Hostname: page-component-78c5997874-fbnjt Total loading time: 0 Render date: 2024-11-10T15:22:58.847Z Has data issue: false hasContentIssue false
  • English
  • Français

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

Published online by Cambridge University Press:  07 February 2017

Kate M. Davidson ,
Michelle L. Rankin ,
Amelie Begley ,
Suzanne Lloyd ,
Sarah J.E. Barry ,
Paula McSkimming ,
Lisa Bell ,
Carole Allan ,
Morag Osborne  and
George Ralston
...Show all authors
Kate M. Davidson*
Affiliation:
Institute of Health and Wellbeing, University of Glasgow
Michelle L. Rankin
Affiliation:
Institute of Health and Wellbeing, University of Glasgow
Amelie Begley
Affiliation:
Institute of Health and Wellbeing, University of Glasgow
Suzanne Lloyd
Affiliation:
Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow
Sarah J.E. Barry
Affiliation:
Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow
Paula McSkimming
Affiliation:
Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow
Lisa Bell
Affiliation:
Institute of Health and Wellbeing, University of Glasgow
Carole Allan
Affiliation:
NHS Greater Glasgow and Clyde
Morag Osborne
Affiliation:
NHS Greater Glasgow and Clyde
George Ralston
Affiliation:
NHS Greater Glasgow and Clyde
Geraldine Bienkowski
Affiliation:
NHS Education for Scotland
John Mellor-Clark
Affiliation:
Centre for Community Mental Health, Birmingham City University
Andrew Walker
Affiliation:
Robertson Centre for Biostatistics, Institute of Health and Wellbeing, University of Glasgow
*
Correspondence to Kate M. Davidson, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK. E-mail: kate.davidson@glasgow.ac.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

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. Method: Using a stepped wedge randomized controlled design, continuous feedback on patient progress during therapy was given either to the therapist and supervisor to be discussed in clinical supervison (MeMOS condition) or only given to the therapist (S-Sup condition). If a patient failed to progress in the MeMOS condition, an alert was triggered and sent to both the therapist and supervisor. Outcome measures were completed at beginning of therapy, end of therapy and at 6-month follow-up and session-by-session ratings. Results: No differences in clinical outcomes of patients were found between MeMOS and S-Sup conditions. Patients in the MeMOS condition were rated as improving less, and more ill. They received fewer therapy sessions. Conclusions: Most patients failed to improve in therapy at some point. Patients’ recovery was not affected by feeding back outcomes into the supervision process. Therapists rated patients in the S-Sup condition as improving more and being less ill than patients in MeMOS. Those patients in MeMOS had more complex problems.

Keywords

Clinical supervisionpatient progresspsychotherapy outcome researchCORErandomized controlled trial
Type
Research Article
Information
Behavioural and Cognitive Psychotherapy , Volume 45 , Issue 3 , May 2017 , pp. 209 - 224
Copyright
Copyright © British Association for Behavioural and Cognitive Psychotherapies 2017 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Barkham, M., Bewick, B., Mullin, T., Gilbody, S., Connell, J., Cahill, J., Mellor-Clark, J., Richards, S., Unsworth, G. and Evans, C. (2013). The CORE-10: A short measure of psychological distress for routine use in the psychological therapies. Counselling and Psychotherapy Research, 13, 3–13.CrossRefGoogle Scholar
Barkham, M., Gilbert, N., Connell, J., Marshall, C. and Twigg, E. (2005). Suitability and utility of the CORE-OM and CORE-A for assessing severity of presenting problems in psychological therapy services based in primary and secondary care settings. British Journal of Psychiatry, 186, 239–246.CrossRefGoogle ScholarPubMed
Barkham, M., Mellor-Clark, J., Connell, J. and Cahill, J. (2006). A core approach to practice-based evidence: A brief history of the origins and applications of the CORE-OM and CORE system. Counselling and Psychotherapy Research, 6, 3–15.Google Scholar
Brown, C. and Lilford, R. J. (2006) The stepped wedge trial design: a systematic review. BMC Medical Research Methodology, 6, 54. www.biomedcentral.com/1471-2288/6/54/prepub Google Scholar
Carlier, I. V. E., Meuldijk, D., Van Vliet, I. M., Van Fenema, E., Van der Wee, N. J. A. and Zitman, F. G. (2012). Routine outcome monitoring and feedback on physical or mental health status: evidence and theory. Journal of Evaluation in Clinical Practice, 18, 104–110. doi:10.1111/j.1365-2753.2010.01543.x CrossRefGoogle ScholarPubMed
Crits-Christoph, P., Ring-Kurtz, S., Hamilton, J. L., Lambert, M. J., Gallop, R., McClure, B., Kulaga, A. and Rotrosen, J. (2012). A preliminary study of the effects of individual patient-level feedback in outpatient substance abuse treatment programs. Journal of Substance Abuse Treatment, 42, 301–309.Google Scholar
Curtis Jenkins, A. and Mellor-Clark, J. (2007). CORE NET [computer program]. Available at: http://www.coreims.co.uk/Buy_Net_Software.html (accessed 18 January 2015).Google Scholar
Davidson, K., Perry, A. and Bell, L. (2015). Would continuous feedback of patient's clinical outcomes to practitioners improve NHS psychological therapy services? Critical analysis and assessment of quality of existing studies. Psychology and Psychotherapy: Theory, Research and Practice, 88, 21–37. doi: 10.1111/papt.12032 Google Scholar
de Jong, K., van Sluis, P., Nugter, M. A., Heiser, W. J. and Spinhoven, P. (2012). Understanding the differential impact of outcome monitoring: Therapist variables that moderate feedback effects in a randomized clinical trial. Psychotherapy Research, 22, 464–474.Google Scholar
Guy, W. (1976) Clinical Global Impressions. In ECDEU Assessment Manual for Psychopharmacology, revised (DHEW Publ. No. ADM 76-338), pp. 218‒222. National Institute of Mental Health: Rockville, MD.Google Scholar
Hannan, C., Lambert, M. J., Harmon, C., Nielson, S. L., Smart, D. W., Shimokawa, K. and Sutton, S. W. (2005). A lab test and algorithms for identifying clients at risk of treatment failure. Journal of Clinical Psychology, 61, 155–163.Google Scholar
Harmon, S. C., Lambert, M. J., Smart, D. M., Hawkins, E., Nielsen, S. L., Slade, K. and Lutz, W. (2007). Enhancing outcome for potential treatment failures: Therapist-client feedback and clinical support tools. Psychotherapy Research, 17, 379–392.CrossRefGoogle Scholar
Kendrick, T., El-Gohary, M., Stuart, B., Gilbody, S., Churchill, R., Aiken, L., Bhattacharya, A., Gimson, A., Brütt, A. L., de Jong, K. and Moore, M. (2016). Routine use of patient reported outcome measures (PROMs) for improving treatment of common mental health disorders in adults. Cochrane Database of Systematic Reviews, 7, CD011119. doi: 10.1002/14651858.CD011119.pub2 Google Scholar
Knaup, C., Koesters, M., Schoefer, D., Becker, T. and Puschner, B. (2009). Effect of feedback of treatment outcome in specialist mental healthcare: Meta-analysis. British Journal of Psychiatry, 195, 15–22.CrossRefGoogle ScholarPubMed
Kraus, D. R., Castonguay, L., Boswell, J. F., Nordberg, S. S. and Hayes, J. A. (2011). Therapist effectiveness: implications for accountability and client care. Psychotherapy Research, 21, 267‒276.Google Scholar
Lambert, M. J. and Shimokawa, K. (2011). Collecting client feedback. Psychotherapy, 48, 72‒79.CrossRefGoogle ScholarPubMed
Lambert, M. J., Whipple, J. L., Smart, D. W., Vermeersch, D. A. and Nielsen, S. L. (2001). The effects of providing therapists with feedback on patient progress during psychotherapy: Are outcomes enhanced? Psychotherapy Research, 11, 49–68.CrossRefGoogle ScholarPubMed
Lambert, M. J., Whipple, J. L., Bishop, M. J., Vermeersch, D. A., Gray, G. V. and Finch, A. E. (2002). Comparison of empirically derived and rationally derived methods for identifying patients at risk for treatment failure. Clinical Psychology and Psychotherapy, 9, 149–164.Google Scholar
Lyons Reardon, M., Cukrowicz, K. C., Reeves, M. D. and Joiner, T. E. (2002). Duration and regularity of therapy attendance as predictors of treatment outcome in an adult outpatient population. Psychotherapy Research, 12, 273–285.Google Scholar
Macdonald, J. and Mellor-Clark, J. (2014). Correcting psychotherapists’ blindsidedness: formal feedback as a means of overcoming the natural limitations of therapists. Clinical Psychology and Psychotherapy, 22, 249–257. doi: 10.1002/cpp.1887 Google Scholar
Mellor-Clark, J., Barkham, M., Connell, J. and Evans, C. (2000). Practice-based evidence and need for a standardised evaluation system: Informing the design of the CORE System. European Journal of Psychotherapy, Counselling and Health, 2, 357–374.Google Scholar
Mellor-Clark, J., Connell, J., Barkham, M. and Cummins, P. (2001). Counselling outcomes in primary health care: a CORE system data profile. European Journal of Psychotherapy and Counselling, 4, 65–86.Google Scholar
Shimokawa, K., Lambert, M., and Smart, D. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78, 298–311.CrossRefGoogle ScholarPubMed
Simon, W., Lambert, M. J., Busath, G., Vazquez, A., Berkeljon, A., Hyer, K. et al. (2013). Effects of providing patient progress feedback and clinical support tools to psychotherapists in an inpatient eating disorders treatment program: A randomized controlled study. Psychotherapy Research, 23, 287–300.Google Scholar
Simon, W., Lambert, M. J., Harris, M. W., Busath, G. and Vazquez, A. (2012). Providing patient progress information and clinical support tools to therapists: Effects on patients at risk of treatment failure. Psychotherapy Research, 22, 638–647.Google Scholar
Slade, K., Lambert, M. J., Harmon, S. C., Smart, D. W. and Bailey, R. (2008). Improving psychotherapy outcome: The use of immediate electronic feedback and revised clinical support tools. Clinical Psychology and Psychotherapy, 15, 287–303.Google Scholar
Walfish, S., McAlister, B., O'Donnell, P. and Lambert, M. J. (2012). An investigation of self-assessment bias in mental health providers. Psychological Reports, 110, 639–644.Google Scholar
Whipple, J. L., Lambert, M. J., Vermeersch, D. A., Smart, D. W., Nielsen, S. L. and 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 Counselling Psychology, 50, 59–68.Google Scholar
Submit a response

Comments

No Comments have been published for this article.