Do we know when our clients get worse? an investigation of therapists' ability to detect negative client change.

Routine clinical judgment is often relied upon to detect client deterioration. How reliable are therapists' judgments of deterioration? Two related studies were conducted to investigate therapist detection of client deterioration and therapist treatment decisions in situations of deterioration. The first study examined therapists' ability to detect client deterioration through the review of therapy progress notes. Therapist treatment decisions in cases of client deterioration were also explored. Therapists had considerable difficulty recognizing client deterioration, challenging the assumption that routine clinical judgment is sufficient when attempting to detect client deterioration. A second study was a survey of therapists asking how they detect client deterioration and what treatment decisions they make in response. Symptom worsening was the most commonly stated cue of deterioration.

Models of case mix adjustment for Ohio Mental Health Consumer Outcomes among children and adolescents.

Outcome data collection systems provide the opportunity for comparing agencies, programs, and therapists. However, the political stakes of comparisons raise important issues regarding their perceived validity. The goal of case-mix adjustment is to eliminate potential biasing factors that might render comparisons as inappropriate or irrelevant. In this paper, case-mix adjustment variables are identified using regression analysis followed by developing models of case mix adjustment using a sample of youth participants in the Ohio Mental Health Consumer Outcomes System. Results indicate that certain client level variables do predict outcomes. The total variance accounted for by variables other than baseline ratings of the outcome measure was small. When comparing agencies using adjusted and unadjusted models, some agencies did vary relative to other agencies. As with previous studies, however, the rank order of agencies was largely unchanged and the correlation between adjusted and unadjusted outcomes among agencies was significant.

Why some clinicians use outcome measures and others do not.

Due to their potential as helpful clinical tools, it is necessary to understand the reasons why certain practitioners are currently using outcome measures and certain others are not. This study investigated the reasons why clinicians use outcome measures based upon factors such as work setting, theoretical orientation and source of payment. Similar analyses were conducted for reasons that clinicians do not use outcome measures. Findings suggest that several practical barriers are the primary reasons for not using outcome measures, although a subset of clinicians have additional concerns. Results also emphasized the need for clinicians to be trained on how to maximize the clinical benefits of formalized outcome assessment.

The influence of outcome measures in assessing client change and treatment decisions.

This study investigated the influence that information in the form of outcome measures and client verbal reports can have on treatment decisions and clinician judgment of client change. A random national sample of psychologists (N=810, 45% response rate) were given clinical vignettes and asked questions regarding their view of client progress and subsequent treatment decisions. Despite clinicians reporting that verbal report is more influential in their actual clinical practice than outcome measure information, both sources of information had an equal impact on judgments of client change. Negative information (from either source) influenced clinicians more than positive information. Outcome measure information indicating client deterioration led more clinicians to choose to alter treatment than client verbal report of deterioration. Information indicating client improvement led some clinicians to continue treatment in the same manner as they had been. Insight-oriented therapists were more likely to continue treatment-as-usual than were cognitive-behavioral therapists.