Sudden gains--large, enduring reductions in symptom intensity from one session to the next--were identified by T. Z. Tang and R. J. DeRubeis (1999b) on the basis of data from 2 manualized clinical trials of cognitive therapy for depression. The authors found similar sudden gains among clients with a variety of disorders treated with a variety of approaches in routine clinic settings. Clients (N = 135 who met inclusion criteria) completed short forms of the Clinical Outcomes in Routine Evaluation (CORE-SF) preceding 7 to 74 individual sessions. Those who experienced sudden gains within their first 16 sessions (n = 23) had significantly lower CORE-SF scores in their final 3 sessions than did the other clients.

This study extended client-focused research by using the nearest neighbor (NN) approach, a client-specific sampling and prediction strategy derived from research on alpine avalanches. Psychotherapy clients (N=203) seen in routine practice settings in the United Kingdom completed a battery of intake measures and then completed symptom intensity ratings before each session. Forecasts of each client's rate of change and session-by-session variability were computed on the basis of that client's NNs (n=10-50 in different comparisons). Alternative forecasts used linear or log-linear slopes and were compared with an alternative prediction strategy. Results showed that the NN approach was superior to the alternative model in predicting rate of change, though the advantage was less clear for predicting variability.

CORE-OM and BDI can be compared in routine clinical settings with acceptable accuracy.

This paper describes a systematic approach to generating practice‐based evidence in a United Kingdom adult psychological therapies service. Routine clinical outcomes using standardized measures at referral, assessment, the beginning of therapy, discharge and 6‐month follow‐up are reported. The system is integrated into the clinical service in many ways including contributing to risk assessment and feeding back clinical outcome data to the therapists. A number of issues related to such an approach are discussed in the light of the clinical governance and clinical effectiveness agendas in the UK NHS. These include practical constraints, the costs, getting staff on board, attrition from such services and service user involvement. Such an approach provides a framework for routine, systematic and integrated service evaluation that can be fed back to therapists. It contributes to the evidence for the effectiveness of psychological therapies in routine clinical settings and also provides opportunities to link evidence with practice in more creative ways to enhance therapists' reflection on their practice. Copyright © 2003 John Wiley & Sons, Ltd.

We describe the use of a number of outcome measures that have been used over the past eight years to evaluate adult psychological therapies services in the Wakefield & Pontefract locality of the South West Yorkshire Mental Health NHS Trust. The psychological therapies service now has a unique database of outcome measures completed by 5563 clients, which has been used nationally and internationally for service evaluation and research purposes. Internally, the database has informed the clinical service, allowing prioritising of referrals and feedback to clinicians and referral agencies on the quality of the service and appropriateness of referrals.We describe the properties and intended use of the measures, the way results are fed back to the service and evaluate the usefulness of the measures in routine service settings. Implications for psychological therapies and other mental health services are discussed including: • Choice of generic or specific outcome measures • How the measures relate to one another • Clinical usefulness of the measures, including risk assessment • Interpretation of results, including availability of norms and how to assess change • Practical utility, including cost