Experiences of outcome monitoring in service users with psychosis: Findings from an Improving Access to Psychological Therapies for people with Severe Mental Illness (IAPT‐SMI) demonstration site

Abstract

Objectives Psychological therapy services are increasingly required to instate routine outcome monitoring (ROM), to demonstrate the clinical and economic impact of interventions. Professionals’ views of ROM are an acknowledged barrier to implementation. Service user perspectives have rarely been examined, but acceptability and perceptions of ROM are critical to successful implementation. We investigated service users’ experiences of ROM in an Improving Access to Psychological Therapies for people with Severe Mental Illness psychosis demonstration site. Design ROM comprised a periodic assessment battery completed at baseline, mid‐therapy, and end‐of‐therapy and a single measure completed session‐by‐session. Qualitative and quantitative feedback were sought at each periodic ROM administration, and, for sessional ROM, at mid‐therapy and end‐of‐therapy. Demographic and clinical correlates of satisfaction were examined cross‐sectionally at baseline. Consistency of satisfaction over time and associations of satisfaction with engagement were examined longitudinally. Methods Service users rated baseline (n = 281/289), mid‐therapy (n = 114/121), end‐of‐therapy (n = 124/154), and session‐by‐session (mid‐therapy n = 63/87 and end‐of‐therapy n = 90/123) ROM from 0 (‘extremely unhelpful’) to 10 (‘extremely helpful’) and gave qualitative feedback. Results Service users predominantly found ROM helpful (score 6–10; 64–72%) or neutral (score 5; 19–29%). Finding ROM less helpful was associated with younger age and poorer general outcomes, but not with psychotic symptoms or therapy dropout. Emerging qualitative themes included feeling understood, valuing opportunities to reflect, expressing feelings, and tracking progress towards goals. Shorter batteries would be preferable, particularly for younger respondents, and those with poorer outcomes. Conclusions ROM is acceptable for people with psychosis. Tailoring assessments to specific subgroups should be considered. Practitioner points Routine outcome monitoring for psychological therapy is acceptable to people with psychosis. Most respondents experienced outcome monitoring as an opportunity to feel understood. Younger people and those with poorer functioning and well‐being might be at higher risk of dissatisfaction. Short assessment batteries and less frequent outcome monitoring might be preferable for some service users. Feedback about session‐by‐session outcome monitoring was not contemporaneous with completion and may be subject to memory or other biases. Only two‐thirds of service users provided feedback about session‐by‐session ROM (compared to >94% for periodic ROM) so findings may not be fully representative. Feedback about measures was not provided anonymously, and it is possible that service users were reluctant to express criticism about ROM to the assessor.

Measuring Wellbeing in a Healthcare Setting: a Qualitative Study of Staff and Service User Perspectives

“…Moreover, again reflecting our findings, a recent study exploring service evaluation questionnaires (including the WEMWBS) used in the context of NHS-based psychological therapy found that service users suggested that these type of questionnaires may have some potential to elicit distress (Fornells-Ambrojo et al 2017). In this study, respondents mentioned how such measurement was seen as potentially intrusive and upsetting for those who are seeking support for a mental health related issue.…”

Exploring the implementation of cognitive behaviour therapy for psychosis using the Normalization Process Theory framework

“…The role of clinical leadership is perceived as crucial in facilitating changes in service structures responsible for effective implementation of CBTp, which is corroborated by a recent pilot study (Fornells‐Ambrojo et al ., ). Similar to previous studies (Gray et al ., ; Jolley et al ., ), the findings highlight the championing nature that clinical leadership can take in order to facilitate CBTp implementation.…”

A systematic review of qualitative studies of adults’ experiences of being assessed for psychological therapies

“…Techniques—ranging from Rorshach to symptom measures—were often experienced positively, helping people express themselves (particularly where spoken communication was difficult); gain clarity around feelings; positively reframe issues; and open space for thinking and reflection . Where people were ambivalent or disliked techniques, it was typically because they were lengthy, challenging, upsetting, inflexible or difficult to engage with .…”