A qualitative process evaluation of electronic session-by-session outcome measurement in child and adolescent mental health services

Abstract

BackgroundRegular monitoring of patient progress is important to assess the clinical effectiveness of an intervention. Recently, initiatives within UK child and adolescent mental health services (CAMHS) have advocated the use of session-by-session monitoring to continually evaluate the patient’s outcome throughout the course of the intervention. However, the feasibility and acceptability of such regular monitoring is unknown.MethodSemi-structured qualitative interviews were conducted with clinicians (n = 10), administrative staff (n = 8) and families (n = 15) who participated in a feasibility study of an electronic session-by-session outcome monitoring tool, (SxS), which is based on the Strengths and Difficulties Questionnaire (SDQ). This study took place in three CAMHS clinics in Nottinghamshire. The interview transcripts were thematically analysed.ResultsWe found clinicians accepted the need to complete outcome measures, particularly valuing those completed by the patient. However, there were some difficulties with engaging clinicians in this practice and in the training offered. Generally, patients were supportive of completing SxS in the waiting room prior to the clinic session and assistance with the process from administrative staff was seen to be a key factor. Clinicians and families found the feedback reports created from SxS to be helpful for tracking progress, facilitating communication and engagement, and as a point of reflection. The use of technology was considered positively, although some technological difficulties hindered the completion of SxS. Clinicians and families appreciated the brevity of SxS, but some were concerned that a short questionnaire could not adequately encapsulate the complexity of the patient’s issues.ConclusionsThe findings show the need for appropriate infrastructure, mandatory training, and support to enable an effective system of session-by-session monitoring. Our findings indicate that clinicians, administrative staff and young people and their parents/carers would support regular monitoring if the system is easy to implement, with a standard ‘clinic-wide’ adoption of the procedure, and the resulting data are clinically useful.

Functionality and feedback: a realist synthesis of the collation, interpretation and utilisation of patient-reported outcome measures data to improve patient care

“…giving you motivation to try and get it up another step'. 339 However, this was possible only if clinicians discussed the findings of the measure with them; otherwise, they felt that there was no point to completing it, as one young person observed: 'I think there's not really much point in sitting and doing a questionnaire that isn't being used to DOI: 10.3310/hsdr05020 HEALTH SERVICES AND DELIVERY RESEARCH 2017 VOL. 5 NO.…”

“…As a result of this, families reported feeling more prepared for their session. 339 Some patients also commented that completing the measure showed them how far they had progressed over time and that this provided the motivation to keep working on themselves in therapy. As one young person explained, 'It showed you .…”

“…Completing the measure during the session could 'sometimes just get in the way of the therapeutic process a bit'. 339 Completing the measure after the session would not enable data to be used with patients during the session and could also resulted in flawed data for service monitoring purposes because patients may feel 'like they are giving us feedback' instead of reporting on the symptoms and thus could 'feel under pressure to say something . .…”

“…more positive than they really think'. 339 Patients and clinicians held different views of the benefits of PROM collection. The authors observed that families felt that 'completing the questions was a helpful process in its own right', 339 because it provided an opportunity to reflect and assess their condition, which made them more prepared for discussion with clinicians.…”

“…it would be more useful if we were getting feedback from them. 339 In this study, patients completed the questionnaire prior to their session with the clinician. Clinicians felt that this was the most appropriate time to complete the measure.…”