Routine Outcome Monitoring in Clinical Practice: Benefits and Challenges
April 7, 2021, 7:30 - 8:30 PM
The CAPDA Board of Directors is pleased to offer a series of monthly Zoom sessions titled "Truth Through Discourse", which offers open discussion on various topics of interest to psychologists, psychological associates and clinical psychology graduate students.
The discussion will be moderated by Dr. Paul Kelly, C.Psych.
Dr. Paul Kelly is the founder and Clinical Director of The Mindfulness Clinic (TMC), a private practice Psychology Clinic based in Toronto. For the past 11 years Dr. Kelly has used routine outcome monitoring (ROM) measures to help train, supervise, and support 50+ therapists. Over those years, measures to monitor progress, outcomes and therapeutic alliance have been administered to over 14,000 clients during 66,000+ therapy sessions. Dr. Kelly is familiar with the practicalities of implementing, training and maintaining an ROM approach in a private practice setting. As moderator, Dr. Kelly will help guide a discussion about the potential benefits and challenges of the routine outcome monitoring approach.
There is a lot at stake here. The ROM approach is not just a passing fad. It has already gained a lot of traction with third party payors, agencies and regulators in the USA and parts of Europe, and it is coming to Canada. If the implementation of ROM is left solely to non-clinicians, the resultant problems may outweigh, if not obliviate, the potential benefits. It is important that psychologists, at a minimum, familiarize themselves with the approach – and hopefully some of us will take on a leading role for the implementation of the ROM approach in Canada. A task force of the Canadian Psychological Association has made a good beginning. It recommended that all psychology practitioners begin to implement routine outcome monitoring and that the ROM approach be included in training for psychologists.
What are the potential benefits and challenges? “If implemented well, Quality Improvement (ROM is the same thing) could improve clinical outcomes, reduce costs, improve public perception of the effectiveness of mental health treatment, inform and enhance clinical development of practising clinicians, and empower clients to make more informed choices about their healthcare. If implemented poorly, Quality Improvement could result in an unrealistically heavy paperwork burden, invalid or misleading data, confused clients, clinical errors, poor administrative decisions, and demoralized clinicians.” (From a 2020 article by Tony Rousmaniere, et al, in the journal Psychotherapy, full reference given below.)
Dr. Kelly will make a few introductory remarks about the routine outcome monitoring approach and then moderate what will hopefully be an interesting discussion. If you are not already familiar with this topic, your participation in the discussion could be enriched with a little background reading. Two useful documents are available online. They are described immediately below. Dr. Kelly has also recommended some journal articles. PDF copies of the journal articles will be sent out to everyone who registers for the discussion.
The first online article is available from the website for The Atlantic magazine. It is a good introduction to the topic from the point of view of therapists who would like to be more effective with their clients. If you only read one thing – read this one…
The second online document is the 2018 task force report from CPA. Here is the link:
PDF copies of the following 3 articles will be sent to everyone who registers for the discussion. The articles may also be accessed through the APA website directly if you are a member.
- Keeping Psychologists in the Driver’s Seat: Four perspectives on quality improvement and clinical data registries. Rousmaniere, Tony, et al Psychotherapy, Vol. 57, No. 4, 562-573, 2020.
A summary from this article was quoted above, in the third paragraph. It looks at the topic of routine outcome monitoring, or Quality Improvement, as they call it, from the perspective of professional governance, quantitative research, qualitative research, and clinical practice.
The authors also offer seven recommendations based on their belief that routine outcome monitoring, and related procedures, need to carefully balance the complex demands and realities of clinical practice including client needs and satisfaction, cost reductions and resource management, therapist expertise and training needs, so that the ultimate goal of improving patient centred care can be furthered.
- Beyond Measures and Monitoring: Realizing the potential of Feedback-Informed Treatment. Miller, Scott, at all, Psychotherapy, Vol. 52, No. 4, 449-457, 2015.
The authors begin this article with a summary of research findings regarding the potential benefits of routine outcome monitoring. I have paraphrased slightly.
“More than a dozen randomized controlled trials (RCTs) and several meta-analyses have provided strong empirical support for routine outcome monitoring (ROM) in clinical practice. Evidence has shown that the process may (a) double the effect size of treatment and increase the proportion of clients with reliable and clinically significant change; (b) cut dropout rates in half; (c) reduce the risk of deterioration by one third; (d) shorten the length of treatment by two thirds; and (e) drive down the cost of care.”
- Routine Outcome Monitoring: Coming-of-age-with the usual developmental challenges, Wampold, Bruce. Psychotherapy, Volume 52, Number 4, 458-462, 2015
Dr. Wampold’s article provides commentary on a set of articles that were published in the journal Psychotherapy in 2015. He offers a sage overview and some caution about not overhyping what we think we know about the topic.
He states: “In my view, the use of ROM is the most noteworthy advance in psychotherapy in the last 25 years, yet the potential of this method will be realized only if several important challenges are met.” His comments provide some caution regarding the current state of evidence about the potential benefits of routine outcome monitoring but, overall, he believes that the initiative is important and worth developing further for clinical practice in psychology and elsewhere in mental health.
Feedback Informed Treatment in Clinical Practice: Reaching for Excellence. Edited by David S. Prescott, Cynthia L. Maeschalck, & Scott D. Miller, American Psychological Association, 2017.
How and Why Are Some Therapists Better Than Others: Understanding Therapist Effects. Edited by Louis G. Castonguay and Clara E. Hill, American Psychological Association, 2017.
Better Results: Using Deliberate Practice to Improve Therapeutic Effectiveness. Scott D. Miller, Mark A. Hubble, and Daryl Chow. American Psychological Association, 2020.
Prevention of Treatment Failure: The Use of Measuring, Monitoring, and Feedback in Clinical Practice. Michael J. Lambert, American Psychological Association, 2010.
NOTE: This session is open to psychologists, psychological associates and clinical psychology graduate students only.