A mixed-method investigation of patient monitoring and enhanced feedback in routine practice: Barriers and facilitators

Abstract

Objective: To investigate the barriers and facilitators of an effective implementation of an outcome monitoring and feedback system in a UK National Health Service psychological therapy service. Method: An outcome monitoring system was introduced in two services. Enhanced feedback was given to therapists after session 4. Qualitative and quantitative methods were used, including questionnaires for therapists and patients. Thematic analysis was carried out on written and verbal feedback from therapists. Analysis of patient outcomes for 202 episodes of therapy was compared with benchmark data of 136 episodes of therapy for which feedback was not given to therapists. Results: Themes influencing the feasibility and acceptability of the feedback system were the extent to which therapists integrated the measures and feedback into the therapy, availability of administrative support, information technology, and complexity of the service. There were low levels of therapist actions resulting from the feedback, including discussing the feedback in supervision and with patients. Conclusions: The findings support the feasibility and acceptability of setting up a routine system in a complex service, but a number of challenges and barriers have to be overcome and therapist differences are apparent. More research on implementation and effectiveness is needed in diverse clinical settings.

Implementing routine outcome monitoring in public mental health services in Israel: Shared and unique challenges

“…While most ROM studies have focused on a single patient‐therapist dyad, psychiatric hospitals tend to use a multidisciplinary approach, involving multiple therapists (eg, a psychiatrist and psychologist), multiple modalities (individual and group therapy), and at times multiple patients (eg, family interventions). We concur with other researchers who have previously highlighted this obstacle in complex large sites such as mental health hospitals . One proposed solution was to measure outcomes only in the main therapy while assessing the working alliance in all other modalities.…”

“…The increasing use of ROM over the past decade has fostered many discussions related to challenges and obstacles of outcome measurement implementation, producing many experience‐drawn conclusions to learn from . Simultaneously, it is well acknowledged that different countries and mental health facilities have different obstacles to face while attempting implementation . In this article, we report on the first systematic and elaborative effort to widely assimilate the use of empirical measurements in the daily routine of a large, active and hectic, mental health hospital in Israel, while facilitating the elaboration of ROM feedback reports into its clinical work.…”

“…This trend is not unique to ROM, as studies show that only a few of all health promotion interventions in mental health document steps taken towards effective implementation . This has led many important contributors to point to the need to document, study, and assess the adoption, implementation, and sustained use of outcome monitoring in different mental health settings …”

Mixed methods in psychotherapy research: A review of method(ology) integration in psychotherapy science

“…They indicated that their design was "the most suitable and comprehensive approach to ascertain the effectiveness of the interventions whilst also gathering participants' views on the intervention" (Lopez et al, 2014, p. 412). Similar findings emerged in other studies where qualitative data were indicated to have deepened the findings by going beyond statistical testing (e.g., Finucane & Mercer, 2006;Grocke et al, 2014;Herrera-Mercadal et al, 2015;Lucock et al, 2015;Lucre & Corten, 2013;Robinson, McCague, & Whissell, 2014;Werbart et al, 2015). This reinforces the value derived from speaking with participants to better conceive the fruitfulness of interventions.…”

Routine Outcome Monitoring in Mental Health Care and Particularly in Addiction Treatment: Evidence-Based Clinical and Research Recommendations

“…An important concern generally remains the implementation and the integration of ROM in clinical practice [26,[78][79][80]. ROM feedback can be considered as a communication tool, and research showed that ROM feedback discussions have a positive effect on treatment cooperation [81].…”