Basis 24 and MyOutcomes: Tools to Help Clinicians Achieve Higher Client Success Rates
During the last two decades, the approach towards psychotherapy has been undergoing dramatic changes. Terms like evidence-based treatment and feedback informed treatment are used to summarize the philosophical shift towards a therapeutic practice that emphasizes the client's experience and perception of the therapeutic process as well as acknowledging the necessity for having a strong client-therapist alliance in achieving the therapeutic goals. As a result of this movement, numerous tools have been developed to help the clinician achieve a high client success rate.
The Behavioral and Symptom Identification Scale-24 (Basis-24) is one such instrument. Derived from the Basis-32, the Basis-24 is a 24-item questionnaire written at an elementary school level that can take up to 15 minutes to complete. Upon completion of the questionnaire, an overall score can be obtained as well as scores for each of its six sub-domains: Depression & Functioning, Psychosis, Substance Abuse, Self Harm, Interpersonal Relationships and Emotional Lability. The Basis-24 can be used to provide some measure of the client's functioning in each of these domains at different points of the therapeutic process, when therapy reaches a conclusion and during any follow-up.
MyOutcomes' Outcomes Rating Scale (ORS) and the Session Rating Scale (SRS) are likewise tools that have been designed to facilitate these trends toward a more inclusive approach to therapy. The ORS consists of four measures (individual well-being, interpersonal, socially and overall) that ask the client to rate their perception of their functioning in these areas during the last week or since the last therapeutic session. The client's rating of these measures is obtained using easy-to-use sliding scales. Since working with the scale and getting an overall performance score takes only 1-2 minutes, the ORS is an ideal tool to use and integrate into each session with the client.
The Basis-24 provides domain specific information similar to that obtained during intake. This information can be of value in evaluating the client's progress on those measures. Unlike the ORS, however, the Basis-24 doesn't measure the client's subjective experience in several key areas of life. Since it is usually the client's subjective feelings about their life in these areas that brings the client to the therapist in the first place, it would logically follow that regular monitoring of the client's perceptions should play a critical role in evaluating progress towards achieving the therapeutic goals.
Aside from its quick and easy use and its ability to take a snapshot of the client's subjective perceptions, the Outcomes' tools have one further advantage over the Basis-24. It has been well established that the client-therapist alliance plays a major role in predicting successful outcomes. The stronger that alliance, the greater the likelihood will be that client will achieve their therapeutic goals. The SRS is comparable to the ORS in its ease of use and operation. Consisting of four measures (relationship, goals and topics, approach or method and overall), it can be administered toward the end of each session and it provides the therapist with a picture of the client's perception of their therapeutic relationship. If there are potential problems in that relationship, the therapist and client can immediately address them.
The Basis-24 appears to be a very useful tool in providing insight in changes in several key categories that are explored in the initial diagnosis. It's â€œbulkiness,â€ however, makes it impractical to use during each session. Furthermore, unlike the ORS and the SRS, it doesn't tap into the client's perception of how well they are doing in some key areas, nor does it provide insight into the therapist-client bond.