Progress Monitoring

The MPPRG aims to collect, analyze, and share information about progress monitoring in psychotherapy practice.

Progress Monitoring

Progress monitoring can be achieved with the use of tools that continuously assess client change and provide practitioners with systematic feedback regarding clients’ response to psychotherapy treatment (Overington & Ionita, 2012).  These Progress Monitoring measures are intended to be used regularly (e.g. at every session) during the course of treatment. Their main function is to provide practitioners with a client’s “vital-signs” of psychological functioning allowing practitioners to easily and quickly assess progress in treatment (Lambert & Shimokawa, 2011).

Popular Progress Monitoring Measures

  • Polaris - Mental Health (formerly known as the Treatment Evaluation and Management System; Grissom, Lyons, & Lutz, 2002)
    http://www.polarishealth.com/
  • Behaviour and Symptom Identification Scale – 24 (BASIS-24; Eisen, Normand, Belanger, Spiro, & Esch, 2004)
    http://ebasis.org
  • Behavioural Health Measure – 20 (BHM-20; Kopta & Lowry, 2002; formerly Behavioural Health Questionnaire-20)
    http://www.celesthealth.com/
  • Partners for Change Outcome Management System (PCOMS) which includes the Outcome Rating Scale (ORS) and the Session Rating Scale (Miller, Duncan, Sorrell, & Brown, 2005) 
    http://www.scottdmiller.com/?q+node/6 

Note: This is not an exhaustive list. If you have a measure that you would like us to add to this list, please email Gabriela Ionita at gabriela.ionita@mail.mcgill.ca

Benefits of Progress Monitoring

Identifying Clients Who are Not Progressing

  • The OQ-45 identified 100% of clients who experienced deterioration at termination, 86% of whom were identified by the third session. It also correctly predicted 82% of clients who experienced positive outcomes in therapy (Hannan et al., 2005).
  • Providing practitioners with feedback from Progress Monitoring measures (specifically, the OQ-45 and the PCOMS) has been found to lead to better outcomes for clients not responding well to therapy than when no feedback is given (e.g. Bohanske & Franczak, 2010; Hawkins, Lambert, Vermeersch, Slade, & Tuttle, 2004; Lambert & Shimokawa, 2011; Lambert & Vermeersch, 2008; Lambert, Whipple, Hawkins, Vermeersch, Nielson, & Smart, 2003; Miller, Duncan, Sorrel & Brown, 2005; Reese, Toland, Slone & Norsworthy, 2010; Shimokawa, Lambert & Smart 2010).

Increasing Cost Effectiveness

  • The OQ-45 helped to keep clients who were not progressing as expected from dropping out of therapy prematurely and reduced the number of sessions provided to clients who were progressing as expected, without reducing the effectiveness of therapy (Lambert & Vermeersch, 2008).
  • The PCOMS helped to decrease cancellation and no-show rates and to reduce the amount of time that clients required services (Bohanske & Franczak, 2010).
  • PM measures require minimal time to administer, score and interpret. Time to administer ranges from less than 2 minutes for the PCOMS (Miller, Duncan, Sorrel, & Brown, 2005) to 10-15 min for the Polaris-MH (APA, 2011).
  • Scoring and interpretation of results has been facilitated by the combination of most of the popular progress monitoring measures with online scoring and reporting systems. Thisallows for individual client, aggregate and benchmarking reports to be created almost instantaneously.
  • The combination of these measures with advanced technology, eliminates time-consuming paperwork; clients can complete the measures electronically on a computer in the practitioners’ office or on their own computer before arriving for their session.   

Evaluating Quality of Services

  • Progress Monitoring measures can be used to compare the data of different states (e.g. BHL, 2003) or provincesorganizations (Barkham, Hardy, & Mellor Clark, 2010; Barkham et al., 2001; Lueger & Barkham, 2010), practitioners and clients (e.g. Behavioral Health Laboratories, 2003).

Broad Application

  • Measures generally assess three main domains:
    • psychological symptoms (e.g. anxiety, depression, sleep, etc.) 
    • Well being (e.g. life satisifaction, etc.)
    • Functioning (e.g. school/work, sexutal, etc.)
  • Measures are intended to be pan-theoretical (e.g. Kraus & Castonguay, 2010; Lueger & Barkham, 2010)

Evidence in Practice

  • Progress Monitoring measures allow practitioners to introduce evidence into routine practice:
    • The OQ-Analyst (the system combined with the OQ-45) has been added to the US Department for Health and Human Services: Substance Abuse and Mental Health Services Administration’s (SAMHSA; 2010) National Registry of Evidence-based Programs and Practices (NREPP).
    • The PCOMS is under review by the SAMHSA’s NREPP (Duncan, 2011)
    • Grissom and Lyons (2006) argue that the Polaris-MH allows practitioners to document the effectiviess of their services as it can provide evidence of clients’ progress and answer the question “Is this treatment working for this particular patient?” (p. 13). 

How Progress Monitoring Measures Work

Client’s progress is assessed by comparing the client’s score on a measures to either:

  • Preestablished cutoffs (e.g. CORE-OM; K. McCrea personal communiction, February 15, 2012)
  • The client’s intake scores (e.g. BASIS-24; J. Berkowitz, personal communication, February 15, 2012)
  • A dosage curve (e.g. TOP; Kraus, personal communication, February 8, 2012) – a curve which illustrates the relationship between the number of treatment sessions and client improvement.

Deviations from expected changes in scores signal to the practitioner that clients are progressing as expected, are experiencing deteriotion in treatment or are experiencing no change.   

Training

Recent Publications

Overington, L., & Ionita, G. (2012). Progress monitoring measures: A brief guide. Canadian Psychology/Psychologie canadienne53(2), 82.  The purpose of this article is to introduce a group of such tools, referred to as progress monitoring (PM) measures, and to highlight features relevant in selecting and implementing a PM measure in practice. Areas covered include domains assessed, target populations, administration, scoring, feedback and interpretation, cost, training and privacy. While there exist numerous outcome and assessment measures (e.g., Froyd, Lambert, & Froyd, 1996), this article focuses specifically on seven popular progress monitoring measures for adult mental health populations, that are brief, comprehensive and easily accessible tools designed to be used to monitor change throughout the therapeutic process".  To access article, click here.

Outcomes monitoring and Alberta psychologists" written for the newsletter called Psymposium, for the Psychological Association of Alberta (PAA). This article provides an overview of Progress Monitoring (PM) measures, their efficacy, and barriers experienced and perceived by clinicians across Canada. It also provides information regarding the number of psychologists using PM measures in Alberta is provided, as well as an overview of the Health Professions Act, and how using PM measures increase clinicians' evidence-based practice. To access arcticle, click here.

Outcomes monitoring and Canadian psychotherapists" written for the newsletter called Cognica, for the Canadian Counselling and Psychotherapy Association (CCPA). Published in the Fall, 2013 edition of the newsletter. This article provides information on the usage of PM measures across Canada.  To access article, click here.

Outcomes monitoring and British Columbia psychotherapists" written for the newsletter BC Psychologist, for the British Columbia Psychological Association (BCPA). Published in the Fall 2013 edition of the newsletter. This article provides information specific to the context in British Columbia.  To access article, click here.

Linking research and practice through progress monitoring: Learning from clinicians" written for the newsletter Psynopsis, for the Canadian Psychological Association (CPA). Published in the Winter, 2013 edition of the newsletter. This article advocates for the use of PM measures as an evidence-based support tool for clinicians, and discusses how the McGill Psychotherapy Process Research Group (MPPRG) is working to address barriers to implementation. To access article, click here.

Join a Practice Research Network (PRN) using a Progress Monitoring Measure.

Please CLICK HERE if you wish to be notified of updates regarding Progress Monitoring measures.

© 2014 Ionita, Fitzpatrick & Overington

References