Systematic Feedback in Therapy: Two New Studies with Children and Adolescents

While the Partners for Change Outcome Management System (PCOMS) has demonstrated significantly improved outcomes for adults in seven randomized clinical trials (RCTs) and two benchmarking studies, to date, no controlled studies have evaluated the impact of systematic client feedback in therapy with children or adolescents. Two exciting new studies put PCOMS to the test, one an RCT of children and the other a benchmarking study in a large public behavioral health setting.

PCOMS with Children in Play Therapy: Cooper, Duncan, Golden, & Toth (2019)

Preliminary but promising evidence for PCOMS was found in a cohort study with children (ages 7–11; Cooper, Stewart, Sparks, & Bunting, 2013). This study found gains on the parent completed Strengths and Difficulties Questionnaire (SDQ) that were almost twice those of school-based counselling in the UK where PCOMS was not used, with a small but significant advantage also for teacher completed SDQs.

But now there is an RCT that demonstrates improved outcomes for children whose therapists implemented PCOMS. Cooper, Duncan, Golden, and Toth (2019; available for a limited time here) conducted a pilot RCT in the schools in the UK using the SDQ as the outcome measure. Notably, the therapists in the this study practiced play therapy. 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 favor of PCOMS.

More specifically, on the parent completed outcome measure, the SDQ, participants in the treatment as usual group deteriorated by 1.3 point, while participants in the PCOMS group improved by 6 points. Similarly, on the teacher completed SDQ, participants in the treatment as usual group improved by 1.1 point, while participants in the PCOMS group improved by 5.3 points.

The positive results of this pilot study pave the way for a large scale RCT of children and PCOMS.

Cooper, M., Duncan, B., Golden, S., & Toth, K. (2019). Systematic client feedback in therapy for children with psychological difficulties: Pilot cluster randomised controlled trial. Counselling Psychology Quarterly. https://doi.org/10.1080/09515070.2019.1647142

PCOMS with Youth in the Real World: Kodet, Reese, Duncan, & Bohanske (2019)

Research demonstrating the effectiveness of treatment with youth from low socioeconomic backgrounds is limited, making this investigation all the more exciting. Using a benchmarking methodology, Kodet, Reese, Duncan, & Bohanske (2019) evaluated the effectiveness of services provided to impoverished, racially and ethnically diverse children and young people (199 aged 6–12 years old and 270 aged 13-17) diagnosed with depression at a public behavioral health agency. Benchmarking permits comparisons with results attained in real clinical settings to those achieved in randomized clinical trials (RCTs). This study evaluated outcomes of children and adolescents after PCOMS was implemented as a quality improvement strategy. (Read more about this agency.)

Outcomes of both children and adolescents diagnosed with depression who received PCOMS as part of their treatments were clinically superior to a wait list benchmark drawn from clinical trials of youth depression, and clinically equivalent to a treatment benchmark drawn from youth depression clinical trials. Findings demonstrate that mental health services for depressed youth in poverty can be effective, and systematic client feedback may be a useful strategy to improve treatment outcomes. Previous studies have demonstrated that mental health care for youth from economically impoverished backgrounds results in negligible to small treatment effects. Our findings of large effect sizes and overall clinical equivalency with RCT treatment outcomes support the contention that psychotherapy that includes systematic client feedback may be an effective quality improvement strategy in services with youth in public behavioral health.

Kodet, J., Reese, R., Duncan, B., & Bohanske, R. (2019). Psychotherapy for depressed youth in poverty: Benchmarking outcomes in a public behavioral health settings. Psychotherapy, 56, 254-259.

These two studies, taken together, make a strong case for implementing PCOMS with youth.