Partners For Change Outcome Management System Research Articles

The effect of therapist characteristics on the use and outcome of systematic client feedback in outpatient mental healthcare.

Therapist characteristics are known to affect treatment outcome in general and could also influence the use of systematic client feedback (SCF). The current study explores the effect of feedback orientation, regulatory focus, self-efficacy, attitude towards feedback resources and perceived feedback validity on the use and outcome of SCF in outpatient mental healthcare. The data of therapists (n = 12) and patients (n = 504) of two outpatient centres offering brief psychological treatment were analysed when SCF, based on the Partners for Change Outcome Management System (PCOMS), was added to treatment as usual. The data of therapists were obtained through a therapist questionnaire composed of relevant characteristics from feedback studies in social and organizational psychology. The effect on the use of SCF was analysed using logistic regression; whereas, the effect on outcome was assessed using a two-level multilevel analysis. Regular use of SCF and the Outcome Questionnaire (OQ-45) were used as outcome variables. DSM-classification, sex and age of each patient were included as covariates. High perceived feedback validity significantly increased the use of SCF. No significant therapist characteristics effects were found on outcome, but high promotion focus was associated with treating more complex patients. The perceived feedback validity of SCF is likely to have an influence on its use and is probably affected by the changes in the organizational climate.

When meta-analysis continues to mislead: A reply to Østergård and Hougaard (2020).

Reply to comments on an article by Duncan and Sparks (see record 2018-10637-001). Østergård and Hougaard (2020) reiterate the flawed conclusions of their meta-analysis of the Partners for Change Outcome Management System (PCOMS) and obfuscate the main point of our critique (Duncan & Sparks, 2020). Despite the lauded statistics and selection criteria, the inclusion of six significantly confounded investigations resulted in a misleading overattribution of meaning to studies of questionable methodology that warranted exclusion. Further, their hypothesis that social desirability leads to inflated effect sizes on the Outcome Rating Scale (ORS) is insufficient. It is not supported by studies finding comparable results to the ORS on independent outcome measures or investigations reporting that change on measures of life functioning, like the ORS, precedes that depicted on symptom scales. While more research is needed, the totality of credible research supports the efficacy of PCOMS. (PsycInfo Database Record (c) 2023 APA, all rights reserved).

Routine outcome monitoring in social service: A cluster randomized controlled trial

ABSTRACT The study examined whether routine outcome monitoring may be a tool that can help improve floating support services aimed at preventing homelessness among vulnerable citizens. We evaluated the effect of routine outcome monitoring using the Partners for Change Outcome Management System (PCOMS) in a cluster randomized controlled trial. PCOMS monitors the progress of the well-being of the client and the working alliance between the therapist and client in order to customize the treatment to the individual client. In all, 530 clients were treated by 42 support workers in the treatment group and 490 clients were treated by 38 support workers in the control group. The outcome measures included clients’ well-being, health and social relations, whether clients benefitted from the service, the duration of the service and whether the clients were at risk of being evicted from their tenancy. We found no statistical difference in outcomes between the treatment group and the control group for any of the included outcomes. It was difficult for the support workers in the floating support service to use PCOMS in every meeting with their clients, and we did not find an effect of PCOMS for the clients in the floating support service.

Enhancing the effect of psychotherapy through systematic client feedback in outpatient mental healthcare: A cluster randomized trial.

ABSTRACT Objective: Systematic client feedback (SCF), the regular monitoring and informing of patients’ progress during therapy to patient and therapist, has been found to have effects on treatment outcomes varying from very positive to slightly negative. Several prior studies have been biased by researcher allegiance or lack of an independent outcome measure. The current study has taken this into account and aims to clarify the effects of SCF in outpatient psychological treatment. Method: Outpatients (n = 1733) of four centers offering brief psychological treatments were cluster randomized to either treatment as usual (TAU) or TAU with SCF based on the Partners for Change Outcome Management System (PCOMS). Primary outcome measure was the Outcome Questionnaire (OQ-45). Effects of the two treatment conditions on treatment outcome, patient satisfaction, dropout rate, costs, and treatment duration were assessed using a three-level multilevel analysis. DSM-classification, sex, and age of each patient were included as covariates. Results: In both analyses, SCF significantly improved treatment outcome, particularly in the first three months. No significant effects were found on the other outcome variables. Conclusions: Addition of systematic client feedback to treatment as usual, is likely to have a beneficial impact in outpatient psychological treatment. Implementation requires a careful plan of action. Clinical or methodological significance of this article: This study, with large sample size and several independent outcome measures, provides strong evidence that addition of systematic client feedback to outpatient psychological treatment can have a beneficial effect on treatment outcome (symptoms and wellbeing), particularly in the first three months. However, implementation requires a careful plan of action.

The Partners for Change Outcome Management System in the psychotherapeutic treatment of cannabis use: a pilot effectiveness randomized clinical trial

Purpose The aim of the study was to investigate the effectiveness of the Partners for Change Outcome Management System (PCOMS) in improving the retention rate and reducing drug use in a clinic for drug use treatment. Material and methods One-hundred outpatients with cannabis use as the primary presenting problem were randomized to either the PCOMS (n = 51) or treatment as usual (TAU; n = 49). Eight weekly psychotherapy sessions were planned in both conditions. The primary outcome was treatment retention measured as the rate of attendance to planned treatment sessions and dropout. The secondary outcomes were current cannabis and other drug use assessed with the European Addiction Severity Index (EuropASI). Several explorative outcomes were analyzed. Blind assessments of drug use were conducted three and six months after baseline. Outcome analyses were conducted on both the treated sample with at least one psychotherapy session (n = 82) and the intention-to-treat sample (n = 100). Results The results showed no incremental effect of the PCOMS compared to the TAU condition, for neither treatment retention, drug use, or therapeutic alliance. Conclusion The main findings align with previous studies that have found no effect of the PCOMS when employing outcome measures independent from the PCOMS intervention. The results are interpreted with caution due to implementation difficulties, which at the same time suggest challenges when employing the PCOMS in large outpatient clinics for drug use treatment.

Validation of the French versions of two brief, clinician-friendly outcome monitoring tools: the ORS and SRS

While Routine Outcome Monitoring (ROM) of change and therapeutic alliance is proving to be a promising way to address the issues of drop-out and client deterioration in psychotherapy, at present ROM is infrequently employed in French-speaking contexts. This study aimed at testing psychometric properties of the French versions of two popular and widely used ROM tools in the Partners for Change Outcome Management System (PCOMS): The Outcome Rating Scale (ORS) and Session Rating Scale (SRS). The project necessitated a multiple study survey with online data collection of clinical and non-clinical samples, to investigate psychometric qualities (including factorial structure of the two scales), using parametric and non-parametric procedures. In addition, we documented, preliminary estimates regarding clinical cut-off and reliable change indices for ORS. Both ORS and SRS have good psychometric properties regarding brevity. Reliability, normative data, a reliable change index and scale thresholds are reported for the French versions. The clinical use of PCOMS appears promising regarding delivering, regulation, and improvement of psychotherapy in French-speaking areas.

The effect of implementing the partners for change outcome management system in a nationwide student counseling service.

The aims of the present study were to investigate the effect of implementing the Partners for Change Outcome Management System (PCOMS) in the Danish Student Counseling Service and to explore both between-condition moderators and within-condition predictors of outcomes. The study was a nonrandomized controlled study, comparing the outcome of individual and group student counseling for 634 PCOMS clients to that of 740 clients having started treatment as usual (TAU) 2 years before the PCOMS data collection began. The primary outcome measure was the Global Severity Index on the Symptom Checklist 90-Revised. Main analyses were conducted with multilevel models on the intention-to-treat sample. The results demonstrated no effect of the PCOMS compared with the TAU condition, neither for the primary outcome nor for the number of dropouts or clients experiencing deterioration. The PCOMS effect was not predicted by the counselors' adherence to the PCOMS protocol. Because the counselor level explained less than 1% of the variance in outcome, the counselor factors (i.e., attitude to feedback, reactions to negative feedback, and deliberate practice) were not analyzed as predictors. In conclusion, this study does not align with previous studies finding a positive effect of the PCOMS in counseling settings. However, all previous studies relied on the PCOMS Outcome Rating Scale as the only measure of outcome, maybe indicating a measure-specific effect. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Transforming Into Men Who Matter: Increasing Empathy in Domestic Abuse Treatment

ABSTRACT Men referred to domestic abuse treatment are typically involuntary clients, ranging from being legally mandated to being under significant pressure from others to attend. Such treatment programs have mixed results in achieving change in abusive behaviours. Most programs emphasise taking responsibility for abusive behaviour by examining the precursor thinking beliefs and values, with less attention paid to learning new interpersonal skills that replace antisocial behaviours with prosocial alternatives. Empathy provides a measurable moderator of moving beyond simply acknowledging responsibility for past abuse into learning and applying prosocial relationship enhancement skills with their treatment cohort, families, and significant others. This paper describes a program that builds empathy skills through a series of program and mentalisation tasks that include routine client feedback using the Partners for Change Outcome Management System (PCOMS). Evidence of increased retention and statistically significant changes in empathy using the Social Empathy Index are provided from a previous study examining the same program. The practice and research implications for domestic abuse clients and other involuntary populations are discussed. IMPLICATIONS Involuntary clients continue to have high dropout rates across a range of client populations and are a challenge to engage in the change process. With the application of the client feedback tools and relationship enhancement skills described in this paper professionals can more effectively engage other types of involuntary clients in their change efforts. The focus on empathy and relationship enhancement skills can lead to reduced treatment dropout across involuntary client populations referred for substance use, domestic violence, or other offender behaviours.

Systematic client feedback in therapy for children with psychological difficulties: pilot cluster randomised controlled trial

ABSTRACT The use of systematic client feedback tools are known to enhance outcomes in adults psychotherapy clients, but their effects with children have yet to be adequately tested. Hence, we piloted a cluster randomised controlled trial of the Partners for Change Outcome Management System (PCOMS) with children aged 7–11 years old; comparing play-based counselling with, and without, the use of this tool. Ten UK primary schools were randomly allocated to either the intervention or control condition. Data were available for 38 children in total: 20 girls and 18 boys, of predominantly a white ethnic origin (mean age = 8.5 years). Clinical outcomes were the total difficulties scores on the teacher and parent completed Strengths and Difficulties Questionnaire (SDQ). Fifty percent of the schools left the trial between initial recruitment and end of data collection, but participant dropout was low and recruitment rates were satisfactory. Participants in the PCOMS condition showed significantly greater reductions in parent completed total difficulties than those in the control condition, with small to moderate effect sizes on all outcomes in favour of PCOMS. Overall, our design appeared feasible, but needs to ensure adequate school retention and counsellor adherence.

Systematic Client Feedback: A naturalistic pilot study

IntroductionRoutine outcome monitoring or systematic client feedback (SCF) continues to garner empirical support. The Partners for Change Outcome Management System (PCOMS) is one application of SCF with significant research support but no studies have been conducted in Spain. This investigation describes the effects of PCOMS in routine practice via a comparison to published PCOMS studies. Material and methodsIn a retrospective observational study, PCOMS was implemented with 42 clients treated in routine psychotherapy. Outcomes were measured by the Outcome Rating Scale (ORS) and descriptively compared to PCOMS studies included in a meta-analysis and a PCOMS benchmarking study regarding reliable and/or clinically significant change, no change, and deterioration. ResultsThe current study achieved similar rates of reliable and clinically significant change (73.8%) to the benchmarking study (65.6%) and the RCTs (67.5%). Regarding no change rates, the current study (23.8%) mirrored results of the RCTs (25.6%) and was better than the benchmarking study (35.4%). The current study incurred a low 2.4% deterioration rate compared to a 10.7% and 7.0% rate of the benchmarking study and RCTs, respectively. ConclusionsWhile not without flaws, this pilot study offers some evidence that the improved outcomes associated with PCOMS may also occur in psychotherapy settings in Spain.

Systematic client feedback to brief therapy in basic mental healthcare: study protocol for a four-centre clinical trial

IntroductionThe Partners for Change Outcome Management System (PCOMS) is a client feedback-system built on two brief visual analogue self-report scales. Prior studies of PCOMS have found effects varying from significant...

Patient feedback as a quality improvement strategy in an acute care, inpatient unit: An investigation of outcome and readmission rates.

High psychiatric readmission rates continue while evidence suggests that care is not perceived by patients as "patient centered." Research has focused on aftercare strategies with little attention to the inpatient treatment itself as an intervention to reduce readmission rates. Quality improvement strategies based on patient-centered care may offer an alternative. We evaluated outcomes and readmission rates using a benchmarking methodology with a naturalistic data set from an inpatient psychiatric facility (N = 2,247) that used a quality-improvement strategy called systematic patient feedback. Benchmarks were constructed using randomized clinical trials (RCTs) from inpatient treatment for depression, RCTs from patient feedback in outpatient settings, and national data on psychiatric hospital readmission rates. A systematic patient feedback system, the Partners for Change Outcome Management System (PCOMS), was used. Overall pre-post effect sizes were d = 1.33 and d = 1.38 for patients diagnosed with a mood disorder. These effect sizes were statistically equivalent to RCT benchmarks for feedback and depression. Readmission rates were 6.1% (30 days), 9.5% (60 days), and 16.4% (180 days), all lower than national benchmarks. We also found that patients who achieved clinically significant treatment outcomes were less likely to be readmitted. We tentatively suggest that a focus on real-time patient outcomes as well as care that is "patient centered" may provide a path toward lower readmission rates in addition to other evidence-based strategies after discharge. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The effects of routine outcome monitoring (ROM) on therapy outcomes in the course of an implementation process: A randomized clinical trial.

This study investigated the effects of the Partners for Change Outcome Management System (PCOMS) in adult outpatient treatment at a hospital-based mental health clinic. It also investigated whether the effects differed with the timing of the treatment within a 4-year implementation period, with clients' initial distress levels, and between therapists. Adult clients (N = 170) were randomized to treatment as usual (TAU) or routine outcome monitoring (ROM). Twenty therapists provided therapy in both conditions. Therapy outcome was measured by the Behavior and Symptoms Identification Scale (BASIS-32). Data were analyzed in a series of multilevel models (MLMs). Clients in the ROM condition were 2.5 times more likely to demonstrate improvement than those in the TAU condition. Controlling for therapist variability, the overall effect size (ES) in favor of ROM was small (d = 0.26, p = .037). The superiority for ROM over TAU increased significantly over the duration of the study. ROM effects were not moderated by clients' initial distress levels. Differences between therapists accounted for 9%-10% of the variability in outcomes, and there were no significant differences in ROM effects between therapists. ROM was associated with better treatment outcomes independent of clients' initial distress levels. Clients treated later in the study benefitted more from ROM than those treated earlier. (PsycINFO Database Record (c) 2018 APA, all rights reserved).

The effect of using the Partners for Change Outcome Management System as feedback tool in psychotherapy—A systematic review and meta-analysis

Objective: The aims of the study were to evaluate the effects of using the Partners for Change Outcome Management System (PCOMS) in psychotherapy and to explore potential moderators of the effect. Method: A comprehensive literature search including grey literature was conducted to identify controlled outcome studies on the PCOMS, randomized (RCTs), or non-randomized trials (N-RCT). Results: The literature search identified 18 studies, 14 RCTs, and four N-RCTs, including altogether 2910 participants. The meta-analysis of all studies found a small overall effect of using the PCOMS on general symptoms (g = 0.27, p = .001). The heterogeneity of the results was substantial. Moderation analyses revealed no effect of the PCOMS in psychiatric settings (g = 0.10, p = .144), whereas a positive effect was found in counseling settings (g = 0.45, p < .001), although almost all of these studies were characterized by a positive researcher allegiance and using the PCOMS Outcome Rating Scale (ORS) as the only outcome measure. Conclusion: The meta-analysis revealed a small overall effect of using the PCOMS, but no effect in psychiatric settings. The positive results in counseling settings might be biased due to researcher allegiance and use of the ORS as the only outcome measure.

The Partners for Change Outcome Management System: A Both/And System for Collaborative Practice.

Systematic client feedback (SCF) is increasingly employed in mental health services worldwide. While research supports its efficacy over treatment as usual, clinicians, especially those who highly value relational practices, may be concerned that routine data collection detracts from clinical process. This article describes one SCF system, the Partners for Change Outcome Management System (PCOMS), along a normative (standardized measurement) to communicative (conversational) continuum, highlighting PCOMS' origins in everyday clinical practice. The authors contend that PCOMS represents "both/and," providing a valid signal of client progress while facilitating communicative process particularly prized by family therapists steeped in relational traditions. The article discusses application of PCOMS in systemic practice and describes how it actualizes time-honored family therapy approaches. The importance of giving voice to individualized client experience is emphasized.

Beyond Critique: The Partners for Change Outcome Management System as an Alternative Paradigm to Psychiatric Diagnosis

Critics claim that current psychiatric diagnostic systems lack reliability, validity, and clinical utility; are incompatible with known evidence of how change occurs in psychotherapy; are compromised by bias; and risk harmful effects for clients. This article argues that the Partners for Change Outcome Management System (PCOMS), a transparent, egalitarian process that collects and utilizes client feedback at each session, convincingly addresses these concerns. Furthermore, it suggests that PCOMS offers a viable alternative to the reimbursement and administrative functions of the Diagnostic and Statistical Manual of Mental Disorders and the International Classification of Diseases. The authors propose that PCOMS represents a radical realignment of the practitioner/client relationship via full, dialogical partnership at every level of psychotherapy practice and thus constitutes a step toward a new paradigm that reconnects psychotherapy and humanistic psychology with its core relational values.

Commentary: Client V. Therapist‐Directed Supervision: A Question of Emphasis

Australian and New Zealand Journal of Family TherapyVolume 37, Issue 3 p. 299-300 Article Commentary: Client V. Therapist-Directed Supervision: A Question of Emphasis Barry L. Duncan, Corresponding Author Barry L. Duncan barrylduncan@comcast.net Heart and Soul of Change Project, Jensen Beach, FloridaBarry L. Duncan is a co-holder of the copyright of the Partners for Change Outcome Management System (PCOMS) instruments. The measures are free for individual use, but Duncan receives royalties from licenses issued to groups and organisations. In addition, the web application of PCOMS, BetterOutcomesNow.com, is a commercial product and he receives profits based on sales.Address for correspondence: barrylduncan@comcast.netSearch for more papers by this author Barry L. Duncan, Corresponding Author Barry L. Duncan barrylduncan@comcast.net Heart and Soul of Change Project, Jensen Beach, FloridaBarry L. Duncan is a co-holder of the copyright of the Partners for Change Outcome Management System (PCOMS) instruments. The measures are free for individual use, but Duncan receives royalties from licenses issued to groups and organisations. In addition, the web application of PCOMS, BetterOutcomesNow.com, is a commercial product and he receives profits based on sales.Address for correspondence: barrylduncan@comcast.netSearch for more papers by this author First published: 21 September 2016 https://doi.org/10.1002/anzf.1163 Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume37, Issue3September 2016Pages 299-300 RelatedInformation

The Partners for Change Outcome Management System (PCOMS) revisiting the client’s frame of reference.

Despite overall psychotherapy efficacy (Lambert, 2013), many clients do not benefit (Reese, Duncan, Bohanske, Owen, & Minami, 2014), dropouts are a problem (Swift & Greenberg, 2012), and therapists vary significantly in success rates (Baldwin & Imel, 2013), are poor judges of negative outcomes (Chapman et al., 2012), and grossly overestimate their effectiveness (Walfish, McAlister, O'Donnell, & Lambert, 2012). Systematic client feedback offers 1 solution (Duncan, 2014). Several feedback systems have emerged (Castonguay, Barkham, Lutz, & McAleavey, 2013), but only 2 have randomized clinical trial support and are included in the Substance Abuse and Mental Health Administration's National Registry of Evidence-Based Programs and Practices: The Outcome Questionnaire-45.2 System (Lambert, 2010) and the Partners for Change Outcome Management System (PCOMS; Duncan, 2012). This article presents the current status of PCOMS, the psychometrics of the PCOMS measures, its empirical support, and its clinical and training applications. Future directions and implications of PCOMS research, training, and practice are detailed. Finally, we propose that systematic feedback offers a way, via large-scale data collection, to reprioritize what matters to psychotherapy outcome, reclaim our empirically validated core values and identity, and change the conversation from a medical model dominated discourse to a more scientific, relational perspective.

The long-term effect on mental health symptoms and patient activation of using patient feedback scales in mental health out-patient treatment. A randomised controlled trial

ObjectiveTo investigate the long-term effect on mental health symptoms and patient activation, from using the Partners for Change Outcome Management System (PCOMS) feedback scales in out-patient mental health consultations, compared to not using feedback scales. MethodsAn open parallel-group randomised controlled trial was conducted in a mental health hospital in Norway. Eight therapists treated the intervention group, using two feedback scales, and seventeen therapists treated the treatment as usual group. ResultsSeventy-five patients participated. Six and twelve months after starting treatment there were no significant effects on the primary outcomes mental health symptoms or patient activation. Compared to baseline assessment the PCOMS group had significantly improved their patient activation scores after twelve months. ConclusionWe found no long-term effects from using the PCOMS scales on mental health symptoms or patient activation. Practice implicationsThis study shows that the use of a feedback system does not increase mental health outcomes or patient activation.

Using client feedback in training of future counseling psychologists: An evidence-based and social justice practice

Training in counseling psychology has evolved to emphasize both evidence-based practice (EBP) and social justice, though these two dimensions have often seemed disconnected, or even at odds in the practice of psychotherapy. The Partners for Change Outcome Management System (PCOMS), an EBP that monitors treatment outcomes and the therapeutic alliance across treatment (often called “client feedback”), may offer a means to connect evidence-based and socially just practices. The purpose of this article was to outline how the use of PCOMS in psychotherapy and supervision can serve as a useful training tool that is a form of EBP and also promotes a socially just paradigm in psychotherapy. We also offer an implementation example from a counseling psychology doctoral program to demonstrate how PCOMS can be used with clients in psychotherapy and included within the supervisory process.