Outcome Feedback Research Articles

Routine outcome monitoring and feedback in alcohol and other drug treatment: A qualitative study of client perspectives on implementation.

Routine outcome monitoring (ROM) and feedback is an evidence-supported strategy for evaluating alcohol and other drug (AOD) treatment outcomes. However, the implementation of ROM and feedback into AOD services remains a significant challenge. Research aimed at understanding client perspectives on ROM and feedback is needed to facilitate successful implementation. This study examined experiences with and perceptions of ROM and feedback in a sample of clients receiving AOD treatment. Interviews and online surveys were conducted with N = 26 people (13 male; Mage = 36.12 years, SD = 10.29) enrolled in an AOD treatment program in Australia. Data analysis of the transcripts was guided by thematic analysis, while descriptive statistics were used to analyse quantitative survey data. Four major themes were identified in the qualitative data: (i) ROM and feedback is valuable to AOD treatment; (ii) clear and concise outcome measures with an integrated feedback loop are vital to reliable ROM; (iii) desire for visual and verbal feedback that highlights progress; and (iv) ROM and feedback can be emotionally challenging. Participants valued ROM when it was clearly integrated within AOD treatment and they received feedback on their responses. Potential facilitators to implementing and improving the provision of ROM and feedback in AOD treatment include: (i) a clear, treatment-based rationale to foster client buy-in for ROM and maximise AOD treatment benefit; (ii) brief outcome measure surveys; and (iii) graphical visualisations of ROM feedback.

Dynamics of Reliance on Algorithmic Advice

ABSTRACTThis study examines the dynamics of human reliance on algorithmic advice in a situation with strategic interaction. Participants played the strategic game of Rock–Paper–Scissors (RPS) under various conditions, receiving algorithmic decision support while facing human or algorithmic opponents. Results indicate that participants often underutilize algorithmic recommendations, particularly after early errors, but increasingly rely on the algorithm following successful early predictions. This behavior demonstrates a sensitivity to decision outcomes, with asymmetry: rejecting advice consistently reinforces rejecting advice again while accepting advice leads to varied reactions based on outcomes. We also investigate how personal characteristics, such as algorithm familiarity and domain experience, influence reliance on algorithmic advice. Both factors positively correlate with increased reliance, and algorithm familiarity significantly moderates the relationship between outcome feedback and reliance. Facing an algorithmic opponent increases advice rejection frequencies, and the determinants of trust and interaction dynamics differ from those with human opponents. Our findings enhance the understanding of algorithm aversion and reliance on AI, suggesting that increasing familiarity with algorithms can improve their integration into decision‐making processes.

Neural mechanisms of cooperation and fairness in iterative prisoner’s dilemma

Cooperation is a universal human principle reflecting working with others to achieve common goals. The rational decision-making model contends that cooperation is the best strategy for maximizing benefits in an iterative prisoner’s dilemma. However, the motivations for cooperation (or betrayal) are complex and diverse, and often include fairness reflections. In this study, we used functional magnetic resonance imaging to study underlying neural differences in brain regions related to fairness when people interact with an opponent who tend to cooperate or betray, at different decision-making stages. Results based on 40 university students (25 women) indicate that experiences of cooperation or betrayal affect people’s fairness perception. Distinct neural activities occur in expectation, decision, and outcome phases of decisions. In the expectation phase, those in the cooperative condition exhibited increased activation in the anterior cingulate gyrus, medial superior frontal gyrus, and caudate nucleus compared to those in the uncooperative condition. During the decision phase, those in the cooperative condition showed greater activation in the middle frontal gyrus, caudate nucleus/frontal insula, inferior frontal gyrus, and cingulate gyrus compared to those in the uncooperative condition. In the outcome feedback phase, the caudate nucleus, insula, cingulate gyrus, and inferior frontal gyrus of the orbit were more active in the uncooperative condition than in the cooperative condition. Results also showed a significant correlation between caudate activity and the perception of fairness when expecting uncooperative conditions.

Prevalence, predictors and outcomes of self-reported feedback for EMS professionals: a mixed-methods diary study

BackgroundProviding feedback to healthcare professionals and organisations on performance or patient outcomes may improve care quality and professional development, particularly in Emergency Medical Services (EMS) where professionals make autonomous, complex decisions and current feedback provision is limited. This study aimed to determine the content and outcomes of feedback in EMS by measuring feedback prevalence, identifying predictors of receiving feedback, categorising feedback outcomes and determining predictors of feedback efficacy.MethodsAn observational mixed-methods study was used. EMS professionals delivering face-to-face patient care in the United Kingdom’s National Health Service completed a baseline survey and diary entries between March-August 2022. Diary entries were event-contingent and collected when a participant identified they had received feedback. Self-reported data were collected on feedback frequency, environment, characteristics and outcomes. Feedback environment was measured using the Feedback Environment Scale. Feedback outcomes were categorised using hierarchical cluster analysis. Multilevel logistic regression was used to assess which variables predicted feedback receipt and efficacy. Qualitative data were analysed using content analysis.Results299 participants completed baseline surveys and 105 submitted 538 diary entries. 215 (71.9%) participants had received feedback in the last 30 days, with patient outcome feedback the most frequent (n = 149, 42.8%). Feedback format was predominantly verbal (n = 157, 73.0%) and informal (n = 189, 80.4%). Significant predictors for receiving feedback were a paramedic role (aOR 3.04 [1.14, 8.00]), a workplace with a positive feedback-seeking culture (aOR 1.07 [1.04, 1.10]) and white ethnicity (aOR 5.68 [1.01, 29.73]). Feedback outcomes included: personal wellbeing (closure, confidence and job satisfaction), professional development (clinical practice and knowledge) and service outcomes (patient care and patient safety). Feedback-seeking behaviour and higher scores on the Feedback Environment Scale were statistically significant predictors of feedback efficacy. Solicited feedback improved wellbeing (aOR 3.35 [1.68, 6.60]) and professional development (aOR 2.58 [1.10, 5.56]) more than unsolicited feedback.ConclusionFeedback for EMS professionals was perceived to improve personal wellbeing, professional development and service outcomes. EMS workplaces need to develop a culture that encourages feedback-seeking to strengthen the impact of feedback for EMS professionals on clinical decision-making and staff wellbeing.

Learning traps and change blindness in dynamic environments.

Learning traps arise when early experience leads to a false belief about the reward structure of the environment which, in turn, leads to avoidance of rewarding options. Previous work on the negative effects of such traps has focused on static learning environments. The current work examines an additional negative effect of learning traps in dynamic environments-blindness to change in the features that predict decision outcomes. In two experiments (N = 416), participants had to decide whether to approach members of two different categories, respectively associated with either gains or losses. Early in learning, a category rule involving two feature dimensions predicted category membership. Subsequently, there was a change in the feature composition of this rule. When outcome feedback was only provided when an item was approached, a substantial proportion of participants fell into the trap of using a simple one-dimensional rule to guide approach decisions. Most of these participants did not notice the subsequent rule change and never learned the new rule. Signaling the possibility of rule change (Experiment 2) had no effect on change blindness for those in the learning trap but did improve learning of the new rule for those who initially avoided the trap. (PsycInfo Database Record (c) 2024 APA, all rights reserved).

Impact of an automated patient outcome feedback system on emergency medicine resident patient follow-up: An interrupted time series analysis.

Emergency medicine (EM) residents desire, but often lack, reliable feedback of patient outcomes following handoffs to other providers. This gap is a substantial barrier to calibrating their diagnostic decision making and learning. To address this educational priority, we developed and evaluated the Post-Handoff Reports of Outcomes (PHAROS) system-an automated system within our electronic health record (EHR) to deliver provider-specific patient outcome feedback. PHAROS includes: (1) individualized lists of patients seen and brief summaries of each case, (2) flags for important posthandoff events, and (3) links to charts to facilitate review. Starting June 2020, we coupled PHAROS with a resident educational session and individualized emails every 2 weeks outlining patients seen, number of posthandoff events, and instructions on how to access the PHAROS system. From July 2017 through April 2022, we measured the proportion of handoffs followed by reaccessing patients' charts between 2 and 14 days posthandoff-a proxy for following up on the patient's outcomes. We performed an interrupted time series analysis on this outcome to determine if PHAROS was associated with a significant change in the trend of our outcome over time. Our secondary outcome was the number of times PHAROS was viewed each month. Our primary outcome had a significant increase in the slope over time (+0.13%/month, p = 0.03) after the introduction of the personalized reports and a nonsignificant change (-1.6%, p = 0.07) at the time of the intervention. The median (IQR) number of views of PHAROS per month was 33.2 (23.75-38.75). The PHAROS system was associated with a significant increase in the rate of posthandoff chart reaccess among EM residents over time. The PHAROS project demonstrated the feasibility of harnessing the capabilities of the EHR to create an automated system to support EM trainee feedback of patient outcomes-a key component of diagnostic calibration and learning.

The influence of reward and loss outcomes after free- and forced-tasks on voluntary task choice

In four experiments, we investigated the impact of outcomes and processing mode (free versus forced) on subsequent voluntary task-switching behavior. Participants freely chose between two tasks or were forced to perform one, and the feedback they received randomly varied after correct performance (reward or no-reward; loss or no-loss). In general, we reasoned that the most recently applied task goal is usually the most valued one, leading people to prefer task repetitions over switches. However, the task values might be additionally biased by previous outcomes and the previous processing mode. Indeed, negatively reinforcing tasks with no-reward or losses generally resulted in more subsequent switches. Additionally, participants demonstrated a stronger attachment to free- compared to forced-tasks, as indicated by more switches when the previous task was forced, suggesting that people generally value free over forced-choice task goals. Moreover, the reward manipulation had a greater influence on switching behavior following free- compared to forced-tasks in Exp. 1 and Exp. 3, suggesting a stronger emphasis on evaluating rewarding outcomes associated with free-task choices. However, this inflationary effect on task choice seemed to be limited to reward and situations where task choice and performance more strongly overlap. Specifically, there was no evidence that switching behavior was differentially influenced after free-and forced-task as a function of losses (Exp. 2) or reward when task choice and task performance were separated (Exp. 4). Overall, the results provide new insights into how the valuation of task goals based on choice freedom and outcome feedback can influence voluntary task choices.

Decoding behaviour change techniques in opioid deprescribing strategies following major surgery: a systematic review of interventions to reduce postoperative opioid use

Background and objectivesMethodsA structured search strategy encompassing databases including MEDLINE, Embase, CINAHL Plus, PsycINFO and Cochrane Library was implemented from inception to October 2023. Included studies focused on interventions targeting...

Sensorimotor prediction is used to direct gaze toward task-relevant locations in a goal-directed throwing task.

Previous research has shown that action effects of self-generated movements are internally predicted before outcome feedback becomes available. To test whether these sensorimotor predictions are used to facilitate visual information uptake for feedback processing, we measured eye movements during the execution of a goal-directed throwing task. Participants could fully observe the effects of their throwing actions (ball trajectory and either hitting or missing a target) in most of the trials. In a portion of the trials, the ball trajectory was not visible, and participants only received static information about the outcome. We observed a large proportion of predictive saccades, shifting gaze toward the goal region before the ball arrived and outcome feedback became available. Fixation locations after predictive saccades systematically covaried with future ball positions in trials with continuous ball flight information, but notably also in trials with static outcome feedback and only efferent and proprioceptive information about the movement that could be used for predictions. Fixation durations at the chosen positions after feedback onset were modulated by action outcome (longer durations for misses than for hits) and outcome uncertainty (longer durations for narrow vs. clear outcomes). Combining both effects, durations were longest for narrow errors and shortest for clear hits, indicating that the chosen locations offer informational value for feedback processing. Thus, humans are able to use sensorimotor predictions to direct their gaze toward task-relevant feedback locations. Outcome-dependent saccade latency differences (miss vs. hit) indicate that also predictive valuation processes are involved in planning predictive saccades.NEW & NOTEWORTHY We elucidate the potential benefits of sensorimotor predictions, focusing on how the system actually uses this information to optimize feedback processing in goal-directed actions. Sensorimotor information is used to predict spatial parameters of movement outcomes, guiding predictive saccades toward future action effects. Saccade latencies and fixation durations are modulated by outcome quality, indicating that predictive valuation processes are considered and that the locations chosen are of high informational value for feedback processing.

From not knowing to doing: An interprofessional approach to clinician training in use of Goal Attainment Scaling (GAS) as a recovery-oriented outcome measure in a rural mental health service.

Outcome measurement and feedback are key to quality improvement in healthcare. Goal attainment scaling (GAS) is a tool that could be used to measure outcomes of mental health services delivering recovery-oriented care. The objective of this prospective study was to evaluate the effectiveness of tailored, interprofessional, multilevel and adaptable GAS training on clinician views, learning, competence, performance and confidence in the use of GAS. Thematic analysis of eight clinician participant views was done using the method proposed by Braun and Clarke (Thematic analysis: a practical guide to understanding and doing, 2022). Four main themes were generated: clinicians found that this type of training is useful, GAS influenced the way they thought about their roles in goal setting and recovery-oriented care and COVID-19 pandemic impacts. Furthermore, clinicians' skills to set scalable GAS goals with consumers and clinician confidence in using GAS improved. The results of this study show a positive impact of tailored, interprofessional, multilevel and adaptable training supporting development of clinician skills in the GAS process. The training design had a favourable effect on clinician views, learning, competence, performance and confidence of GAS as a recovery-oriented outcome measure. The approach to GAS training and use of GAS as a recovery-oriented outcome measure should be considered in response to mental health service reform.

Is Anticipation Skill Learning Bayesian?

ABSTRACT Purpose: The aims of this study were to examine the learning of anticipation skill in the presence of kinematic and outcome probabilities information, and to see if this learning exhibited characteristics of Bayesian integration. Method: Participants with no competitive tennis playing experience watched tennis player stimuli playing forehand tennis shots and were tasked with predicted shot outcomes. Accuracy, response times and perceived task effort were recorded, pre, post and during four acquisition blocks where outcome feedback was provided. In both Experiment 1 and 2, kinematic information about shot direction was either present in the training group stimuli or absent. In Experiment 1, left/right shot probability information remained equi-probable for both groups. In Experiment 2, both groups also trained with a bias in the shot outcome probability toward one shot direction on 80% of the trials across acquisition blocks (and were not told about this manipulation). Results: Pre-to-post anticipation performance improved in the presence of kinematic (EXP 1) or both information sources (EXP 2). Pre-to-post improvements in the presence of shot outcome probability information were congruent with the bias in the shot direction trained (EXP 2). Superior anticipation performance was found when both information sources were present. The presence of kinematic information resulted in increased perceived effort during early training (EXP 1 & 2). Bayesian odds ratios indicated that shot direction probabilities and kinematic information were integrated during anticipation skill learning. Conclusion: Learning with shot direction probabilities and kinematic information shows characteristics of Bayesian integration.

Abstract TP46: Improving Efficiency of Interfacility Transfer for Mechanical Thrombectomy: Delaware Stroke System Experience

Introduction: Delaware (DE) created a stroke system with a primary objective to improve the interfacility transfer process between DE PSCs and its only CSC to improve efficiency and outcomes for mechanical thrombectomy (MT) transfer patients. Methods: The DE stroke system, including stroke coordinators/medical directors and EMS, defined criteria for MT eligibility, identified barriers to transfer, and implemented the interventions listed below. Data on transfer volumes, thrombectomy rates, and outcomes were collected. Objectives were to improve early detection of MT eligible patients, improve rate of thrombectomy on MT transfers, and track patient outcomes (mRS 0-2 at 90 days). • MT eligibility defined as any patient with a significant/disabling deficit with target lesion identified on CTA. • Implementation of “EZ” button in PSC EDs for early activation of flight team for suspected MT candidates upon initial clinical evaluation. • Time goal of 30 min for PSC arrival to call out to CSC for MT candidates. • Implementation of RAPID.AI platform at PSCs to allow CSC immediate access to imaging. • Revision of CSC transfer process: conference call with transfer center, PSC physician, and CSC stroke team physicians to discuss case. • Transport expedited for MT eligible patients; ineligible patients stay at PSC. • CSC provides outcome feedback and time goals to PSC on each transfer. • Variant cases reviewed by CSC and DE Stroke System Quality & Data committee as needed. Results: From FY22 to FY23, there was a 39% increase in MT transfers, 20% increase from 52% to 72% in rate of thrombectomy, and 15% increase in # patients in mRS 0-2 category at 90d (figure 1). Conclusion: By implementing collaborative and focused interventions, the DE stroke system increased rates of MT in transferred patients while reducing unnecessary transfers and improving patient outcomes.

Improving Audit Quality with Data Analytic Visualizations: The Importance of Spatial Abilities and Feedback in Anomaly Identification

SYNOPSIS Public accounting firms and internal audit departments are implementing data analytics to enhance effectiveness and efficiency; however, there is a shortage of professionals with data analysis skills and the ability to derive meaningful insights. We conducted a quasiexperiment to examine whether and how individuals’ spatial abilities and types of feedback are related to anomaly identification performance. We predict and find that those with higher spatial abilities choose better visualizations and, in turn, are more accurate at anomaly identification. Auditors with lower spatial abilities can choose better visualizations and more accurately identify anomalies when they are provided task property feedback (i.e., feedback about the process) rather than outcome feedback or no feedback. Finally, a combination of high spatial abilities and task property feedback significantly reduces the number of false positive anomalies identified for all auditors. Our findings suggest practitioners should consider measuring spatial abilities during recruitment and when assigning visualization tasks.

교수역량진단을 통한 교수자 특성 분석과 프로그램 지원 방안: F대학을 중심으로

The purpose of this study is to diagnose the level of teaching competency and propose a teaching competency priority and teaching competency program by analyzing the difference in perception between the importance and implementation of the competency. For this purpose, data from 175 University F faculty members who participated in the survey were analyzed using paired-sample t-test, Borich needs assessment, and The Locus for Focus model. As a result of the study, first, significant differences in teaching competency were found by major, gender, rank, and number of participation in teaching methods programs. Second, for some competencies, significant differences were found between the importance and degree of implementation by employment experience and age. Third, as a result of comparing The Locus for Focus model analysis and Borich needs analysis, the teaching competencies that need to be developed as a top priority to strengthen teaching competency were motivational design competency, learning outcome evaluation and feedback competency, and lifelong learner competency. And, the next-highest priority competency was professional development regarding educational content and class time management competency. Based on the research results, a professor capacity building program considering characteristics such as professor experience was proposed. The significance of this study is that the programs proposed for each competency can be used as basic data for establishing and improving faculty support programs at other universities.

Identifying patients at imminent risk of out-of-hospital cardiac arrest during the Emergency Medical call: The views of call-takers

IntroductionThere is little research on the triage of patients who are not yet in cardiac arrest when the emergency call is initiated, but who deteriorate and suffer a cardiac arrest during the prehospital phase of care. The aim of this study was to investigate Emergency Operation Centre staff views on ways to improve the early identification of patients who are at imminent risk of cardiac arrest, and the barriers to achieving this. MethodsA qualitative interview and focus group study was conducted in two large Emergency Medical Services in England, United Kingdom. Twelve semi-structured interviews and one focus group were completed with Emergency Operations Centre staff. Data were analysed using reflexive thematic analysis. ResultsThree main themes were identified: The dispatch protocol and call-taker audit; Identifying and responding to deteriorating patients; Education, knowledge and skills. Barriers to recognising patients at imminent risk of cardiac arrest include a restrictive dispatch protocol, limited opportunity to monitor a patient, compliance auditing and inadequate education. Clinician support is not always optimal, and a lack of patient outcome feedback restricts dispatcher learning and development. Suggested remedies include improvements in training and education (call-takers and the public), software, clinical support and patient outcome feedback. ConclusionsEmergency Operation Centre staff identified a multitude of ways to improve the identification of patients who are at imminent risk of out-of-hospital cardiac arrest during the Emergency Medical Service call. Suggested areas for improvement include education, triage software, clinical support redesign and patient outcome feedback.

Different Faces of Medial Beta-Band Activity Reflect Distinct Visuomotor Feedback Signals.

Beta-band (13-35 Hz) modulations following reward, task outcome feedback, and error have been described in cognitive and/or motor adaptation tasks. Observations from different studies are, however, difficult to conciliate. Among the studies that used cognitive response selection tasks, several reported an increase in beta-band activity following reward, whereas others observed increased beta power after negative feedback. Moreover, in motor adaptation tasks, an attenuation of the postmovement beta rebound follows a movement execution error induced by visual or mechanical perturbations. Given that kinematic error typically leads to negative task-outcome feedback (e.g., target missed), one may wonder how contradictory modulations, beta power decrease with movement error versus beta power increase with negative feedback, may coexist. We designed a motor adaptation task in which female and male participants experience varied feedbacks-binary success/failure feedback, kinematic error, and sensory-prediction error-and demonstrate that beta-band modulations in opposite directions coexist at different spatial locations, time windows, and frequency ranges. First, high beta power in the medial frontal cortex showed opposite modulations well separated in time when compared in success and failure trials; that is, power was higher in success trials just after the binary success feedback, whereas it was lower in the postmovement period compared with failure trials. Second, although medial frontal high-beta activity was sensitive to task outcome, low-beta power in the medial parietal cortex was strongly attenuated following movement execution error but was not affected by either the outcome of the task or sensory-prediction error. These findings suggest that medial beta activity in different spatio-temporal-spectral configurations play a multifaceted role in encoding qualitatively distinct feedback signals.SIGNIFICANCE STATEMENT Beta-band activity reflects neural processes well beyond sensorimotor functions, including cognition and motivation. By disentangling alternative spatio-temporal-spectral patterns of possible beta-oscillatory activity, we reconcile a seemingly discrepant literature. First, high-beta power in the medial frontal cortex showed opposite modulations separated in time in success and failure trials; power was higher in success trials just after success feedback and lower in the postmovement period compared with failure trials. Second, although medial frontal high-beta activity was sensitive to task outcome, low-beta power in the medial parietal cortex was strongly attenuated following movement execution error but was not affected by the task outcome or the sensory-prediction error. We propose that medial beta activity reflects distinct feedback signals depending on its anatomic location, time window, and frequency range.

Observing the creation of new knowledge in the economics laboratory—Do participants discover how to learn from outcome feedback in a dynamic decision problem?

Domain-general learning rules often enable decision makers to learn from outcome feedback which actions tend to achieve a desired goal. However, in novel and complex environments decision makers must explore how to learn, i.e., acquire procedural knowledge of how to elicit and evaluate outcome feedback that will enable them to navigate toward a desired goal despite the vastness of the set of possible policies. Using a dynamic business simulation, this study investigated: (1) whether and how frequently participants discovered an effective procedure to learn from outcome feedback that allowed them to navigate toward a policy that maximizes long-term business profit (and hence their monetary payoff from the experiment), and (2) whether high monetary incentives affected learning procedures and performance. We found that a number of participants discovered an effective learning procedure and succeeded in approximating the optimal policy. In line with the heuristic method, this learning procedure involved a simplification of the search space and the application of domain-general learning rules to this simplified space. Although the decision histories of about half of the participants feature the key aspect of the effective learning procedure—search among the different steady states of the dynamical system—implementation errors prevented many of the participants from realizing the full potential of the learning procedure. We found no evidence to suggest that high monetary incentives affect the effectiveness of learning. Overall, the study illustrates that a “prepared mind” can discover new, effective learning procedures, although their initial implementation may require substantial refinement.

Feedback processing in cognitive and motor tasks: A meta-analysis on the feedback-related negativity.

For motor learning, the processing of behavioral outcomes is of high significance. The feedback-related negativity (FRN) is an event-related potential, which is often described as a correlate of the reward prediction error in reinforcement learning. The number of studies examining the FRN in motor tasks is increasing. This meta-analysis summarizes the component in the motor domain and compares it to the cognitive domain. Therefore, a data set of a previous meta-analysis in the cognitive domain that comprised 47 studies was reanalyzed and compared to additional 25 studies of the motor domain. Further, a moderator analysis for the studies in the motor domain was conducted. The FRN amplitude was higher in the motor domain than in the cognitive domain. This might be related to a higher task complexity and a higher feedback ambiguity of motor tasks. The FRN latency was shorter in the motor domain than in the cognitive domain. Given that sensory information can be used as an external feedback predictor prior to the presentation of the final feedback, reward processing in the motor domain may have been faster and reduced the FRN latency. The moderator variable analysis revealed that the feedback modality influenced the FRN latency, with shorter FRN latencies after bimodal than after visual feedback. Processing of outcome feedback seems to share basic principles in both domains; however, differences exist and should be considered in FRN studies. Future research is motivated to scrutinize the effects of bimodal feedback and other moderators within the motor domain.

Patients’ and Therapists’ Experiences of Standardized Group Cognitive Behavioral Therapy: Needs for a Personalized Approach

Personalizing psychotherapy can be challenging within standardized group Cognitive Behavioral Therapy (CBT), in which sessions are structured according to a protocol and must accommodate the needs and preferences of multiple patients. In the current study, we aimed to examine patients’ and therapists’ experiences of standardized group CBT and identify their perceptions of different patient needs. Furthermore, we explored how these needs can inform possible content of add-on interventions for patients who are not improving as expected during group CBT.We conducted 21 individual in-depth interviews with patients with depression and their therapists about their experiences during group CBT with Routine Outcome Monitoring (ROM) and feedback. Interviews were analyzed by using a hermeneutic-phenomenological thematic analysis. Five themes, representing different patient needs, were identified: (1) Individual attention, (2) Psychological exploration, (3) A focus on the patient’s life outside of therapy, (4) Extended assessment, and (5) Agreement on therapeutic tasks.The study supports that “one size does not fit all” when it comes to psychotherapy. Patients have varying needs when they are not making progress in therapy, and these needs, when unmet, can negatively impact the overall experience of group CBT. By acknowledging the unique needs of each patient and providing additional individual sessions as necessary, we can move towards a more personalized approach that maximizes the benefits of group psychotherapy.

Routine outcome monitoring (ROM) and feedback in university student counselling and mental health services: Considerations for practitioners and service leads

AbstractAimRoutine outcome monitoring (ROM), including the use of feedback, has become a much vaunted method in psychological therapies but is little used in university/college counselling and mental health services, perhaps because its adoption raises questions for many practitioners and service leaders. There is a need for both clinical‐ and research‐based statements to clarify the reasoning and rationale for ROM. This paper aims to present and respond to common challenges of and reservations about using ROM in student counselling and/or mental health services.MethodThe article poses 15 questions and issues about the adoption of ROM drawn from the literature on this topic and further refined by practitioner‐ and researcher‐members of a consortium comprising service leads, practitioners, and researchers working in the field of student counselling in the UK. The questions address nine themes: (1) the purpose and yield of ROM; (2) the burden of measurement; (3) the impact on clients and process of therapy; (4) consistency with therapeutic theory; (5) client groups and settings; (6) concern from practitioners; (7) equality, diversity, and inclusion; (8) implementation; and (9) relationship with the paradigm of practice‐based evidence.FindingsResponses to each of the 15 questions are provided from a methodological, evidence‐based, and clinical perspective.ConclusionsThe responses provide practitioners with the necessary information to enable them to make informed decisions as to the value, or otherwise, of adopting ROM, including feedback, in the delivery of counselling interventions, and generating evidence created from clinical practice.