Challenges in Investigating the Effective Components of Feedback from Routine Outcome Monitoring (ROM) in Youth Mental Health Care

Maartje A M S Van Sonsbeek,Marloes Kleinjan,Ad Vermulst,Bea G Tiemens,Jan W Veerman,Giel J M Hutschemaekers

doi:10.1007/s10566-020-09574-1

Abstract

BackGroundStudies on feedback in youth mental health care are scarce and implementation of feedback into clinical practice is problematic.ObjectiveTo investigate potentially effective components of feedback from Routine Outcome Monitoring (ROM) in youth mental health care in the Netherlands through a three-arm, parallel-group, randomized controlled trial in which a literature-based, multi-faceted implementation strategy was used.MethodParticipants were randomly allocated to three conditions (basic feedback about symptoms and quality of life; basic feedback supplemented with clinical support tools; discussion of the feedback of the second condition with a colleague while following a standardized format for case consultation) using a block randomization procedure, stratified by location and participants’ age. The youth sample consisted of 225 participants (mean age = 15.08 years; 61.8% female) and the parent sample of 234 mothers and 54 fathers (mean age of children = 12.50 years; 47.2% female). Primary outcome was symptom severity. Secondary outcomes were quality of life and end-of-treatment variables. Additionally, we evaluated whether being Not On Track (NOT) moderated the association between condition and changes in symptom severity.ResultsNo significant differences between conditions and no moderating effect of being NOT were found. This outcome can probably be attributed to limited power and implementation difficulties, such as infrequent ROM, unknown levels of viewing and sharing of feedback, and clinicians’ poor adherence to feedback conditions.ConclusionsThe study contributes to our limited knowledge about feedback from ROM and underscores the complexity of research on and implementation of ROM within youth mental health care.Trial registration Dutch Trial Register NTR4234 .

Highlights

Worldwide 10–20% of children and adolescents experience mental disorders (World Health Organization 2018)
We examined the effects of different components of feedback from Routine Outcome Monitoring (ROM) in youth mental health care through a three-arm, parallel-group, randomized controlled trial, in which a literature-based, multi-faceted implementation strategy was used
The final comparison included children and adolescents in feedback Condition 1 versus children and adolescents in feedback Condition 2 including the children and adolescents in feedback Condition 3 for whom a case consultation had not been used, as opposed to children and adolescents from feedback Condition 3 for whom a case consultation had been used. For both the youth sample and the parent sample, we found no significant differences among the three feedback conditions in symptom severity (SDQ total), quality of life (KIDSCREEN total), or the end-of-treatment variables satisfaction with treatment, length of treatment, number of sessions, and rate of dropout

Summary

Introduction

Worldwide 10–20% of children and adolescents experience mental disorders (World Health Organization 2018). Providing successful treatments for mental disorders and prevention of treatment failures are the main goals of clinical practice. Many children, adolescents, and adults drop out of therapy prematurely (Swift and Greenberg 2012; Warnick et al 2012) or have negative therapy outcomes (Reese et al 2014; Warren et al 2010). Clients who do not achieve positive change during treatment will require a disproportionately greater amount of treatment resources (Lambert et al 2007). Clinicians, may benefit from having systematic and reliable information about the functioning of their clients (Hamilton and Bickman 2008)

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