Outcome Rating Scale

FIT Outcomes

Feedback Informed treatment, FIT Outcomes
Feedback Informed treatment or FIT is a process of integration of PCOMS or Partners for Change Outcome Management System into clinical practice. Behavioral health service providers regularly solicit feedback from clients. The treatment meted out as a result is informed as it is based on the information given by the client himself and hence the name feedback informed treatment. This helps to empower the client and engage them more deeply in the process.

Research on how FIT can improve outcomes started in the 80's and 90's and even though it was clear that FIT outcomes have a positive impact, it was difficult to apply in practice, as the instruments used were extremely lengthy.

A group of researchers including Dr. Scott Miller, Founder of The International Center for Clinical Excellence, aimed at creating brief versions of these measures so that they could be applied more regularly during sessions.  Thus came into being two brief scales called the Outcome Rating Scale (ORS) and the Session Rating Scale (SRS) that measure how a client is doing and how the therapist is faring in helping them. These scales are so brief that they take only a minute to complete and are designed to be administered at the beginning and end of each therapy session.

A number of researches and several randomized clinical trials have since shown the benefits of using these measures of feedback in therapy. Some of the proven FIT benefits are:

  • “Total program costs were reduced by 10 to 35 percent while outcomes and satisfaction improved.” Bohanske, R. T., & Franczak, M. (2010). “Transforming public behavioral health care: A case example of consumerdirected services, recovery, and the common factors.” In B. L. Duncan, S. D. Miller, B. E. Wampold, & M. A. Hubble (Eds), The Heart and Soul of Change: Delivering What Works in Therapy (2nd ed., pp. 299-322). Washington, D.C.: American Psychological Association. doi:10.1037/12075-010
  •  â€œSuccess rates increased in one study by 65 percent and by as much as 100 percent in others.” (Anker, Duncn, & Sparks, 2009; Miller, Duncan, Brown, Sorrell, & Chalk, 2006). Independently confirmed by Reese, Norsworthy, and Rowlands, 2009.
  •  â€œCancellation rates declined by 40 percent and no-shows by 25 percent.” (Bohankse & Franczak, 2010; Duncan, Miller, Wampold, & Hubble, 2010).
  • “Length of stay in psychotherapy was reduced by 40 to 50 percent across a broad range of behavioral health services.” (Bohanske & Franczak, 2010; Duncan, Miller, Wampold, & Hubble, 2010; Miller, Duncan, Sorrell, & Brown, 2005).

MyOutcomes has taken this science and developed a web-based tool where ORS and SRS can be filled directly using our software. Results can be derived almost instantly at the click of a button and depicted graphically for easy interpretation.

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Early Change as a Predictor of Therapy Outcomes

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“Clients who show little or no early change are at a greater risk of dropping out if corrective measures are not taken”

The only way a behavioural health professional can improve outcomes is to know early on in therapy whether or not the client is benefiting from the treatment. The late Ken Howard, in the 1970's did pioneering work in this field and it has been shown in more recent studies using more sophisticated investigations that the majority of change happens in the first 6 to 8 sessions. Trajectory of change in psychotherapy is the steepest in the beginning and this is true for all bonafide treatments like TDCRP (Treatment of Depression Collaborative Research Program), Project Match, The Cannabis Youth Treatment Project etc. whose trajectories revealed the same pattern upon inspection.

This research has given the therapist an insight as to what course the therapy needs to take to improve effectiveness as clients who show little or no early change are at a greater risk of dropping out if corrective measures are not taken.

MyOutcomes has taken all this information and put it into a web-based system that provides the ability to record and analyse data and interpret results. It is a powerful tool in the hands of the clinicians as they can now easily monitor these trajectories of change by simply asking the clients to fill ORS (Outcome Rating Scale) and SRS (Session Rating Scale) forms at the beginning and end of each session and compare their results.

In this short video clip, you can watch Dr. Barry Duncan talking about early change as a predictor of therapy outcomes.

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Feedback Sources & Aggregate Stats

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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

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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/

Outcome Rating Scale: Performance and Case Alert Reports

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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…

The OQ-45 and MyOutcomes

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The Outcome Questionnaire 45 (OQ-45) is one of several tools that have been developed to address the goals of evidence-based therapy. Even more so, this tool is similar to MyOutcomes’ Outcome Rating Scale (ORS) which itself was designed to work within the framework of the feedback-informed therapy model.

Like the ORS, the OQ-45 is a measure of subjective comfort/discomfort, interpersonal relationships and social role performance since the last meeting with their therapist. It also includes nine items that measure psychopathology. Both of these tools are comparable in their ability to detect clients at risk of failing to achieve their therapeutic goals and they both reduce client deterioration rates to a similar degree.

The OQ-45 is ideally administered prior to the beginning of a session, since it can take as long as 10 minutes to complete. The ORS, on the other hand, takes less than a minute and therefore doesn't require special scheduling nor does it take valuable time away from the therapeutic session. The OQ-45 lacks efficacy with populations under 18 years of age whereas the ORS can be used easily with adults, adolescents and the CORS has been normed for use with children. As home atmosphere can play a role in the subjective well-being of children and teenagers, the ORS is also able to collect and integrate the same information from their caretaker.

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Isn’t the ORS and SRS just a patient satisfaction measure?

“Isn't it really just a patient satisfaction measure and what do they tell you anyway?” is one of the three typical questions asked regarding the ORS and SRS, according to Scott Miller, who along with Barry Duncan, developed these two therapeutic tools. This is actually a two-part question that attempts to challenge the validity of the MyOutcomes tools.

The first part of the question, “Isn't it really just a patient satisfaction measure,” not only misses the mark but its underlying sentiment is disturbing. Although it probably isn't intended, the question seems to suggest that the client's subjective experience of the clinical process is of little consequence. The therapeutic process, however, is about the patient and the patient's goals. It is the client's subjective state that brings the clinician and the client together and it will be the client's subjective state that will determine when that relationship comes to an end. Any information that can provide insight into the client's ongoing experiences toward achieving their goals should be considered of high value to the therapist. Furthermore, patient satisfaction is critical to the success of an agency or a clinician's practice. Satisfied patients can mean continued funding for an agency because that agency is achieving their raison d’être. Patients who are happy with their treatment will tell others; others who are potential clients. An increased amount of clients translates into a growing practice for the individual clinician.

Success is not simply a matter of clients achieving their therapeutic goals. It is also measured by retention of the more difficult cases.It might sound pretty impressive for a therapist to claim that 95% of their clients are successful in achieving their goals. If, however, that same therapist has an attrition rate of 40%, an entirely different light is shed upon that therapist's practice and claimed success.

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