There is much evidence to suggest that psychotherapy is effective, however, it is far from flawless (e.g., Lilienfield, 2007; Stuart, 1970). As the field of mental health changes, there has been a recent movement in routine practice toward the use of standardized measures to track client progress and to collect feedback about treatment response (Lambert & Shimokawa, 2011). The use of standardized tools can help practitioners identify when clients are not progressing in therapy and have been linked to better outcomes for nonresponsive clients than when these measures are not used (e.g., Shimokawa, Lambert, & Smart, 2010). The purpose of this article is to introduce a group of such tools, referred to as progress monitoring (PM) measures, and to highlight features relevant in selecting and implementing a PM measure in practice. Areas covered include domains assessed, target populations, administration, scoring, feedback and interpretation, cost, training and privacy. While there exist numerous outcome and assessment measures (e.g., Froyd, Lambert, & Froyd, 1996), this article focuses specifically on seven popular progress monitoring measures for adult mental health populations, that are brief, comprehensive and easily accessible tools designed to be used to monitor change throughout the therapeutic process.
There is growing support for the use of progress monitoring (PM) measures to monitor client change throughout treatment. As little is known about the training of PM, the present study surveyed doctoral psychology graduate trainees across North America. Responses from 605 students indicated that the majority of trainees (69.9%) had heard of PM measures; of this group who were aware of PM measures, 82.7% reported experience using a PM measure with at least 1 client. Users and nonusers used identical methods of monitoring client change, except that PM users ranked the measures as their second most important way of assessing change. Users' identified PM measures as useful for a range of practices, not just tracking client change but also facilitating client discussions and helping with clients who are not progressing as expected. Actual challenges reported by users were significantly lower than anticipated challenges as perceived by nonusers. Users were almost twice as likely to predict that they would use PM measures in the future as compared with nonusers. The discussion highlights the differences between PM users and nonusers and their implications for trainees and trainers.
Although integrating progress monitoring (PM) measures into psychotherapy practice can provide numerous benefits, including improved client outcomes, relatively few clinicians use these measures (e.g., Ionita & Fitzpatrick, 2014). To better understand the reasons for clinicians' reluctance, consensual qualitative research methodology was used to examine the challenges faced by clinicians currently using PM measures. Open-ended, semistructured interviews, with 25 clinicians who chose to use PM measures, revealed that clinicians tended to face challenges involving technical concerns, negative responses from others, and personal barriers such as anxiety. The majority of participants discussed ways to overcome the challenges they experienced, including ensuring the fit of the PM measure, explaining measures to others to help engender a positive response, adapting their own perspective, and increasing their own and others' knowledge of the measures. Implications for practicing psychologists and for knowledge translation efforts are discussed.
Objectives: Problematic alcohol use accounts for a large proportion of Emergency Department (ED) visits and revisits. We developed the Alcohol Medical Intervention Clinic (AMIC), a Rapid Access Addiction Medicine (RAAM) service, to reduce alcohol-related ED re-utilization and improve care for individuals with alcohol problems. This article describes the AMIC model and reports on an evaluation of its impact on patients and the ED system. Methods: Individuals presenting to The Ottawa Hospital Emergency Departments (TOH-ED) for an alcohol-related issue were referred to AMIC. Using data collected via medical chart review, and also self-report questionnaires, we assessed ED visits, revisits, and changes in alcohol use and mental health symptoms in patients before and after receiving services in AMIC. The incidence of alcohol-related ED visits and re-visits from 12-month periods before and after the introduction of AMIC were compared using data from TOH Data Warehouse. Connections made to additional services and patient satisfaction was also assessed. Results: For patients served by AMIC, from May 26, 2016 to June 30, 2017 (n = 194), there was an 82% reduction in 30-day visits and re-visits (P < 0.001). An 8.1% reduction in total alcohol-related 30-day TOH-ED revisit rates and a 10% reduction in total alcohol-related TOH-ED visits were found. After receiving AMIC services, clients reported reductions in alcohol use, depression, and anxiety (P < 0.001). Conclusions: AMIC demonstrated positive impacts on patients and the healthcare system. AMIC reduced ED utilization, connected people with community services, and built system capacity to serve people with alcohol problems.
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