Chapter 5 Systematic Feedback through the Partners for Change Outcome Management System (PCOMS) (original) (raw)

Group Session Rating Scale: Preliminary psychometrics in substance abuse group interventions

Counselling and Psychotherapy Research, 2013

Background: Although ultra-brief outcome and process measures have been developed for individual therapy, currently there are no ultra-brief alliance measures for group therapy. Method: The current study examined 105 clients in group therapy for issues related to substance abuse or with issues related to the substance abuse of a significant other. We tested whether a newly developed group therapy alliance measure Á the Group Session Rating Scale would be related to other commonly used group process measures (Working Alliance Inventory, Group Cohesion, Group Climate) and early change (change over the first four sessions of group therapy). Results: The findings provided support for reliability based on Cronbach alphas and test-retest coefficients. Additionally, the GSRS was a one-factor measure that was related to other group process measures as well as predicted early change. Discussion: Clinical implications for how to utilise ultra-brief outcome and alliance measures are provided.

The Partners for Change Outcome Management System (PCOMS): The Heart and Soul of Change Project

Two continuous monitoring and feedback models have demonstrated gains in randomized clinical trials (RCTs): Lambert's Outcome Questionnaire (OQ) System and the Partners for Change Outcome Management System (PCOMS). This article chronicles the evolution of PCOMS from a simple way to discuss the benefit of services with clients to its emergence as an evidenced based practice to improve outcomes. Although based in Lambert's model, several differences are described: PCOMS is integrated into the ongoing psychotherapy process and includes a transparent discussion of the feedback with the client; PCOMS assesses the alliance every session; and the Outcome Rating Scale, rather than a list of symptoms rated on a Likert Scale, is a clinical tool as well as an outcome instrument that requires collaboration with clients. The research supporting the psychometrics of the measures and the PCOMS intervention is presented and the clinical process summarised. Examples of successful transportation to public behav-ioural health are offered and an implementation process that values consumer involvement, recovery, social justice, and the needs of the front-line clinician is discussed. With now nine RCTs and American Psychological Association endorsements to support it, it is argued that client-based outcome feedback offers a pragmatic way to transport research to practice.

The Session Rating Scale: Preliminary psychometric properties of a" working" alliance measure

Journal of Brief …, 2003

Over 1,000 research findings (Orlinsky, Rønnestad, & Willutzki, 2004) demonstrate that a positive alliance is one of the best predictors of outcome. Paradoxically, despite the robust connection between the alliance and outcome, no alliance measures have been developed specifically as clinical tools for therapists to use on a day-to-day basis with their clients. This article describes the development and validation of an ultra-brief alliance measure, the Session Rating Scale Version 3 (SRS). The instrument' s psychometric properties are examined and reported. Based on experience with the instrument at the various sites in the study, the feasibility of the scale is also considered. Results indicate that the SRS, a clinical rather than research tool, represents a balanced tradeoff between the reliability and validity of the longer research measures, and the feasibility of this brief scale. Results and implications for clinical practice and future research are discussed.

Accounting for Therapist Variability in Couple Therapy Outcomes: What Really Matters?

Journal of Sex & Marital Therapy, 2013

This study examined whether therapist gender, professional discipline, experience conducting couple therapy, and average second-session alliance score would account for the variance in outcomes attributed to the therapist. The authors investigated therapist variability in couple therapy with 158 couples randomly assigned to and treated by 18 therapists in a naturalistic setting. Consistent with previous studies in individual therapy, in this study therapists accounted for 8.0% of the variance in client outcomes and 10% of the variance in client alliance scores. Therapist average alliance score and experience conducting couple therapy were salient predictors of client outcomes attributed to therapist. In contrast, therapist gender and discipline did not significantly account for the variance in client outcomes attributed to therapists. Tests of incremental validity demonstrated that therapist average alliance score and therapist experience uniquely accounted for the variance in outcomes attributed to the therapist. Emphasis on improving therapist alliance quality and specificity of therapist experience in couple therapy are discussed.

The alliance in couple therapy: Partner influence, early change, and alliance patterns in a naturalistic sample

Journal of Consulting and Clinical Psychology, 2010

The purpose of this study was to explore the relationship between the alliance and outcome in couple therapy and examine whether the alliance predicted outcomes over and above early change. The authors also investigated partner influence and gender and sought to identify couple alliance patterns that predicted couple outcomes. Method: The authors examined the alliances and outcomes at posttreatment and follow-up of 250 couples seeking treatment for marital distress in a naturalistic setting. The Session Rating Scale was used to measure the alliance; the Outcome Rating Scale and Locke Wallace Marital Adjustment Scale were used to measure outcomes. Couples were White, Euro-Scandinavian, and heterosexual, with a mean age of 38.5 years and average number of years together of 11.8. On a subsample (n ϭ 118) that included couples with 4 or more sessions, the authors investigated the relationship between the alliance and outcome controlling for early change, and patterns of alliance development were delineated. Results: In the full sample, first-session alliances were not predictive of outcomes, but last-session alliances were predictive for both individuals and their partners. In the subsample, third-session alliances predicted outcome significantly above early change (d ϭ 0.25) that exceeded the reliable change index. Couple alliances that started over the mean and increased were associated with significantly more couples achieving reliable or clinically significant change. Gender influences were mixed. Conclusions: Given the current findings suggesting a potential alliance impact over and above symptom relief as well as the importance of ascending alliance scores, continuous assessment of the alliance appears warranted.

The Partners for Change Outcome Management System (PCOMS) Revisiting the Client's Frame of Reference

Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates (Baldwin & Imel, 2013), are poor judges of negative outcomes (Chapman et al., 2012), and grossly overestimate their effectiveness (Walfish, McAlister, O’Donnell, & Lambert, 2012). Systematic client feedback offers 1 solution (Duncan, 2014). Several feedback systems have emerged (Castonguay, Barkham, Lutz, & McAleavey, 2013), but only 2 have randomized clinical trial support and are included in the Substance Abuse and Mental Health Administration’s National Registry of Evidence-Based Programs and Practices: The Outcome Questionnaire– 45.2 System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012). This article presents the current status of PCOMS, the psychometrics of the PCOMS measures, its empirical support, and its clinical and training applications. Future directions and implications of PCOMS research, training, and practice are detailed. Finally, we propose that systematic feedback offers a way, via large-scale data collection, to reprioritize what matters to psychotherapy outcome, reclaim our empirically validated core values and identity, and change the conversation from a medical model dominated discourse to a more scientific, relational perspective.

Measuring Feedback From Clients

European Journal of Psychological Assessment, 2014

Treatment results can be improved by obtaining feedback from clients concerning their progress during therapy and the quality of the therapeutic relationship. This feedback can be rated using short instruments such as the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS), which are being increasingly used in many countries. This study investigates the validity and reliability of the Dutch ORS and SRS in a large sample of subjects (N = 587) drawn from the clients of an outpatient mental healthcare organization. The results are compared to those of previous Dutch and American studies. While both the ORS and the SRS exhibited adequate test-retest reliability and internal consistency, their concurrent validity was limited (more for the SRS than for the ORS). New standards are proposed for the Dutch ORS and SRS. The scores obtained with these standards are interpreted differently than those obtained using American standards. The clinical implications of the limited validity of the ORS and the SRS are discussed, as is the use of different standards in conjunction with these instruments.

Using formal client feedback to improve retention and outcome: Making ongoing, real-time assessment feasible

Journal of Brief …, 2006

Research has found that client change occurs earlier rather than later in the treatment process, and that the client's subject experience of meaningful change in the first few sessions is critical. If improvement in the client's subject sense of well-being does not occur in the first few sessions then the likelihood of a positive outcome significantly decreases. Recent studies have found that there are significant improvements in both retention and outcome when therapists receive formal, realtime feedback from clients regarding the process and outcome of therapy. However, the most used instruments in these feedback studies are long and take up valuable therapy time to complete. It has been found that most therapists are not likely to use any feedback instruments if it takes more than five minutes to complete, score and interpret. This article reports the results of an evaluation of the use of two very brief instruments for monitoring the process and outcome of therapy, the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS), in a study involving 75 therapists and 6,424 clients over a two year period. These two instruments were found to be valid and reliable and had a high use-rate among the therapists. The findings are discussed in light of the current emphasis on evidence-based practice.

Using Formal Client Feedback to Improve Retention and Outcome: Making Ongoing, Real-time Assessment Feasible

2006

Research has found that client change occurs earlier rather than later in the treatment process, and that the client's subject experience of meaningful change in the first few sessions is critical. If improvement in the client's subject sense of well-being does not occur in the first few sessions then the likelihood of a positive outcome significantly decreases. Recent studies have found that there are significant improvements in both retention and outcome when therapists receive formal, realtime feedback from clients regarding the process and outcome of therapy. However, the most used instruments in these feedback studies are long and take up valuable therapy time to complete. It has been found that most therapists are not likely to use any feedback instruments if it takes more than five minutes to complete, score and interpret. This article reports the results of an evaluation of the use of two very brief instruments for monitoring the process and outcome of therapy, the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS), in a study involving 75 therapists and 6,424 clients over a two year period. These two instruments were found to be valid and reliable and had a high use-rate among the therapists. The findings are discussed in light of the current emphasis on evidence-based practice.