Services to the poor and disabled can be effective, and continuous outcome feedback may be a viable means both to improve outcomes and to narrow the gap between research and practice.

Nobody can go back and start a new beginning, but anyone can start today and make a new ending.-Maria Robinson Behavioral or mental health disorders rank first among the causes of disability in the United States and Westem Europe. In the United Kingdom, fot example, 38% of individuals teceiving disability benefits have a mental health diagnosis, neatly twice the next highest leason foi ieceipt of government subsidy (i.e., unemployment; Layaid, 2006). Disability rates in the United States have soared. In 2003, there were neatly 6 million people who were either disabled by mental illness (Social Security Disability statistics) or diagnosed as mentally ill (Social Security Income statistics), a disability rate of about 20 people pet 100,000 population, neatly 6 times what it was in 1955 (Whitaket, 2005).Accoiding to a Substance Abuse Mental Health Seivices Administiation report, $104 billion goes each year to mental health and substance abuse treatment services (Mark et al, 2005). It is suiptising that more public funds ate spent on behavioral than physical health cate (57% vs. 46%; President's New Freedom Commission on Mental Health [PNFCMH], 2003). Despite the staggeting costs, the very system set up to help those in need is seriously fragmented, in disanay, and in need of majoi tefoim.

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.

The WRS and PAS demonstrate sufficient reliability and validity to move to the next phase of research: a randomized clinical trial comparing the use of real-time feedback from the two measures to treatment as usual targeting outcomes of chronic disease patients.