To Change or Not to Change? When to Change a Client's ORS Score

To Change or Not to Change - ORS

Thousands of agencies, practitioners, and their clients have found MyOutcomes' web-based application of the Outcome Rating Scale (ORS) to be a powerful tool. The process is simple. Using MyOutcomes' extensive database, the feedback of all clients with the same initial intake score is used to predict an expected course of therapeutic progress. Deviations from the predicted path of successful treatment alert the therapist of issues needing to be addressed.


As the client's predicted progress is predicated on the initial intake score, the first score is crucial in interpreting client change during the therapeutic process. Errors involving this first score can lead to erroneous conclusions and ill-advised decisions.

There are two types of errors involving the initial intake score that warrant correcting. One is an administrative error that occurs when scores are entered manually. These errors can be corrected by MyOutcomes' IT staff. A second error involves the client deciding their first ORS score is wrong. For example, during the second session, the client may realize that they didn't completely understand how to use MyOutcomes the first time. They may feel that the initial score doesn't accurately reflect their reality. This type of error can also be fixed by MyOutcomes' IT staff.

Practitioners may see errors where there are no errors. For example, mandated clients typically enter the therapeutic context not seeing themselves having any problems or issues. Their initial ORS score, therefore, is usually high. After a few sessions, however, the client becomes engaged in the therapeutic process and their ORS scores drop.

Therapists may want to “correct” this “measurement error,” using the lower ORS score as the new initial baseline. A therapist may believe that such a change more accurately reflects the client's psychological state. Alternatively, a clinician might be concerned that this drop might be seen by others as a poor reflection on their clinical skills. Neither of these notions are accurate nor are they beneficial to the client. Regardless of the motivation, changing the intake score in these circumstances reflects seeing the ORS scores as only numbers, rather than seeing the ORS as the client's voice.

The client's initial ORS score and all subsequent scores are an accurate reflection of the client's psychological state. Changes in the scores reveal the process of change that the client is undergoing. This is what the clinician should work with. If the therapist changes the baseline ORS to what they think it should be, then they're imposing their beliefs on top of the client's needs. The ORS no longer reflects what is going on with the client. This completely contravenes the power of the ORS and it's ability to provide the client a voice in the therapeutic context.

It is the client's voice that's valued in feedback-informed therapy. When a mandated client reports that they are “okay,” the therapist should ask them, “Why are you here?” When they reply that someone sent them, the therapist should set up the person as a feedback source for the client, then ask the client to complete the ORS for the feedback source. Using a “collateral rater” allows the therapist to honor the client's voice while at the same time acknowledging that issues exist.

If the therapist disregards what the client reports simply because they are mandated, the therapist may stop believing what the client says and ignore the client's voice. This puts the therapist at risk for doing things clinically that will lead to client deterioration, which might be misinterpreted as the client “self-correcting.”

MyOutcomes IT support won't change scores in these situations. There are, of course, strong statistical reasons why they won't manipulate the data without strong theoretical reasoning to support it. If therapists could change willy-nilly any data as they wished, an unknown source of variability would be introduced into the database. Put differently, clinicians deciding on what the correct score should be would introduce an error into the database that would compromise the ability of MyOutcomes', or any similar tool, to make valid predictions. The validity of prediction models is contingent upon consistent data collection. Changing ORS baselines because the therapist doesn't feel it's correct is no different than tossing outliers from a dataset simply because you don't like them. In either situation, your predictive model is going to begin to reflect therapist's feelings rather than reflect the actual process of change clients are undergoing.

To change or not to change, that is the question. At least, according to Hamlet, it is. Although Hamlet engaged in a complicated argument regarding life and death, for MyOutcomes, the answer is quite simple. If addressing a data entry error, change is appropriate. Change is not appropriate if the driving force behind it is a whim and a feeling that ignores the client's reality.

Is there no way to record and plot the ORS in Child Therapy?

ORS for Child Therapy

How to record and plot the ORS for child therapy in MyOutcomes version 14

In the case of child therapy, it is often left to the therapist to determine whether the child is making progress. It is important that the stakeholders in those young children's lives agree that progress is being made and seek other collateral scores to measure the outcome.

Clinicians and psychotherapists in evidence based practice, often ask the question; though the ORS scores in child therapy are available but there is no way to record and plot it to measure the outcomes.

Dr Scott D.Miller scrutinizes the accuracy of ORS in child therapy  in twofold:

1. The scales might be useful for engaging children, but getting reliable scores from children that young for a four item measure is just nearly impossible.

2. Most of the children visit a therapist because someone else is concerned for them rather than they themselves, hence collateral scores should guide the outcomes of such sessions.

Live consultation with Dr Scott D. Miller for new features of MyOutcomes Version 14.

Individual Sub Scales-Predictive and Clinical Utility

Predictive Utility and Clinical Utility

Live consultation about Predictive Utility and Clinical Utility.

Dr. Scott D Miller indicates that we only score on the ORS as predictive of the total score. If we are working with an individual who is not progressing, then we look at individual sub-scales to find something clinically useful, but that is not of any predictive utility so we don't use sub scales in the algorithm.

Are clients with very high ORS scores considered to be at risk ?

High ORS scores

High ORS scores; a risk or not?

The continuous high ORS scores are a good predictor of success and there are a large group of people who don't experience a decline after early improvement, but it is good clinical practice to prepare the client in case it doesn't maintain. This would then have a much greater engagement of the client with the therapist.

Live consultation with Dr. Scott D Miller

Feedback in Child and Adolescent Mental Health Services

myoutcomes, Better outcomes in mental health services

The use of the ORS and SRS to facilitate better outcomes in mental health services

Parents and family members are usually the first to notice if a child has problems with emotions or behaviour. Some children are not fortunate enough and have to deal with a childhood that is filled with displeasure, aversion, distrust, and constant negativity. Coping with their emotions can be a big challenge. It is a difficult job for any person, let alone a child, to overcome such adversity. But it can definitely be achieved, with the support of the family members and a systematic therapeutical approach.

Once the problem is understood, setting clear and focused goals and getting the right kind of treatment towards achieving these goals are the key points.

This is not all though; keeping a constant track of their progress in terms of symptom change by getting regular feedback from children, young people and families working with them can significantly impact the outcomes of treatment to bring in a positive change.

But how do the therapists achieve that quality of alliance?

This is when the use of the ORS and SRS can facilitate better outcomes if used together to enhance engagement and participation in the care provided as the measures are discussed with young people and caregivers.

Why only ORS and SRS??

The ORS and SRS fit very well with family work. The degree to which they can be explained, completed, and interpreted is really high.They are quick and easy to use for different age groups including small children and, allow all members of the family an important feedback voice into the therapeutic system. They give young people and carers a voice in treatment as it allows them to provide immediate feedback on what is working and what is not.

The Child ORS (CORS) is a simple modification of the ORS and was developed to facilitate the child's understanding when completing the scales for children age 6-12 and for the young teens aged 13-17. It has the same format as the ORS but with more child-friendly language. Depending on the clinical judgment, either of the versions could be used to engage the young person.

  • Do you deal with the behavioural health of young people?
  • Are you a therapist looking to improve your client outcomes with children or adolescents?
  • At times, do you find it difficult to predict accurately how well you are working together with the younger users??
  • Do you ever wonder- “Maybe things are going well but the goals are taking too long to complete?”

Then what are you waiting for?

The CORS of MyOutcomes is the measuring tool you need!

Click here to schedule an implementation consultation.

For more information call us on 1-877-763-4775 (Toll-free)



Using MyOutcomes® and Feedback Informed Treatment to create a culture of continuous performance improvement

Feedback Informed Treatment

This webinar will help you use MyOutcomes to facilitate a culture of continuous performance improvement through Feedback Informed Treatment (FIT).

Specifically you will learn how:

  • MyOutcomes‘ session feedback signals facilitate therapist self-evaluation
  • Data from the SRS and ORS can be used to inform and direct clinical supervision
  • Analysis of data helps practitioners discover the qualities, personal biases and gaps in understanding that might adversely effect client outcomes

Click here to access free recording

The webinar was presented by Randy Moss, PhD.

Dr. Moss is a certified FIT trainer who has spent the last thirty years practicing psychotherapy, as well as working as a researcher, presenter and implementation consultant. His primary focus now is using translational research and implementation science along with local adaptations to help make the transition to evidence based practices in large agencies/organizations.

Feedback Informed Treatment, Dr Randy Moss
MyOutcomes is currently implemented in a variety of service settings including: outpatient, inpatient, case-management, prison-based, child protection, in home and at work

MyOutcomes successfully serves providers globally, every day, as they administer well over half a million surveys into our secure, U.S. and Canadian-based servers

MyOutcomes is the only registered web-based version of the ORS and SRS included in SAMHSA's National Registry of Evidence-based Programs and Practices

Click here to access free recording


Feedback Sources & Aggregate Stats

feedback system, therapy feedback system, feedback sources

A behavioral health practitioner's workload is increasing dramatically as a result of today's increased demand for mental health services. With limited time and with other things interfering with the ability to help clients achieve their therapeutic goals, it is imperative to be able to find information quickly and get results at the click of a button. Therefore, in order to improve your ability to create and access reports as well as make appropriate comparisons between critical individuals, MyOutcomes version 11 has this aggregate stats feature that plots multiple feedback source trajectories on a single graph. Outcome Rating Scale (ORS) and Session Rating Scale (SRS) data from two or more sources can be seen on the same ORS – SRS client graph.

It is also possible to export this data on your device and in order to ease this export in a csv or xls format, extra column is added to help the practitioner identify if ORS or Couple Outcome Rating Scale was used. Other information like assessment date, birth date, gender etc. is also included. Language has been simplified and on screen pop-ups added for greater clarity, ease of use and to help save the behavioral health practitioner's time.

Listen as I describe how Version 11 improves your ability to compare feedback sources with the client and improves the ease of viewing and interpreting the Aggregate Stats.

Expected Treatment Response in a Graphical Form

psychotherapy feedback system, expected treatment response

Expected Treatment Response in graphical form in MyOutcomes V11 for easier depiction of change

Expected Treatment Response (ETR) or the predicted change in the Outcome Rating Scale (ORS) over the course of the treatment, that was previously referred to as the Trajectory of Change, now has enhanced features in the MyOutcomes version11 software that allows the viewer to determine how much information is presented. This helps the behavioral healthcare providers to organize reports that fit their organization's need.

The Expected Treatment Response graph is located on the client console page and is now more interactive with the ability to compare different session feedback scores side by side. The Outcome Rating scale (ORS) and Session Rating Scale (SRS) lines are displayed simultaneously and on roll over on data points, the session dates and the corresponding scores pop up. SRS scores are included on the Expected Treatment Response graph to enable comparison of changes in the client's feedback on the alliance to changes in their ORS scores. For convenience, the clinical cut-offs for both the ORS and the SRS are also included on the graphs. There is also the option of simplifying the look of the graph by clicking on the titles and legends and adding / removing the different layers.

MyOutcomes Vice-President, Cindy Hansen, illustrates the new interactive features of the Expected Treatment Response graph with its enhanced functionality

For more information, please contact MyOutcomes on toll free 1-877-763-4775 or visit our website http://myoutcomes.com/

Feedback in Therapy and Technology

improve outcomes software, measurable outcomes, feedback in therapy

With the advent of new technology and web-enabled devices like smart phones, iPads, tablets etc. the way we do things and store data has drastically changed. Healthcare in general and behavioral healthcare per se is also keeping up with this trend with more and more practitioners preferring electronic records over paper. The benefits are galore with the biggest one being stated as the improvement in quality of healthcare provided due to the ready availability of information wherever and whenever. Some of the other benefits of maintaining electronic records are:

–          Increase in patient participation

–          Quick and easy retrieval of information

–          Better coordination between various healthcare providers

–          Increase in efficiency

–          Reduction in storage space requirement

–          Cost savings in the long run

As part of its partnership with practitioners and with the aim of improving outcomes, MyOutcomes, a web-based tool for measuring feedback in therapy, provides an ease of access for its users that is unparalleled. The staff at MyOutcomes takes this partnership seriously and is, therefore, committed to keeping at the forefront of technology. The newly launched version 11 is browser-friendly and multi-platform compatible. It has been optimized for iPad and android tablets and supports Internet explorer 9 and 10, Firefox, Google Chrome and Safari's latest versions. Not only practitioners, but even patients love completing the Outcome Rating Scale (ORS) and Session Rating Scale (SRS) on the electronic device.

MyOutcomes' Vice-President, Cindy Hansen, introduces the many new platforms that are compatible with MyOutcomes

For more information contact MyOutcomes on (250) 763-4775 or 1 877 763-4775 (international toll-free)

Outcome Rating Scale: Performance and Case Alert Reports

psychotherapy feedback system, ORS, Outcome Rating Scale

The new MyOutcomes Dashboard enables users to generate real-time reports and case alerts for clinical, supervisory, and administrative purposes.  It is comprised of three sections:  Key Performance Indicators, Case Alerts and the Report Parameters section. The Dashboard provides supervisors and administrators with access to client progress reports by program, provider or location.The Key Performance Indicators section provides a snapshot of progress reported by clients in the selected population.  By default, the population shown will be all active clients assigned to the logged-in user and will exclude clients with only one session of data. The Key Performance Indicators include: Continue reading…