Boswell, J.F., Kraus, D.R., Miller, S.D., & Lambert, M.J. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25, 6-19.
Routine outcome monitoring (ROM) refers to: (1) systematically assessing patient outcomes at every session, (2) comparing patient scores and progress to a database of similar patients, (3) using algorithms or decision tools to identify patients who are not improving or deteriorating, (4) providing regular and immediate feedback to therapists about the patient, and (5) in some cases providing clinical decision aids to help therapists improve outcomes for patients who are not improving or who are deteriorating. Boswell and colleagues review the research related to ROM. Generally, about 30% to 50% of patients do not respond to treatment, and 8% of patients tend to get worse during treatment. Therapists tend to overestimate their patients’ improvement, and so therapists may not always identify patients who do not respond or get worse. Therapists may need assessment aids to help them make decisions about patient progress and treatment. Boswell and colleagues point out that ROM have a proven ability to predict treatment failure and other negative outcomes. In a meta analysis of over 6,000 patients, the patients at risk of a negative outcome whose therapist received ROM feedback prior to every session were better off than 70% of at-risk patients whose therapist received no feedback. When therapists are provided feedback and suggestions for interventions, their patients had almost four times higher odds of achieving clinically significant improvement. Boswell and colleagues list a number of barriers that psychotherapists and agencies experience to implementing ROM in their practices. Many therapists are not aware of or have no experience with ROM, and so they may not be aware of its benefits to their practice and patients. Time and money are two practical issues that may arise. This type of assessment is not always reimbursed and the average clinician may feel that they do not have enough time to reflect on routine assessment and feedback so as to reconsider their interventions. Agencies may not understand the value of allocating resources to this type of testing (although medically oriented agencies would not hesitate to order a blood test or an x-ray). Finally, some therapists might experience ROM as intrusive, as impeding the therapeutic relationship, and as a means for an agency to control therapist decisions.
Routine outcome monitoring (ROM) has clear benefits to patients, therapists, and agencies. To overcome barriers, therapists and agencies could implement ROM as part of routine clinical care, and advertise this as an evidence-based practice that will benefit prospective patients. Clients generally appreciate knowing that they will receive the best possible care. ROM can enhance the therapeutic relationship if it is presented to clients as a collaborative endeavor. For example, if a patient is not improving or is deteriorating, therapists can discuss this with patients as well as a plan to alter aspects of the treatment in order to improve the prospects for a better outcome. Therapists can choose from a number of possible ROM options to best tailor the approach to their clients based on cost, time, and relevance. Currently, there are several outcome monitoring systems available to clinicians including: the Partners for Change Outcome Management System (PCOMS), the Treatment Outcome Package (TOPS), the Clinical Outcomes in Routine Evaluation (CORE), and the Outcome Questionnaire (OQ) system.