Monitoring progress in psychotherapy routinely (i.e., client feedback) has yielded positive results for improving both outcome and retention in individual and couple therapy; however, evidence of client feedback efficacy in a group format is limited. Using a randomized cluster design, group therapy participants (N = 84) were assigned to a client feedback or treatment-as-usual (TAU) condition in a university counseling center. Clients in the feedback condition used the Partners for Change Outcomes Management System (PCOMS; Duncan, 2011). Feedback participants had significantly larger pre-post group therapy gains (d = 0.41) and higher rates of reliable and clinically significant change when compared to TAU participants on the Outcome Rating Scale . Clients in the feedback condition also attended more group sessions compared to TAU participants. Study implications and future recommendations are provided.

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High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as "patient centered." Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N = 2,247) that used a quality-improvement strategy called systematic patient feedback. Benchmarks were constructed using randomized clinical trials (RCTs) from inpatient treatment for depression, RCTs from patient feedback in outpatient settings, and national data on psychiatric hospital readmission rates. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d = 1.33 and d = 1.38 for patients diagnosed with a mood disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression. Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is "patient centered" may provide a path toward lower readmission rates in addition to other evidence-based strategies after discharge. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

Research demonstrating the effectiveness of treatment with youth from low socioeconomic backgrounds is limited. To address this limitation, we evaluated pre-post psychotherapy treatment outcomes with youth presenting with depression-related diagnoses (N ϭ 469) at a public behavioral health agency after they implemented a systematic client feedback approach as a quality improvement strategy. Clients were ethnically diverse youth at or under the poverty line. Treatment outcome was measured with the Outcome Rating Scale and the Child Outcome Rating Scale (Duncan, Sparks, Miller, Bohanske, & Claud, 2006). Benchmark methodology was used to compare effect size estimates to those achieved in randomized clinical trials. Average treatment effect sizes for the public behavioral health depression samples of children and adolescents (d ϭ 1.39 and d ϭ 1.69, respectively) were clinically superior to a waitlist benchmark drawn from clinical trials of youth depression, and clinically equivalent to a treatment benchmark drawn from youth depression clinical trials. Findings demonstrate that mental health services for depressed youth in poverty across an agency can be effective, and systematic client feedback may be a useful strategy to improve treatment outcomes. Clinical Impact StatementQuestion: Is psychotherapy utilizing systematic client feedback effective in reducing distress among depressed youth in poverty within a public behavioral setting? Findings: We found psychotherapy for depressed youth in a public behavioral setting in which systematic feedback was conducted showed similar effect sizes to treatments in clinical trials. Meaning: Systematic client feedback may be a useful quality improvement strategy for serving depressed youth. Next Steps: Although this study provides a more optimistic outlook on treatment of youth in a public behavioral setting than many previous studies, follow-up research is needed that uses a control condition to isolate the effects of client feedback to better understand how such processes benefit youth in psychotherapy.

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The findings of this study may be useful in providing preliminary empirical data for future explorations of the mechanism whereby SHS exposure can influence behavioral outcomes in nonsmokers. Such studies can inform future interventions to reduce the physical and behavioral health risks associated with SHS exposure.