There is a need for a measure of outcome in systemic family and couples therapy (SFCT) that reflects current theory and practice. To meet the needs of SFCT practice the measure needs to use self-report by family members, take a short time to complete and be easy to understand. The development of such a measure, called the SCORE, is reported in this article. Substantial piloting, consultation and review in terms of clinical judgement led to the construction of the SCORE 40 which has forty items about how the family functions, rated by family members over 11 years of age on a Likert scale, in addition to independent ratings of the family and its difficulties. The SCORE 40 is shown to be a viable instrument but is too substantial for everyday clinical use. In a research project to reduce and refine the measure and determine its psychometric properties the SCORE 40 was administered to 510 members of 228 families at the start of their first appointment for family therapy at clinics throughout the UK. The scale has good psychometric properties and could operate with either three or four dimensions. The analyses of these data, combined with data from a convenience sample of 126 non-clinical families, allowed a reduction to fifteen items while retaining most of the information provided by the SCORE 40. This version is offered with three dimensions of: (1) Strengths and adaptability; (2) Overwhelmed by difficulties; and (3) Disrupted communication. It is hoped that the ready availability of the SCORE 15 will encourage routine evaluation of outcomes in clinics as well as the SCORE being used flexibly for both therapy and research.

The SCORE index of family functioning and change is an established measure, with strong psychometric properties, of the quality of family life. We report the sensitivity to therapeutic change of the short form, the SCORE-15. Data are reported from 584 participants aged above 11 years, representing 239 families. All couples and families had been referred for systemic couples and family therapy, completing the form at start of the first session and close to the fourth. The SCORE-15 is shown to be acceptable with strong consistency and reliability. Change over only three sessions was highly statistically significant. Further validation is provided by improvements in quantified scores correlating significantly with independent measures provided by family members and by their therapists. The SCORE-15 is a proven measure of therapy and of therapeutic change in family functioning. It is therefore a routinely usable tool applicable to service evaluation, quality improvement, and to support clinical practice. Practitioner Points• The SCORE provides practitioners with brief descriptions of varied aspects of family interaction that have proven significance for many families who present for therapy. • SCORE-15 can be used with confidence to monitor and report proven indicators of progress in systemic therapy. • Because SCORE identifies clinically significant issues of family interaction it has many potential uses in therapy. • There are many new possibilities for therapists to undertake collaborative research.

Background: In the United Kingdom, specialist treatment and intervention services for doctors are underdeveloped. The MedNet programme, created in 1997 and funded by the London Deanery, aims to fill this gap by providing a self-referral, face-to-face, psychotherapeutic assessment service for doctors in London and South-East England. MedNet was designed to be a low-threshold service, targeting doctors without formal psychiatric problems. The aim of this study was to delineate the characteristics of doctors utilising the service, to describe their psychological morbidity, and to determine if early intervention is achieved.

Aims and methodOur aim was to follow-up on a cohort of self-referred doctors who attended MedNet. We used a two-point cross-sectional design. Measures included three standardised self-report questionnaires administered before and after consultation. Doctors were also asked to complete a service user questionnaire, and data regarding engagement and onward referrals were gathered through case-note review.ResultsA statistically significant improvement in scores on all three questionnaires was found after intervention; however, scores on one subscale, the risk domain of the Clinical Outcomes in Routine Evaluation – Outcome Measure, did not change significantly. Of the doctors at no risk of suicide at intake, nearly two-thirds (n = 41/70, 59%) were sufficiently helped by the consultations provided to not need further treatment. Of the doctors at some risk of suicide at intake, two-thirds (n = 34/51, 67%) did need an onward referral. Only one doctor required hospital admission, an outcome that suggests the approach used is containing and clinically responsive.Clinical implicationsThis paper highlights the efficacy, need and importance of specialist services for doctors in difficulty. We found that the bespoke consultation model provided at MedNet is valued highly by the doctors as service users.

Increasing numbers of doctors sought help from the doctors' mental health support service. More than half scored above the thresholds for burnout and psychological distress and these proportions were consistent over 10 years. Doctors may be more willing to seek help than a decade ago. Further research is needed to confirm the underlying reasons for this. More resource is needed to meet the increase in demand.