Outcomes of Client-Based Feedback: Comments and a third option
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1 Digital George Fox University Faculty Publications - Graduate School of Clinical Psychology Graduate School of Clinical Psychology Outcomes of Client-Based Feedback: Comments and a third option Rodger K. Bufford George Fox University, rbufford@georgefox.edu Follow this and additional works at: Part of the Clinical Psychology Commons Recommended Citation Bufford, Rodger K., "Outcomes of Client-Based Feedback: Comments and a third option" (2011). Faculty Publications - Graduate School of Clinical Psychology. Paper This Conference Proceeding is brought to you for free and open access by the Graduate School of Clinical Psychology at Digital George Fox University. It has been accepted for inclusion in Faculty Publications - Graduate School of Clinical Psychology by an authorized administrator of Digital George Fox University.
2 Outcomes of Client-Based Feedback Comments and a third option Using Client Feedback 1
3 Comments Pertinent to Jeff s presentation Another client-feedback measure: ACORN Using Client Feedback 2
4 Comments Feedback works Feedback provides an alternative to manualized treatment Therapists who use feedback do better it seems to help most those who are doing most poorly Therapist changes in response to feedback appear to be subtle and tailored to the client s unique factors Using Client Feedback 3
5 Comments The generalizability concerns of RCTs are avoided Different clients Different problems Different therapists Different settings Different treatments unless.... No complicating conditions Using Client Feedback 4
6 Comments Some concerns arise The 10 centimeter challenge Session ratings (working alliance) have ceiling effects Here traditional descriptive statistics are not presented: Mean, SD, internal consistency Using Client Feedback 5
7 ACORN George Jeb Brown The ACORN is a brief symptom assessment scale and relationship scale. It is designed to be used repeatedly, ideally at each session. George Jeb Brown developed the ACORN, consults with clinics and managed care organizations, and does ongoing program evaluations on treatment outcomes using this scale. jebbrown@clinical-informatics.com Using Client Feedback 6
8 This is one version of the Acorn Using Client Feedback 7
9 WPC ACORN Outcomes 2007 ES = ES =.81 25% gain Using Client Feedback 8
10 WPC Outcomes 2007 ES =.66 Using Client Feedback 9
11 WPC Outcomes 2008 ES =.81 25% gain Using Client Feedback 10
12 ACORN Features of the ACORN o items o Multiple versions, including adolescent, substance abuse o Item interchangeability o Items rated 0-4 for severity o 0 = never o 1 = hardly ever o 2 = sometimes o 3 = often o 4 = very often o Symptom severity or global distress is measured Using Client Feedback 11
13 Features of the ACORN o Mean item score is used o Interpretation ACORN o normal or asymptomatic o moderate distress o severe distress o Four working alliance questions o Using Client Feedback 12
14 OQ-45 Developed by Michael J Lambert and colleagues Face-valid symptom checklist intended for repeated administration Several versions OQ-45 LSQ oq30/ YLSQ-30: youth version Using Client Feedback 13
15 ns::article&id=d110fadcecf943c792dafe7a60820cd6 OQ Session #: Date: INSTRUCTIONS: Looking back over the last week, including today, help us understand how you have been feeling. Read each item and mark the answer that best describes your current situation. Work is defined as employment, school, housework, volunteer work, etc. Almost Never Rarely Sometimes Frequently Always 1. I get along well with others [] [] [] [] [] 2. I am easily fatigued [] [] [] [] [] 3. I feel little interest in life [] [] [] [] [] 4. I feel stressed at work/school [] [] [] [] [] 5. I blame myself for things [] [] [] [] [] 6. I feel irritated [] [] [] [] [] 7. I feel unhappy in my marriage/significant relationship [] [] [] [] [] 8. I have thoughts of ending my life [] [] [] [] [] 9. I feel weak [] [] [] [] [] 10. I feel fearful [] [] [] [] [] 11. After heavy drinking, I need a drink the next morning to get going (if you do not drink, mark 'never') [] [] [] [] [] 12. I find my work/school satisfying [] [] [] [] [] 13. I am a happy person [] [] [] [] [] 14. I work/study too much [] [] [] [] [] 15. I feel worthless [] [] [] [] [] 16. I am concerned about family troubles [] [] [] [] [] Using Client Feedback 14
16 OQ PAGE 2 Almost Never Rarely Sometimes Frequently Always 19. I have frequent arguments [] [] [] [] [] 20. I feel loved and wanted [] [] [] [] [] 21. I enjoy my spare time [] [] [] [] [] 22. I have difficulty concentrating [] [] [] [] [] 23. I feel hopeless about the future [] [] [] [] [] 24. I like myself [] [] [] [] [] 25. I am not able to keep disturbing thoughts out of my mind [] [] [] [] [] 26. I feel annoyed by people who criticize my drinking or drug use (if not applicable, mark 'never') [] [] [] [] [] 27. I have an upset stomach [] [] [] [] [] 28. I am not working/studying as well as I used to [] [] [] [] [] 29. My heart pounds too much [] [] [] [] [] 30. I have trouble getting along with friends and close acquaintances [] [] [] [] [] 31. I am satisfied with my life [] [] [] [] [] 32. I have trouble at work because of drinking or drug use (if not applicable, mark 'never') [] [] [] [] [] 33. I feel that something bad is going to happen [] [] [] [] [] 34. I have sore muscles [] [] [] [] [] 35. I feel afraid of open spaces, of driving, or being on buses, subways, etc. [] [] [] [] [] Using Client Feedback 15
17 OQ PAGE 3 Almost Never Rarely Sometimes Frequently Always 36. I feel nervous [] [] [] [] [] 37. I feel my love relationships are full and complete [] [] [] [] [] 38. I feel that I am not doing well at work/school [] [] [] [] [] 39. I have too many disagreements at work/school [] [] [] [] [] 40. I feel that something is wrong with my mind [] [] [] [] [] 41. I have trouble falling asleep or staying asleep [] [] [] [] [] 42. I feel blue [] [] [] [] [] 43. I am satisfied with my relationships with others [] [] [] [] [] 44. I feel angry enough at work/school to do something I might regret [] [] [] [] [] 45. I have headaches [] [] [] [] [] Using Client Feedback 16
18 OQ-45 References Lambert, M. J. (2005). Early response in psychotherapy: Further evidence for the importance of common factors rather than placebo effects Journal of Clinical Psychology,61, Lambert, M.J. & Asay, T. A (2004). Clinically significant change. In D. Charman (Ed.). Core Processes in brief psychodynamic psychotherapy: Advancing effective practice (Pp ). Mahwah, NJ: Lawrence Erlbaum. Lambert, M. J., Gregersen, A. T., & Burlingame, G.M. (2004). The Outcome Questionnaire. In Maruish, M. (Ed). The use of psychological tests for treatment planning and outcome assessment (3rd ED) (Pp ). Lawrence Erlbaum. Lambert, M. J., & Hawkins, E.J. (2004a). Measuring outcome: Implementing, monitoring and evaluating outcome in clinical practice. Professional Psychology: Research and Practice, 35, Lambert, M. J. & Hawkins, E.J. (2004b). Measuring Psychotherapy Outcome. In Maruish, M. (Ed). The use of psychological tests for treatment planning and outcome assessment (3rd ed., Pp ). Lawrence Erlbaum. Lambert, M. J., Hunt, R. D., & Vermeersch, D. A. (2004). Optimizing outcome through measurement of psychological functioning. In D. Charman (Ed.). Core Processes in brief psychodynamic psychotherapy: Advancing effective practice (Pp ). Mahwah, NJ: Lawrence Erlbaum. Lambert, M. J., & Vermeersch, D. A. (2005). Efficacy and effectiveness. In M. Hersen (Ed.) Encyclopedia of behavior modification and therapy: Vol. I Thousand Oaks: Sage Publications. Nielsen, S. L., Smart, D. W., Isakson, R., Worthen, V., Gregersen, A. T., & Lambert, M. J. (2004). The Consumer Reports effectiveness score: What did consumers report? Journal of Counseling Psychology,51, Vermeersch, D A., Whipple, J. L., Lambert, M. J., Hawkins, E. J., Burchfield, C. M., & Okiishi, J. C. (2004). Outcome Questionnaire: Item sensitivity to changes in counseling center clients. Journal of Counseling Psychology, 51, Using Client Feedback 17
19 Outcome Rating Scale Scott Miller & Barry Duncan Face-valid and simplest rating scale Intended for repeated assessment This scale rates each of four dimensions by placing a mark along a 10 centimeter scale Scores for each dimension are achieved by measuring the placement of the mark in tenths of a centimeter, e.g., 6.7 Miller and Duncan propose that absence of improvement in 3-4 sessions indicates a therapist failure Re-conceptualize and renegotiate plan or refer Failure to do so may result in chronic problems for client Chronicity is viewed as a therapist failure rather than a client failure Using Client Feedback 18
20 Outcome Rating Scale Scott Miller & Barry Duncan 2000 Individually (Personal well-being) I I Interpersonally (Family, close relationships) I I Socially (Work, school, friendships) I I Overall (General sense of well-being) I I Institute for the Study of Therapeutic Change , Scott D. Miller and Barry L. Duncan Using Client Feedback 19
21 Session Rating Scale Scott Miller, Barry Duncan, & Lynn Johnson The Session Rating Scale (SRS V.3.0) rates the work of the therapist It consists of 4 items, again rated by placing a line on a 10 cm scale. Domains include: Relationship I I Goals and Topics I I Approach or Method I I Overall (e.g.) There was something missing in the session today. Overall, today s session was right for me. I I Using Client Feedback 20
22 Session Rating Scale Scott Miller, Barry Duncan, & Lynn Johnson Scott D Miller scottdmiller@talkingcure.com Barry Duncan barrylduncan@comcast.net Using Client Feedback 21
23 PHQ and GAD-7 Pfizer offers free mental health assessment tools to improve care (7/26/2010) Press Release New York, NY Pfizer today announced that it will make available assessment scales used by physicians and others in the healthcare community to support the evaluation and diagnosis of patients suffering from certain mental disorders. Users can directly access and download the Patient Health Questionnaire (PHQ) and the General Anxiety Disorder questionnaire (GAD-7) without copyright restriction and at no charge The PHQ and GAD instruments, including different variations and translations in nearly 80 languages, are available at Using Client Feedback 22
24 GAD-7 GAD-7 Questionnaire How often during the past 2 weeks have you felt bothered by: 1. Feeling nervous, anxious, or on edge? 0 = not at all 1 = several days 2 = more than half the days 3 = nearly everyday 2. Not being able to stop or control worrying? 0 = not at all 1 = several days 2 = more than half the days 3 = nearly everyday 3. Worrying too much about different things? 0 = not at all 1 = several days 2 = more than half the days 3 = nearly everyday 4. Trouble relaxing? 0 = not at all 1 = several days 2 = more than half the days 3 = nearly everyday 5. Being so restless that it is hard to sit still? 0 = not at all 1 = several days 2 = more than half the days 3 = nearly everyday Using Client Feedback 23
25 GAD-7 GAD-7 Questionnaire 6. Becoming easily annoyed or irritable? 0 = not at all 1 = several days 2 = more than half the days 3 = nearly everyday 7. Feeling afraid as if something awful might happen? 0 = not at all 1 = several days 2 = more than half the days 3 = nearly everyday If you checked off any problems, how difficult have these problems made it for you to do your work, take care of things at home, or get along with other people? Not difficult at all Somewhat difficult Very difficult Extremely difficult Scoring: Add the results for question number one through seven to get a total score. 10 or higher = significant anxiety 15 or greater = severe anxiety Using Client Feedback 24
26 PHQ-9 Using Client Feedback 25
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