even shown that administering outcome measures reduces patient cancellations and no-show rates (Bohanske & Franczak, 2010).

2. Early detection of health changes

Regular symptom tracking can allow therapists to detect changes in health status and intervene early if necessary. Studies have shown that assessment results in the first three sessions of therapy are highly predictive of a positive or negative treatment outcome. It is important for therapists to be able to identify patients who are at risk of deterioration with a particular treatment plan. For these patients, measurement provides the greatest benefit (Lambert, 2007).

3. Reduced biases

Real-time measurement and monitoring will allow therapists to obtain a more accurate picture of their patients’ wellbeing and reduce the impact of recall bias on therapy. Measurement does not replace a therapist’s method for decision-making, but instead, supplements and supports the traditional process with additional objective information.

4. Improved commmunication

Research has demonstrated that measurement has a positive effect on communication, which can improve clarity and alignment on treatment goals between the patient and therapist. Since patients are in the best position to assess how they are doing, measurement and display of progress may help patients identify and discuss information that is relevant to their treatment, which they otherwise may not have shared (Carlier et al. 2012).

The research behind the importance of measurement

Goodman, J.D., McKay, J.R., Dephilippis, D., (2013). Progress Monitoring in Mental Health and Addiction Treatment: A Means of Improving Care. Philadelphia: Professional Psychology: Research and Practice, 2013, Vol. 44, No. 4, 231–246.

Carlier, I. V. E., Meuldijk, D., Van Vliet, I. M., Van Fenema, E., Van der Wee, N. J. A., & Zitman, F. G. (2012) Routine outcome monitoring and feedback on physical or mental health status: evidence and theory. Journal of Evaluation in Clinical Practice.

Reese, R. J., Toland, M. D., Slone, N. C., & Norsworthy, L. A. (2010) Effect of client feedback on couple psychotherapy outcomes. Psychotherapy: Theory, Research, Practice, Training.

Bohanske, R. T., & Franczak, M. (2010). Transforming public behavioral health care: A case example of consumer-directed services, recovery, and the common factors. In B. Duncan, S. Miller, B. Wampold, E & M. Hubble. (Eds.), The heart and soul of change: Delivering what works in therapy (2nd ed., Vol. xxix, pp. 255). Washington, DC: American Psychological Association

Reese, R. J., Norsworthy, L. A., & Rowlands, S. R. (2009) Does a continuous feedback system improve psychotherapy outcome? Psychotherapy: Theory, Research, Practice, Training.

Slade, K., Lambert, M. J., Harmon, S. C., Smart, D. W., & Bailey, R. (2008). Improving psychotherapy outcome: The use of immediate electronic feedback and revised clinical support tools. Clinical Psychology & Psychotherapy, 15, 287–303.

Lambert, M.J., (2007). Progress Feedback and the OQ-System: The Past and the Future. Brigham Young University: APA Psychotherapy: 2015, Vol. 52, No. 4, 381–390.

Harmon, C., Lambert, M. J., Slade, K. L., & Smart, D. W. (2007). Enhancing outcome for potential treatment failures: Therapist/client feedback and clinical support tools. Psychotherapy Research, 17, 379– 392.

Azocar, F., Cuffel, B., McCulloch, J., McCabe, J. Tani, S. Brodey, B. (2007). Monitoring Patient Improvement and Treatment Outcomes in Managed Behavioral Health. Journal for Healthcare Quality, March/April 2007.

Lambert, M. J., Harmon, C., Slade, K., Whipple, J. L., & Hawkins, E. J. (2005). Providing Feedback to Psychotherapists on Their Patient’ Progress: Clinical Results and Practice Suggestions. Journal of Clinical Psychology, 61, 165-174.

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 Failure and Problem- Solving Strategies in Routine Practice. Journal of Counseling Psycholtogy, 50, 1, 59-68.

Lambert, M.J. J., Whipple, E. J., Hawkins, D. A., Niewlsen, S. L., Smart, D. W. (2003). Is it Time for Clinicians to Routinely Track Patient Outcome? A Meta-Analysis. Clinical Psychology: Science and Practice, 10, 3, 288-301.

Lambert, M. J., Whipple, J. L., Bishop, M. J., Vermeersch, D. A., Gray, G. V., & Finch, A. E. (2002). Comparison of empirically derived and rationally derived methods for identifying clients at risk for treatment failure. Clinical Psychology & Psychotherapy, 9, 149–164.

Ogles, B. M., Lambert, M. J., Fields S.A. (2002). Essentials of Outcome Assessment. New York: John Wiley & Sons.

Wampold, B. E. (2001). The Great Psychotherapy Debate: Models, Methods, and Findings. Mahwah, NJ: Lawrence Erlbaum Associates.

Lambert, M. J., Whipple, J. L., Smart, D. W., Vermeersch, D.A., Nielsen, S. L. (2001). The Effects of Providing Therapists with Feedback on Patient Progress During Psychotherapy: Are Outcomes Enahanced? Psychotherapy Research, 11, 1, 49-68.

Brown, J., Dreis, S., and Nace, D. K. (1999) What Really Makes a Difference in Psychotherapy Outcome? Why Does Managed Care Want to Know? In M. A. Hubble, B. L. Duncan, and S. D. Miller (eds.). The Heart and Soul of Change: What Works in Therapy. Washington, D.C.: American Psychological Association Press, 389-406.

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