Personalised care requires personalised outcomes and ways of feeding back clinically useful information to clinicians and practitioners, but it is not clear how to best personalise outcome measurement and feedback using existing standardised outcome measures.
Method:
The constant comparison method of grounded theory was used to compare goal themes derived from goals set at the outset of therapy for 180 children aged between 4 and 17 years, visiting eight child and adolescent mental health services, to existing standardised outcome measures used as part of common national datasets.
Results:
In all, 20 out of 27 goal themes corresponded to items on at least one commonly used outcome measure.
Discussion:
Consideration of goal themes helped to identify potential relevant outcome measures. However, there were several goal themes that were not captured by items on standardised outcome measures. These seemed to be related to existential factors such as understanding, thinking about oneself and future planning.
Conclusion:
This presents a powerful framework for how clinicians can use goals to help select a standardised outcome measure (where this is helpful) in addition to the use of a goal-based outcome measure and personalise choices. There may be areas not captured by standardised outcome measures that may be important for children and young people and which may only be currently captured in goal measurement. There is an indication that we may not be measuring what is important to children and young people. We may need to develop or look for new measures that capture these areas.
AldersonP.SutcliffeK.CurtisK. (2006). Children as partners with adults in their medical care. Archives of Disease in Childhood, 91, 300–303.
2.
AsarnowJ.JaycoxL.TangL.DuanN.LaBordeA.ZeledonL.. . .WellsK. (2009). Long-term benefits of short-term quality improvement interventions for depressed youths in primary care. The American Journal of Psychiatry, 166, 1002–1010.
BattyM.MoldavskyM.FouroushaniP.PassS.MarriottM.SayalK.HollisC. (2012). Implementing routine outcome measures in child and adolescent mental health services: From present to future practice. Child and Adolescent Mental Health, 18, 82–87.
5.
BeckA. T. (1997). The past and future of cognitive therapy. Journal of Psychotherapy Practice and Research, 6, 276–284.
6.
BickmanL.KelleyS.BredaC.de AndradeA.RiemerM. (2011). Effects of routine feedback to clinicians on mental health outcomes of youths: Results of a randomized trial. Psychiatric Services, 62, 1423–1429.
7.
BoswellJ.KrausD.MillerS.LambertM. (2015). Implementing routine outcome monitoring in clinical practice: Benefits, challenges, and solutions. Psychotherapy Research, 25, 6–19.
8.
BradleyJ.MurphyS.FugardA.NolasS.LawD. (2013). What kinds of goals do children and young people set for themselves in therapy? Developing a goals framework using CORC data. Child & Family Clinical Psychology Review, 1, 8–18.
9.
BraunV.ClarkeV. (2006). Using thematic analysis in psychology. Qualitative Research in Psychology, 3, 77–101.
10.
BromleyC.WestwoodS. (2013). Young people’s participation: Views from young people on using goals. Clinical and Family Psychology Review, 1, 41–60.
11.
CarlierI.MeuldijkD.Van VlietI.Van FenemaE.Van der WeeN.ZitmanF. (2012). Routine outcome monitoring and feedback on physical or mental health status: Evidence and theory. Journal of Evaluation in Clinical Practice, 18, 104–110.
12.
CauseyD.DubowE. (1992). Development of a self-report coping measure for elementary school children. Journal of Clinical Child and Adolescent Psychology, 21, 47–59.
13.
ChewningB.BylundC. L.ShahB.AroraN. K.GueguenJ. A.MakoulG. (2012). Patient preferences for shared decisions: A systematic review. Patient Education and Counseling, 86, 9–18.
CostelloE. J.MustilloS.ErkanliA.KeelerG.AngoldA. (2003). Prevalence and development of psychiatric disorders in childhood and adolescence. Archives of General Psychiatry, 60, 837–844.
17.
CooperM. (2008). The facts are friendly. Therapy Today, 19, 8–13.
18.
CorbinJ. M.StraussA. (1990). Grounded theory research: Procedures, canons, and evaluative criteria. Qualitative Sociology, 13, 3–21.
19.
CoyneI. (2006). Consultation with children in hospital: Children, parents’ and nurses’ perspectives. Journal of Clinical Nursing, 15, 61–71.
20.
de JongK. (2014). Deriving implementation strategies for outcome monitoring feedback from theory, research and practice. Administration and Policy in Mental Health and Mental Health Services Research, 1–5.
21.
de JongK.van SluisP.NugterM. A.HeiserW. J.SpinhovenP. (2012). Understanding the differential impact of outcome monitoring: Therapist variables that moderate feedback effects in a randomized clinical trial. Psychotherapy Research, 22, 464–474.
DiamondG. M.LiddleH. A.HogueA.DakofG. A. (1999). Alliance-building interventions with adolescents in family therapy: A process study. Psychotherapy, 36, 355–368.
27.
DograN. (2005). What do children and young people want from mental health services?Current Opinion in Psychiatry, 18, 370–373.
28.
Edbrooke-ChildsJ.JacobJ.LawD.DeightonJ.WolpertM. (2015). Interpreting standardized and idiographic outcome measures in CAMHS: What does change mean and how does it relate to functioning and experience?Child and Adolescent Mental Health, 20, 142–148.
29.
Edbrooke-ChildsJ.WolpertM.DeightonJ. (2014). Using patient reported outcome measures to improve service effectiveness (UPROMISE): Training clinicians to use outcome measures in child mental health. Administration and Policy in Mental Health and Mental Health Services Research, 1–7.
30.
EmanuelR.CattyJ.AnscombeE.CantleA.MullerH. (2013). Implementing an aim-based outcome measure in a psychoanalytic child psychotherapy service: Insights, experiences and evidence. Clinical Child Psychology and Psychiatry, 19, 169–183.
31.
FlemingI.JonesM.BradleyJ.WolpertM. (2014). Learning from a learning collaboration: The CORC approach to combining research, evaluation and practice in child mental health. Administration and Policy in Mental Health and Mental Health Services Research, 1–5.
32.
FruehB. C.FordJ. D.ElhaiJ. D.GrubaughA. L. (2012). Evidence-based practice in adult mental health. In SturmyP.HersenM. (Eds.), Handbook of evidence-based practice in clinical psychology, Vol. II: Adult disorder (pp. 3–14) Hoboken, NJ: John Wiley.
33.
GlaserB. S.StraussA. (1967). The discovery of grounded theory. In CorbinJ.StraussA. (2014). Basics of qualitative research: Techniques and procedures for developing grounded theory. London, England: Sage.
34.
GollwitzerP. M.MoskowitzG. B. (1996). Goal effects on action and cognition. In Tory HigginsE.KruglanskiA. W. (Eds.), Social psychology: Handbook of basic principles (pp. 361–399). New York, NY: Guilford Press.
35.
Grosse HoltforthM.GraweK. (2002). Bern Inventory of treatment goals: Part 1: Development and first application of a taxonomy of treatment goal themes. Psychotherapy Research, 12, 79–99.
36.
GyamfiP.Keens-DouglasA.MedinE. (2007). Youth and youth coordinators’ perspectives on youth involvement in systems of care. The Journal of Behavioral Health Services & Research, 34, 382–394.
37.
HallC. L.MoldavskyM.TaylorJ.SayalK.MarriottM.BattyM. J.. . .HollisC. (2014). Implementation of routine outcome measurement in child and adolescent mental health services in the United Kingdom: A critical perspective. European Child & Adolescent Psychiatry, 23, 239–242.
38.
HannanC.LambertM. J.HarmonC.NielsenS. L.SmartD. W.ShimokawaK.SuttonS. W. (2005). A lab test and algorithms for identifying clients at risk for treatment failure. Journal of Clinical Psychology, 61, 155–163.
39.
HawleyK. M.WeiszJ. R. (2005). Youth versus parent working alliance in usual clinical care: Distinctive associations with retention, satisfaction, and treatment outcome. Journal of Clinical Child and Adolescent Psychology, 34, 117–128.
40.
House of Commons Health Committee. (2014). Children’s and adolescents’ mental health and CAMHS: Third report of session 2014–15. London, England: The Stationery Office.
41.
HuffineC. (2005). Supporting recovery for older children and adolescents. Focal Point: Research, Policy and Practice in Children’s Mental Health, 19, 22–24.
42.
Institute of Medicine. (2001). Crossing the quality chasm: A new health system for the 21st Century. Washington, DC: National Academy Press.
43.
KazdinA. E. (1977). Assessing the clinical or applied importance of behavior change through social validation. Behavior Modification, 1, 427–452.
44.
KelseyJ.Abelson-MitchellN.SkirtonH. (2007). Perceptions of young people about decision making in the acute healthcare environment. Paediatric Nursing, 19, 14–18.
45.
KiresukT. J.ShermanR. E. (1968). Goal attainment scaling: A general method for evaluating comprehensive community mental health programs. Community Mental Health Journal, 4, 443–453.
46.
JacobJ.Edbrooke-ChildsJ.HolleyS.LawD.WolpertM. (2015). Horses for courses? A qualitative exploration of goals formulated in mental health settings by young people, parents, and clinicians. Clinical Child Psychology and Psychiatry. Advance online publication. doi:10.1177/1359104515577487
47.
LambertM. (2010). Yes, it is time for clinicians to routinely monitor treatment outcome. In DuncanB. L.MillerS. D.WampoldB. E.HubbleM. A. (Eds.), The heart and soul of change (2nd ed., pp. 239–266). Washington, DC: American Psychological Association
48.
LambertM.WhippleJ.HawkinsE.VermeerschD.NielsenS.SmartD. (2003). Is it time for clinicians to routinely track patient outcome? A meta-analysis. Clinical Psychology: Science and Practice, 10, 288–301.
49.
LawD.JacobJ. (2015). Goals and goals based outcomes (GBOs): Some useful information (3rd ed.). London, England: CAMHS Press.
50.
LawD.WolpertM. (2014). Guide to using outcomes and feedback tools with children, young people and families. London, England: CAMHS Press.
51.
LibermanR. P.KopelowiczA. (2002). Teaching people with severe mental disabilities to be their own case managers. Psychiatric Services, 53, 1377–1379.
52.
MoranP.KelesidiK.GuglaniS.DavidsonS.FordT. (2012). What do parents and carers think about routine outcome measures and their use? A focus group study of CAMHS attenders. Clinical Child Psychology and Psychiatry, 17, 65–79.
53.
MulleyA.TrimbleC.ElwynG. (2012). Stop the silent misdiagnosis: Patients’ preferences matter. British Medical Journal, 345, e6572.
NormanS.DeanS.HansfordL.FordT. (2013). Clinical practitioner’s attitudes towards the use of routine outcome monitoring within child and adolescent mental health services: A qualitative study of two child and adolescent mental health services. Clinical Child Psychology and Psychiatry, 19, 576–595.
56.
O’BrienM.CrickardE.RappC.HolmesC.McDonaldT. (2011). Critical issues for psychiatric medication shared decision making with youth and families. Families in Society: The Journal of Contemporary Social Services, 92, 310–316.
57.
PenderF.TinwellC.MarshE.CowellV. (2013). Evaluating the use of goal-based outcomes as a single patient rated outcome measure across CWP CAMHS: A pilot study. Child and Family Clinical Psychology Review, 1, 29–40.
58.
ReidM. J.Webster-StrattonC.BeauchaineT. P. (2001). Parent training in head start: A comparison of program response among African American, Asian American, Caucasian and Hispanic mothers. Prevention Science, 2, 209–227.
59.
RichterJ.HallidayS.GrømerL. I.DybdahlR. (2009). User and carer involvement in child and adolescent mental health services: A Norwegian staff perspective. Administration and Policy in Mental Health and Mental Health Services Research, 36, 265–277.
60.
RiemerM.BickmanL. (2011). Using program theory to link social psychology and program evaluation. In MarkM. M.DonaldsonS. I.CampbellB. (Eds.), Social psychology and evaluation (pp. 104–138). New York, NY: Guilford Press.
61.
RubleL.McGrewJ. H.TolandM. D. (2012). Goal attainment scaling as an outcome measure in randomized control trials of psychosocial interventions in autism. Journal of Autism and Developmental Disorders, 42, 1974–1983.
62.
SapytaJ.RiemerM.BickmanL. (2005). Feedback to clinicians: Theory, research, and practice. Journal of Clinical Psychology, 61, 145–153.
63.
ShimokawaK.LambertM. J.SmartD. W. (2010). Enhancing treatment outcome of patients at risk of treatment failure: Meta-analytic and mega-analytic review of a psychotherapy quality assurance system. Journal of Consulting and Clinical Psychology, 78, 298–311.
64.
SoffeJ.ReadJ.FrudeN. (2004). A survey of clinical psychologists’ views regarding service user involvement in mental health services. Journal of Mental Health, 13, 583–592.
65.
UngarM.LiebenbergL.BoothroydR.KwongW. M.LeeT. Y.LeblancJ.. . .MakhnachA. (2008). The study of youth resilience across cultures: Lessons from a pilot study of measurement development. Research in Human Development, 5, 166–180.
66.
WeiszJ. R.ChorpitaB. F.FryeA.NgM. Y.LauN.BearmanS. K.. . .HoagwoodK. E. (2011). Youth top problems: Using idiographic, consumer-guided assessment to identify treatment needs and to track change during psychotherapy. Journal of Consulting and Clinical Psychology, 79, 369–380.
67.
WestermannG.VerheijF.WinkensB.VerhulstF.Van OortF. (2013). Structured shared decision-making using dialogue and visualization: A randomized controlled trial. Patient Education and Counseling, 90, 74–81.
68.
WindleG.BennettK.NoyesJ. (2011). A methodological review of resilience measurement scales. Health and Quality of Life Outcomes, 9, 1–18.
69.
WolpertM. (2013). Do patient reported outcome measures do more harm than good?British Medical Journal, 346, f2669.
70.
WolpertM.Curtis-TylerK.Edbrooke-ChildsJ. (2014). A qualitative exploration of patient and clinician views on patient reported outcome measures in child mental health and diabetes services. Administration and Policy in Mental Health and Mental Health Services Research, 1–7.
71.
WolpertM.DeightonJ.De FrancescoD.MartinP.FonagyP.FordT. (2014). From ‘reckless’ to ‘mindful’ in the use of outcome data to inform service-level performance management: Perspectives from child mental health. BMJ Quality & Safety, 23, 272–276.
72.
WolpertM.FordT.TrustamE.LawD.DeightonJ.FlanneryH.FugardA. (2012). Patient-reported outcomes in child and adolescent mental health services (CAMHS): Use of idiographic and standardized measures. Journal of Mental Health, 21, 165–173.
73.
WolpertM.FugardA.DeightonJ.GörzigA. (2012). Routine outcomes monitoring as part of children and young people’s Improving Access to Psychological Therapies (CYP IAPT): Improving care or unhelpful burden?Child and Adolescent Mental Health, 17, 129–130.
74.
WolpertM.HarrisR.HodgesS.FuggleP.JamesR.WienerA.. . .FonagyP. (2014). THRIVE: The AFC–Tavistock Model for CAMHS. London, England: CAMHS Press.
75.
WolpertM.VostanisP.YoungS.ClarkB.DaviesR.FlemingI.. . .WhaleA. (2015). A guide to choosing needs-based groupings in child and adolescent mental health services to inform payment systems: Version 1. London, England: CAMHS Press.
76.
WorthenV.LambertM. (2007). Outcome oriented supervision: Advantages of adding systematic client tracking to supportive consultations. Counseling and Psychotherapy Research, 7, 48–53.
77.
YehM.WeiszJ. (2001). Why are we here at the clinic? Parent-Child (dis) agreement on referral problems at out-patient treatment entry. Journal of Consulting and Clinical Psychology, 69, 1018–1025.
78.
YorkA.KingsburyS. (2013). Choice and partnership approach: Service transformation model. London, England: CAMHS Network.
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