Where Measurement Based Care & Culturally Sensitive Therapy Intersect

The Partners for Change Outcome Management System (PCOMS), a routine outcome monitoring (ROM) system that provides consumer feedback about the benefit and fit of services is widely used across behavioral health centers and multicultural settings. Despite its history of broad implementation for improved therapy outcomes, concerns are sometimes raised about PCOMS’ applicability when working with diverse clients in specific cultural, racial, or ethnic groups. Before addressing how PCOMS is not only applicable, but also provides an antidote to cultural insensitivity, here are some facts:

1. PCOMS evolved in a multicultural setting in South Florida, in a free clinic that Barry Duncan supervised as well as in his private practice;
2. The original research was conducted at a telephonic employee assistance program serving racially and ethnically diverse Walmart employees;
3. PCOMS measures have been validated across Europe and in China;
4. Randomized clinical trials (RCTs) have taken place in multiple settings in the US, UK, Norway, and China;
5. Two RCTs of PCOMS in the US featured greater than 35% minority representation;
6. Real-world studies of PCOMS in public behavioral health care in the Southwest US included more than 30% representation of racially and ethnically diverse clients;
7. PCOMS measures have been translated to 28 languages and implemented in 20 countries; and
8. There has been very little difference across languages and cultures regarding client responses to the measures themselves or to PCOMS in terms of improved therapy outcomes.

Working with Diverse Clients

Digging a little deeper than the numbers, consider the cultural sensitivity/social justice issues involved in measurement based care (MBC). Sometimes, the question arises regarding whether MBC in general and PCOMS specifically impose western thought on non-dominant cultures. Dr. Jacqueline Sparks, leading routine outcome monitoring (ROM) expert and social justice scholar believes that PCOMS measures are different in that they are designed specifically not to impose western ideology on those who come from non-western cultures.

Dr. Sparks asserts:

Our mental health system is western-based, particularly its emphasis on the objective expert apart from the client who can determine the process and procedures that will “cure” the client, based on western norms of [fill in the blank—what is a healthy man, woman, couple, family, etc.]. There are many tragic histories of how this model has produced oppressive practices. PCOMS, instead, fundamentally alters this dynamic, inviting a collaboration where the distinction between us and them is broken down and where client views, including cultural and spiritual preferences, are honored first and foremost. PCOMS is an antidote to western oppression of indigenous and non-European cultures.

Granted, the forms, despite being translated into 28 languages, come from systems of measurement that are rooted in western thought. However, the visual analog continua and lack of specific content questions allow a broad range of flexibility for the client to communicate his or her unique experience. They, not a diagnosis or theoretical lens, provide the starting point for the conversation that unfolds the client’s unique story, views, and preferences. I make the assumption that the desire to not be “done to” but to do (for self/family however conceived), to have a voice that is heard, is valued cross-culturally.

PCOMS offers a way to operationalize interrelated ideas that often sound like platitudes, i.e., individually tailored services, consumer involvement, and cultural sensitivity. Routinely requesting, documenting, and responding to client feedback transforms power relations in the immediate therapy encounter by privileging client beliefs and goals over potential culturally biased and insensitive practices.

Overcoming Inequities

Outside the therapeutic dyad, client-generated data via PCOMS and Better Outcomes Now can help overcome inequities built into everyday behavioral health service delivery by redefining whose voice counts. PCOMS seeks to level the psychotherapy process by inviting collaborative decision making, honoring client diversity with multiple language availability, and valuing local cultural knowledge; PCOMS provides a mechanism for routine attention to multiculturalism and consumer involvement.

Read more about PCOMS as a both/and system, providing a valid signal of client progress while facilitating communicative processes that allow for individual construction and resolution of the reasons for service.