Outcomes Measurement Systems in Mental Health: Comparisons and Contrasts

Kenneth Howard Ph.D., Professor, Department of Psychology, Northwestern University, and Chief Scientific Advisor, COMPASS, Inc.

One key to impacting clinical practice is to provide information relevant to the current case in treatment. How can we design such treatment research? The time-honored approach is the randomized clinical trial. But for this to be informative to a practitioner (or policy maker), the study sample must represent some clinically recognizable patient population and main effects must be unambiguous. Since we are very unlikely to ever mount a clinical trial with a generalizable patient sample, can rarely avoid attrition, outcome distributions will overlap, and there will be reliable within cell variation, this approach seems fruitless in terms of clinical relevance.

The approach that we have taken is to develop a theoretical framework (the dosage and phase models of psychotherapy), operationalize and test the concepts, and develop a system for feedback to the clinician. We advocate a systematic naturalistic strategy that is an outgrowth of the case study method. This method entails the use of objective data, continuous assessment, a model of problem stability, diverse and heterogeneous samples of patients, and clear evidence of an effect that can be quantified and used to modify treatment. Through the use of individual growth models we are able to aggregate treatment responders and treatment non-responders so that the progress of a patient can be evaluated in the contest of these progress benchmarks. This allows for early detection of treatment non-responders in a way that facilitates timely changes in treatment approach. Illustrative material from our large naturalistic study of psychotherapy is presented.

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