Progress monitoring measures: A brief guide.

Abstract

There is much evidence to suggest that psychotherapy is effective, however, it is far from flawless (e.g., Lilienfield, 2007; Stuart, 1970). As the field of mental health changes, there has been a recent movement in routine practice toward the use of standardized measures to track client and to collect feedback about treatment response (Lambert & Shimokawa, 2011). The use of standardized tools can help practitioners identify when clients are not progressing in therapy and have been linked to better outcomes for nonresponsive clients than when these measures are not used (e.g., Shimokawa, Lambert, & Smart, 2010). The purpose of this article is to introduce a group of such tools, referred to as (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 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. Keywords: psychotherapy, (PM) measures, feedback, outcome, tracking Research suggests that 5-10% of clients in psychotherapy experience deterioration, and up to 50% demonstrate no reliable change during treatment (Hansen, Lambert, & Forman, 2002; Lambert & Ogles, 2004). As clinicians do not accurately detect when clients are worsening (Hannan et al., 2005; Hatfield, McCullough, Frantz, & Krieger, 2010), it may be important to supplement clinical judgment with additional tools. Tools that can help clinicians identify clients who are not responding to treatment and that improve therapeutic outcomes may be referred to as (PM) measures. These measures are used to carry out continuous assessment of client change and to give the clinician systematic feedback about treatment response (Lambert & Shimokawa, 2011). In contrast to pre-post assessments, PM measures are completed by the client on a routine basis, and feedback is provided to the clinician throughout the therapeutic process. The practice of tracking client change during therapy has been studied by research teams around the world and is referred to in varying ways, including Client-Directed, Outcome-Informed therapy (CDOI; Miller, Duncan, & Hubble, 2004), Patient Reported Outcome Measures (PROMs; Barkham et al., 2010), Feedback Informed Treatment (FIT; Miller & Bargmann, 201 1), client feedback (Lambert & Shimokawa, 2011), and behavioral health assessment and outcome (Kraus, Seligman, & Jordan, 2005). The term progress monitoring has been chosen for this article due to its emphasis on the continuous nature of assessment that occurs throughout the therapeutic process as opposed to outcome measures, which are generally used in the context of termination. Research has led to the creation of numerous psychometrically sound measures that can be integrated into practice, each with the goal of helping practitioners improve clinical decision making and ameliorate treatment outcomes. As the changing landscape of mental health demands for greater accountability and demonstrable treatment outcomes, the use of PM measures to track may become increasingly prevalent and as such information regarding these measures is timely. The purpose of this article is to provide the individual clinician, and community-, counseling- or hospital-based practices with an introduction and brief guide to some of the popular PM measures. This review is not intended to be exhaustive, but rather to highlight issues important in selecting a measure and to provide relevant information on each measure. …