Clinical Outcomes In Routine Evaluation Research Articles

Exploring the factor structure of a Chinese version of the CORE-OM: insights from network approach and bifactor modeling

ABSTRACT Objective The Clinical Outcomes in Routine Evaluation (CORE-OM) is a measure of clinical outcomes that has been widely used in mental health research. Nevertheless, the exploration of the factor structure of the CORE-OM yields diverse results. This study aims to explore the factor structure with an innovative method known as exploratory graph analysis (EGA) and supplemented with bifactor modeling. Method A Chinese version of the CORE-OM was administrated to a total of 1361 clinical college students. We first examined the factor structure of the CORE-OM using EGA, and then compared the model derived by EGA with other models using CFA to find the most reasonable model. Results The result of EGA indicated a four-factor model of CORE-OM. The CFA further suggested a bifactor model with a four-factor structure combined with a general factor. The bifactor modeling suggested a significant proportion of shared variance among the variables was attributed to the general factor. The four-factor bifactor model exhibited a satisfactory fit to the data. Conclusion The results confirm the robustness and parsimonious nature of a four-factor bifactor model for the Chinese version of CORE-OM. It is suitable for measuring intrapersonal psychological distress, positive emotions, interpersonal problems, and risk-related issues among the Chinese population.

Evaluating changes in functioning and psychological distress in visitors of the @ease youth mental health walk-in centres.

Highly accessible youth initiatives worldwide aim to prevent worsening of mental health problems, but research into outcomes over time is scarce. This study aimed to evaluate outcomes and support use in 12- to 15-year-old visitors of the @ease mental health walk-in centres, a Dutch initiative offering free counselling by trained and supervised peers. Data of 754 visitors, collected 2018-2022, included psychological distress (Clinical Outcomes in Routine Evaluation 10 (CORE-10)), social and occupational functioning (Social and Occupational Functioning Assessment Scale (SOFAS)), school absenteeism and support use, analysed with change indicators (first to last visit), and mixed models (first three visits). Among return visitors, 50.5% were female, 79.4% were in tertiary education and 36.9% were born outside of The Netherlands (one-time visitors: 64.7%, 72.9% and 41.3%, respectively). Moreover, 29.9% of return visitors presented with suicidal ideations, 97.1% had clinical psychological distress levels, and 64.1% of the latter had no support in the previous 3 months (one-time visitors: 27.2%, 90.7% and 71.1%, respectively). From visit 1 to 3, psychological distress decreased (β = -3.79, 95% CI -5.41 to -2.18; P < 0.001) and social and occupational functioning improved (β = 3.93, 95% CI 0.51-7.36; P = 0.025). Over an average 3.9 visits, 39.6% improved reliably and 28.0% improved clinically significantly on the SOFAS, which was 28.4% and 8.8%, respectively, on the CORE-10, where 43.2% improved in clinical category. Counselling satisfaction was rated 4.5/5. Reductions in psychological distress, improvements in functioning and high counselling satisfaction were found among @ease visitors, forming a basis for future research with a control group.

The Hummingbird Project year 2: decreasing distress and fostering flourishing in a pragmatic pre-post study.

Multi-component Positive Psychology Interventions (mPPIs) in secondary schools have been shown to improve mental health outcomes for young people. The Hummingbird Project mPPI is a six-week program of workshops designed to introduce a variety of positive psychology (PP) concepts to secondary school-aged children in schools to improve well-being, resilience, and hope. The effects on mental distress, however, were not explored. The current study, therefore, was designed to replicate the effects of the Hummingbird Project mPPI on positive mental health and to also explore the effects on symptoms of mental distress. Secondary school-aged children (N = 614; mean age = 11.46 years) from a sample of secondary schools located across the North West of England (N = 7) participated in the study; the majority of children were in Year 7 (94%). The PP concepts explored included happiness, hope, resilience, mindfulness, character strengths, growth mindset, and gratitude. The results showed significant improvements associated with the mPPI in well-being (as measured by the World Health Organization Well-Being Index; WHO-5), hope (as measured by the Children's Hope Scale; CHS), and symptoms of mental distress (as measured by the Young Person's Clinical Outcomes in Routine Evaluation; YP-CORE) from pre- to post-intervention. While acknowledging the limits due to pragmatic concerns regarding the implementation of a control group, the effectiveness of the Hummingbird Project mPPI on well-being was replicated alongside reducing the symptoms of mental distress. Future evaluation, however, will need to implement more robust designs and consider follow-up duration to assess the longer-term effects of the Hummingbird Project mPPI.

An evaluation of survive and thrive: a 10-week group psychoeducational course for adult interpersonal trauma survivors in Scotland

ABSTRACT Emerging evidence supports a phased approach to trauma treatment, including manualised group-based interventions, to facilitate symptom reduction resulting from complex trauma sequelae. This study investigates the efficacy of Survive and Thrive, a 10-week group psychoeducational course for adult survivors of interpersonal trauma. Between August 2019 and February 2022, participants were enrolled on the course. The Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE-OM) and Difficulties in Emotion Regulation Scale—Short Form (DERS-SF) were administered pre-intervention and immediately post-intervention. In addition, thematic analysis was applied to qualitative feedback. Results revealed significant reductions in CORE-OM and DERS-SF scores post-intervention, with minimal variability in scores attributed to group delivery (either face-to-face or online). The thematic analysis demonstrated that normalising trauma symptoms and providing coping skills positively impacted participants’ experiences. At the same time, the breadth and nature of the content were observed to be an occasional barrier to engagement. In summary, this study proposes that group-based psychoeducational interventions are generally effective for those with mild-to-moderate symptoms of complex trauma. However, further evidence is needed to offer more nuanced recommendations for identifying individuals who may benefit the most from these interventions.

The reliability, validity and clinical utility of the Clinical Outcomes in Routine Evaluation - ten-item version (CORE-10) in post-acute patients with stroke.

To explore the validity, reliability, and clinical utility of the Clinical Outcomes in Routine Evaluation - ten-item version (CORE-10: a ten-item questionnaire designed to measure psychological distress) in a stroke inpatient sample and calculate reliable and clinically significant change scores. A post-acute stroke rehabilitation ward in the East of England. A total of 53 patients with stroke, capable of completing the CORE-10 as part of their routine clinical assessment. Exclusion criteria included moderate to severe aphasia and/or alexia. Alongside the CORE-10, the Patient Health Questionnaire - 9, the Hospital Anxiety and Depression Scale, the Centre for Epidemiological Studies-Depression Scale, and the Beck Depression Inventory Second Edition were used as concurrent measures. To assess reliability, the internal consistency and test-retest reliability of the CORE-10 were calculated. The average number of days between CORE-10 test-retest administrations was 2.84 (SD = 3.12, Mdn = 1). Concurrent validity was assessed by examining correlations between the CORE-10 and comparable measures, and clinical utility was assessed using the criteria of Burton and Tyson (2015). The internal consistency (Cronbach's alpha) for the CORE-10 was .80, and test-retest reliability interclass correlation coefficient was .81. Total score correlations between the CORE-10 and concurrent measures ranged from r = .49 to r = .89. The CORE-10 achieved the maximum score (i.e. 6/6) on criteria for clinical utility. Calculations demonstrated a reliable change index of nine points and a clinically significant change cut point of 12 on the CORE-10. Percentiles for CORE-10 total scores are reported. This study provides preliminary support for the CORE-10 as a valid and reliable measure that has clinical utility for screening distress in inpatients with stroke.

Psychometric properties of the Chinese version of Young Person’s Clinical Outcomes in Routine Evaluation (YP-CORE)

ABSTRACT In China there is an increasing need for suitable measures to evaluate clinical outcomes in adolescents’ psychological counselling processes. To satisfy this purpose, this study evaluated the Young Person’s Clinical Outcomes in Routine Evaluation (YP-CORE)’s psychometric properties in a Chinese context with two groups: psychiatric outpatients (clinical group: n = 232) and middle-school student controls (non-clinical group: n = 441). All the participants completed the YP-CORE, Strengths and Difficulties Questionnaire (SDQ) and the depression subscale of the Revised Child Anxiety and Depression Scale (RCADS). The results found that the YP-CORE was highly acceptable and reliable with a two-factor solution consistent with original UK model. There were significant differences in mean YP-CORE scores by gender and age band, as well as distinct clinically significant change cut-off points. These findings suggest that the Chinese version of the YP-CORE is psychometrically acceptable for use in Chinese context.

Assessment of perinatal anxiety: diagnostic accuracy of five measures.

Anxiety in pregnancy and after giving birth (the perinatal period) is highly prevalent but under-recognised. Robust methods of assessing perinatal anxiety are essential for services to identify and treat women appropriately. To determine which assessment measures are most psychometrically robust and effective at identifying women with perinatal anxiety (primary objective) and depression (secondary objective). We conducted a prospective longitudinal cohort study of 2243 women who completed five measures of anxiety and depression (Generalized Anxiety Disorder scale (GAD) two- and seven-item versions; Whooley questions; Clinical Outcomes in Routine Evaluation (CORE-10); and Stirling Antenatal Anxiety Scale (SAAS)) during pregnancy (15 weeks, 22 weeks and 31 weeks) and after birth (6 weeks). To assess diagnostic accuracy a sample of 403 participants completed modules of the Mini-International Neuropsychiatric Interview (MINI). The best diagnostic accuracy for anxiety was shown by the CORE-10 and SAAS. The best diagnostic accuracy for depression was shown by the CORE-10, SAAS and Whooley questions, although the SAAS had lower specificity. The same cut-off scores for each measure were optimal for identifying anxiety or depression (SAAS ≥9; CORE-10 ≥9; Whooley ≥1). All measures were psychometrically robust, with good internal consistency, convergent validity and unidimensional factor structure. This study identified robust and effective methods of assessing perinatal anxiety and depression. We recommend using the CORE-10 or SAAS to assess perinatal anxiety and the CORE-10 or Whooley questions to assess depression. The GAD-2 and GAD-7 did not perform as well as other measures and optimal cut-offs were lower than currently recommended.

Evaluation of a community-based intervention for youth mental health in rural Ireland.

This study aimed to provide information about pathways to care and clinical response to community-based brief interventions for improving youth mental health through evaluating the Mindspace Mayo service. Participants were 1,184 individuals aged 12-25 years (Mean = 17.92, SD = 2.66) who engaged with the Mindspace service. Demographic information included gender, age and living situation. The Clinical Outcome in Routine Evaluation (CORE) was used to measure psychological distress before and after attending the Mindspace service between February 2015 and 2022. On average, individuals received six sessions of therapeutic support. Analyses indicated that most referrals were made by either a parent (40%) or self-referral (38%). The most frequent reason for referral was mood and anxiety-related issues. Across the entire sample, reductions in CORE scores were both statistically and clinically significant. Neither the source of the referral nor living situation significantly predicted intervention response. Complexity of issues presented at referral significantly predicted a reduction in psychological distress post-intervention in young people aged over 17 years. This study highlighted the value of primary care mental health services for young people aged 12-25 years, and underlined the importance of recording electronic data to track referral pathways, reasons for referral and the intervention outcomes over time.

The mediating role of flourishing on religious faith and psychological distress: a pilot survey

ABSTRACT Flourishing is a growing topic in positive psychology, and the positive influences of flourishing have been well documented. Although recent literature has shown that religion has an impact on one’s physical and psychological well-being in positive ways, the relationship between religiosity and flourishing has surprisingly not been studied. The present study aimed to explore the relationship of religious faith with flourishing and psychological distress. An online survey has successfully recruited 267 participants from UK and Taiwan. The survey used standardised inventories including the PERMA Profiler, the Santa Clara Strength of Religious Faith Questionnaire, and the Clinical Outcome in Routine Evaluation to measure flourishing, religious faith and psychological distress respectively. Results show that participants with strong religious faith do have higher levels of flourishing. Yet Path Analysis shows that participants who have stronger religious faith is indirectly related to lower psychological distress through the mediating effect of flourishing. Suggestions for future research and implications of the findings are discussed.

Mental health among undergraduate psychology students from a private university in Southern Brazil

The literature indicates that there are stressful events that accompany the initial and final courses of undergraduate studies, which can result in symptoms of stress, mental exhaustion, anxiety, depression, and the prevalence of common mental disorders. In view of this, the present study is a qualitative and descriptive research aimed at assessing the mental health of students in the initial course and the final course of the Psychology undergraduate program at a private university in the southern region of the country. A total of 68 students were interviewed, with 50 in the first semester and 18 in the final semester of the program. Data collection involved a sociodemographic questionnaire, the Subjective Well-being Scale, and the Clinical Outcome Routine Evaluation - Outcome Measure. The results indicate high levels of anxiety and insecurity among psychology students, as well as low levels of interest, joy, attention, engagemen, enthusiasm, disposition, productivity, and well-being.

Feasibility and Efficacy of Intensive Dialectical Behavior Therapy Skills Training in An Outpatient Setting for A Group of Patients with Extensive Care Needs - A Transdiagnostic Approach

PurposeDialectical behavior therapy (DBT) is a treatment originally developed för chronically suicidal adults. It is common to adapt it by using one specific component, the DBT skills training (DBT-ST) and apply it in a group therapy setting for a variety of mental disorders. The primary aim of the study was to explore whether patients with extended care needs would report improved mental health after participating in an intensive form of DBT-ST. The secondary aim was to explore whether the use of psychiatric inpatient care for the group would decrease.MethodsThirty-seven participants completed the Clinical Outcomes in Routine Evaluation - Outcome Measure (CORE-OM), and visual analogue scale (VAS) at three time points: pre-intervention, post-intervention and at 6-month follow-up after intensive DBT-ST. ResultsOne-way ANOVA showed a significant effect for time on the CORE-OM: F (2,35) = 7.93, p = .001, η2 = 0.312 (large effect size). Post hoc tests indicated a significant difference between pre-intervention and post-intervention (p = .001) and between pre-intervention and follow-up (p = .01). A Friedman test indicated a statistically significant difference in the VAS scale scores across the three time points, with p-values between 0.00 and 0.05. There was no difference in psychiatric healthcare consumption.ConclusionThese study results confirm to some extent the feasibility and effectiveness of the intensive DBT-ST in a transdiagnostic clinical setting. The participants had a positive outcome from the skills training program, but psychiatric healthcare consumption did not decrease.

The impact of psychological distress and university counselling on academic outcomes: Analysis of a routine practice‐based dataset

AbstractWhole university approaches to student mental health and well‐being increasingly involve university counselling and mental health services (UCMHSs) as key stakeholders in higher education and the fulfilment of good academic outcomes. However, previous research using routine outcome measures has focussed on psychological distress only. Research is needed to demonstrate the value of university counselling on academic outcomes. This study aimed at profiling the psychological distress of a student sample according to the Clinical Outcomes in Routine Evaluation—Outcome Measure (CORE‐OM); measuring the change in perceived impact of problems on academic outcomes, and measuring the perceived impact of counselling on academic outcomes. Students from two UK university counselling services completed the CORE‐OM and the Counselling Impact on Academic Outcomes (CIAO) questionnaire as part of routine practice. After counselling, 67.4% (n = 323) of students with planned endings to counselling showed at least reliable improvement on the CORE‐OM. Significant reductions in the perceived impact of problems on all academic outcomes were also found. On average, 83% (n = 398) of students found counselling helpful for academic outcomes to at least a limited extent. University counselling was found to reduce psychological distress and the impact of problems on academic outcomes. Psychometric examination of the CIAO tool is warranted to strengthen its use. The need for robust data across UCMHSs is demonstrated by both the strengths and limitations of this study.

Italian validation of the Clinical Outcomes in Routine Evaluation-10 (CORE-10): a short measure for routine outcome monitoring in clinical practice.

The customization of the intervention using patient feedback is an evidence-based practice aimed at the continuous evaluation, during treatment, of the patient's change at a clinical level. There are few easy-to-use tools for common assessment of psychological distress, designed to be used for screening and during treatment to monitor progress. The Clinical Outcomes in Routine Evaluation-10 (CORE-10) is definitely one of them. Thus, the aim of the present study was to examine the psychometric properties of the Italian version of the CORE-10. A sample of 548 participants (females, N=463, 84.5%; mean age 23.29±7.21 years) was recruited in the study and filled out a battery of measures. The internal validity of the CORE-10 was investigated through a confirmatory factor analysis which evidenced a good fit to the data, suggesting a unidimensional factorial structure of the measure. Further, the scale had a good internal reliability and was significantly associated with other measures of distress, interpersonal problems, well-being, and insecure attachment. Finally, it showed excellent diagnostic accuracy, as well as intrinsic and post-test diagnostics. Given its validity and reliability, the CORE-10 may be adopted by Italian-speaking psychotherapists and researchers to evaluate the outcomes of mental health interventions as well as to track the session-to-session changes over time in psychological distress among patients.

Integrated focal psychotherapy: Results from a retrospective study.

The focus-based integrated model (FBIM) is a form of psychotherapy that integrates psychodynamic and cognitive psychotherapy and Erikson's life cycle model. Although there are many studies on the effectiveness of integrated models of psychotherapy, few have examined the efficacy of FBIM. This pilot study explores clinical outcome measures concerning individual wellbeing, the presence/absence of symptoms, life functioning, and risk in a cohort of subjects after they received FBIM therapy. A total of 71 participants were enrolled at the CRF Zapparoli Center in Milan, 66.2% of whom were women (N = 47). The mean age of the total sample was 35.2 years (SD = 12.8). We used the Clinical Outcomes in Routine Evaluation-Outcome Measure (CORE-OM) to test treatment efficacy. The results revealed that participants improved in all four dimensions of CORE-OM (i.e., wellbeing, symptoms, life functioning, and risk), women improved more than men, and in most cases (64%), the change was clinically reliable. The FBIM model seems to be effective for treating several patients. Most of the participants saw significant changes in symptoms, life functioning, and general wellbeing.

Evaluation of a culturally adapted cognitive behavior therapy-based, third-wave therapy manual.

Recommendations for psychotherapy have evolved over the years, with cognitive behavioral therapy (CBT) taking precedence since its inception within clinical guidelines in the United Kingdom and United States. The use of CBT for severe mental illness is now more common globally. To investigate the feasibility and acceptability of a culturally adapted, CBT-based, third-wave therapy manual using the Comprehend, Cope, and Connect approach with individuals from a diverse population presenting to primary and secondary healthcare services. A pilot study was used to assess the feasibility and acceptability of the manualised intervention. Outcome measures were evaluated at baseline, post-intervention and 12 wk-follow up. 32 participants with mental health conditions aged 20-53 years were recruited. Assessments were completed at three time points, using Clinical Outcomes in Routine Evaluation (CORE), Hospital Anxiety and Depression Scale (HADS), Bradford Somatic Inventory and World Health Organization Disability Assessment Schedule 2.0 (WHODAS). The Patient Experience Ques-tionnaire was completed post-treatment. Repeated measures of analysis of variance associated with HADS depression, F (2, 36) = 12.81, P < 0.001, partial η2 = 0.42 and HADS anxiety scores, F (2, 26) = 9.93, P < 0.001, partial η2 = 0.36; CORE total score and WHODAS both showed significant effect F (1.25, 18.72) = 14.98, P < 0.001, partial η2 = 0.5. and F (1.29, 14.18) = 6.73, P < 0.001, partial η2 = 0.38 respectively. These results indicate the effectiveness and acceptability of the culturally adapted, CBT-based, third-wave therapy manual intervention among minoritized groups with moderate effect sizes. Satisfaction levels and acceptability were highly rated. The viability and cost-effectiveness of this approach should be explored further to support universal implementation across healthcare systems.

Referral assessment and patient waiting time decisions in specialized mental healthcare: an exploratory study of early routine collection of PROM (LOVePROM)

BackgroundNorway has prioritized health services according to the principle of “severity of conditions”, where waiting time reflects patients’ medical urgency. We aim to investigate if the “severity-of-condition” principle performs well in the priority setting of waiting time, between and within groups of patients using community mental health services. We also aim to investigate the association between patients’ diagnoses and symptom severity at the start of treatment and the corresponding waiting time.MethodsThe study analyzed routine data from Lovisenberg electronic Patient-Reported Outcome Measurement (LOVePROM) at Lovisenberg Diaconal Hospital in Norway. We estimated patient-reported severity by using Clinical Outcomes in Routine Evaluation – Outcome Measure (CORE-OM), together with patients’ diagnoses to identify patients’ needs in general. To assess the performance of current prioritization, we compared waiting times for patients with major depressive disorder and their maximum recommended waiting time. Multivariate regression models were used to assess the association between patient-reported severity, their diagnosis, and waiting times.ResultsOf the 6108 mental health disorder patients, patients with moderate to severe conditions waited seven weeks, while patients with mild conditions or below clinical cutoff waited 8 weeks. Included in the sample, 1583 were diagnosed with depression. Results indicated that patients with moderate and severe depression had a slightly shorter wait-time than patients with mild depression. However, 32.4% patients with moderate depression and 83.3% patients with severe depression, waited longer than their maximum recommended waiting time. CORE-OM identified depressive patients with risk-to-self harm, who had a 0.84 weeks shorter wait-time. These results were also applied to patients with other common mental health disorders.ConclusionOverall, patients waited in accordance with the “severity of condition” principle, but the trend was not strong. Therefore, we advocate that there is substantial room for quality improvements in priority setting on waiting time. We suggest further research should investigate if routine collection of PROM and assessment of referral letters, can better inform specialists when deciding on waiting time.

Psychometric evaluation of the subjective well-being measure GP-CORE in a group of older adults in Sweden

BackgroundThe world’s growing population of older adults is one population that needs to be focused more regarding subjective well-being. It is therefore important to evaluate self-report instruments that measures general well-being for this specific group - older adults. The aim of the present study was to investigate psychometric properties of the Swedish translation of the GP-CORE (general population – Clinical Outcomes in Routine Evaluation) in a group of older adults (> 65 years).MethodsIn this study, a psychometric evaluation of the GP-CORE is presented for 247 Swedish older adults (> 65 years), 184 women and 63 men who applied for home care assistance for the first time.ResultsThe psychometric evaluation showed high acceptability; provided norm values in terms of means, standard deviations and quartiles; showed satisfactory reliability in terms of both internal consistency and stability; showed satisfactory validity in terms of convergent and discriminant validity; provided a very preliminary cut-off value and quite low sensibility and sensitivity and showed results which indicated that this scale is sensitive to changes. One gender difference was identified in that women without a cohabitant had a higher well-being than men without a cohabitant (as measured by GP-CORE).ConclusionsThe GP-CORE showed satisfactory psychometric properties to be used to measure and monitor subjective well-being in older adults (> 65 years) in the general population of community dwelling. Future studies should establish a cut-off value in relation to another well-being measure relevant for mental health in older adults.

Development and evaluation of a collaborative care intervention for male prison leavers with mental health problems: the Engager research programme

Background Many male prison leavers have significant mental health problems. Prison leavers often have a history of trauma, ongoing substance misuse and housing insecurity. Only a minority of prison leavers receive mental health care on release from prison. Objectives The aim of the Engager research programme was to develop and evaluate a theory- and evidence-informed complex intervention designed to support individuals with common mental health problems (e.g. anxiety, depression) and other complex needs, including mental health comorbidity, before and after release from prison. Methods In phase 1, the intervention was developed through a set of realist-informed substudies, including a realist review of psychosocial care for individuals with complex needs, case studies within services demonstrating promising intervention features, focus groups with individuals from under-represented groups, a rapid realist review of the intervention implementation literature and a formative process evaluation of the prototype intervention. In a parallel randomised trial, methodological development included selecting outcome measures through reviewing literature, piloting measures and a consensus process, developing ways to quantify intervention receipt, piloting trial procedures and modelling economic outcomes. In phase 2, we conducted an individually randomised superiority trial of the Engager intervention, cost-effectiveness and cost–consequence analyses and an in-depth mixed-methods process evaluation. Patient and public involvement influenced the programme throughout, primarily through a Peer Researcher Group. Results In phase 1, the Engager intervention included multiple components. A practitioner offered participants practical support, emotional help (including mentalisation-based approaches) and liaison with other services in prison on the day of the participant’s release and for 3–5 months post release. An intervention delivery platform (i.e. training, manual, supervision) supported implementation. Outcome measures were selected through testing and stakeholder consensus to represent a broad range of domains, with a general mental health outcome as the primary measure for the trial. Procedures for recruitment and follow-up were tested and included flexible approaches to engagement and retention. In phase 2, the trial was conducted in three prison settings, with 280 participants randomised in a 1 : 1 ratio to receive either Engager plus usual care (n = 140) or usual care only (n = 140). We achieved a follow-up rate of 65% at 6 months post release from prison. We found no difference between the two groups for the Clinical Outcomes in Routine Evaluation – Outcome Measure at 6 months. No differences in secondary measures and sensitivity analyses were found beyond those expected by chance. The cost-effectiveness analysis showed that Engager cost significantly more at £2133 (95% of iterations between £997 and £3374) with no difference in quality-adjusted life-years (–0.017, 95% of iterations between –0.042 and 0.007). The mixed-methods process evaluation demonstrated implementation barriers. These barriers included problems with retention of the intervention team, and the adverse health and criminal justice system context. Seventy-seven per cent (108/140) of individuals had at least one community contact. Significant proportions of participants engaging received day release work and practical support. In contrast, there was evidence that the psychological components, mentalisation and developing a shared understanding were used less consistently. When engagement was positive, these components were associated with positive achievement of goals for individuals. We were also able to identify how to improve the intervention programme theory, including how to support individuals who were unrealistic in their perception of their ability to cope with challenges post release. Strengths and limitations Our development work provides a worked example of the development of a complex intervention, particularly given little prior evidence or theory specific to male offenders to build on. Our trial methodological development enabled the completion of, to the best of our knowledge, the first fully powered trial of a mental health intervention for prison leavers with common mental health problems. There were potential weaknesses in the trial methodology in terms of follow-up rates and outcome measures, with the latter potentially being insufficiently sensitive to important but highly individual changes in participants who responded to the intervention. Conclusions Delivering a randomised controlled trial for prison leavers with acceptable levels of follow-up is possible, despite adverse conditions. Full intervention implementation was challenging, but this is to be expected. Some individuals did respond well to the intervention when both practical and psychological support were flexibly deployed as intended, with evidence that most components were experienced as helpful for some individuals. It is recommended that several key components be developed further and tested, along with improved training and supervision, to support delivery of the Engager intervention within existing teams working with prison leavers. Trial registration This trial is registered as ISRCTN11707331. Funding This project was funded by the National Institute for Health and Care Research (NIHR) Programme Grants for Applied Research programme and will be published in full in Programme Grants for Applied Research; Vol. 10, No. 8. See the NIHR Journals Library website for further project information.

Effect of Method Bias on the Internal Structure of the Systemic Clinical Outcomes in Routine Evaluation Measure of Family Functioning

This study was conducted to test for method bias stemming from mixing positively and negatively worded items in a widely used measure of family functioning, the Systemic Clinical Outcomes in Routine Evaluation (SCORE). Data were collected from a community sample of 377 U.S. adults with children in the household, with 32% reporting greater family difficulties than a clinical pre-therapy average and 66% reporting greater difficulties than a clinical post-therapy average. Confirmatory factor analyses (CFA) were performed to test two models: Model 1, a unidimensional model in which items represented a single theoretical construct and Model 2, a multidimensional model in which items represented a method dimension (i.e., positively worded or negatively worded) as well as an underlying theoretical construct. Fit indices showed that Model 2 fit the data better than Model 1 for all dimensions tested, suggesting that method bias had detrimental effects on the factor structure of dimensions of the SCORE.

Practice-based research with psychologists-in-training: presentation of a supervision model and use of routine outcome monitoring (Investigación basada en la práctica con psicólogos en formación: presentación de un modelo de supervisión y uso de la monitorización rutinaria de resultados)

ABSTRACT Objective: To present the training and care model used in a university psychological care centre and its outcomes, framed in the Practice-Based Evidence paradigm. Methods: Naturalistic study on the results of 161 clients seen between 2018 and 2020 who completed the Clinical Outcomes in Routine Evaluation — Outcome Measure. Statistically significant change was measured using multilevel regression models and reliable and clinically significant change was measured by applying the Jacobson and Truax approach. Results: On average, clients were 29.47 years old (SD = 10.11) and the median number of sessions that they attended was five. CORE-OM scores decreased 0.05 points per session and trajectories of change were identified as diverse. Of the total number of clients, 29.4% showed reliable and clinically significant change and 45.1% showed at least reliable change. Discussion: The routine outcome monitoring results from this centre allow us to refine certain training and supervision activities to improve quality-of-care indicators.